If you've had a chance to read my previous post (here), you might remember that I had finally taken the plunge and booked myself in for a laser eye surgery consultation. I had the consultation on Monday, decided I was ready to book the surgery while I was there, then had more tests and eye scans the following day. My surgery is booked for next Friday! Now I'm really hoping I've retained enough information to pass onto those of you interested in getting laser surgery yourselves.
I went to a place called Park Avenue Laser (the website is very "American" and garishly sales-y, which initially put me off going there, but after deciding I wanted LASEK not LASIK, it felt sensible to go to a centre which specialises in LASEK rather than a centre which offers LASEK as a secondary option.
In my consultation, it was mostly about me telling them why I wanted to get laser eye surgery, what concerns I had etc, and about them telling me more about the procedures and answering any questions I had. All in all, it was a very positive experience and made me feel like I was making the right decision to get LASEK. I spoke to several people, including the surgeon himself, one of the "refractive fellows" and an intern who had had the LASEK procedure himself recently.
Rather than walking you through my entire consultation (it was about 1.5 hours long), it's probably more useful if I go through some of the things I learnt while I was there when I bombarded them with questions...
Does the flap created in LASIK really never fully heal?
It heals, but the bond between the eye and the flap is never going to be as strong as when it was one piece (imagine slicing a block of glass then gluing it back together), which is why it is forever susceptible to being unstuck.
Why is LASIK still so popular if LASEK is "better"?
LASEK is a newer procedure than LASIK, and requires surgeons to retrain, which is a heavy investment of time, especially when there is no shortage of customers perfectly happy to go with LASIK (the recovery time is shorter). As with any relatively new treatment, it will take a while for LASEK to be fully phased in (as more and more people become qualified to perform it).
What is the difference between PRK and LASEK?
PRK (where the epithelium (skin) of the eye is scraped off before lasering) was an early procedure of "surface ablation" laser eye correction. LASIK (cutting a deeper flap under the surface) was introduced later and resulted in less patient discomfort and quicker recovery time. But LASIK created new problems, such as flap-related issues, permanent dry eyes and night glare. So surgeons revisited "surface ablation" methods, and came up with LASEK, which removes the epithelium in one clean piece, rather than scraping it off in bits (which heals less effectively).
Is it worth paying extra for Epi-LASEK over LASEK?
Epi-LASEK is where the epithelium is lifted using a special cutting blade, rather than the surgeon loosening it with an alcohol solution and then moving it to the side by hand. Epi-LASEK creates a cleaner, more precise cut, so the healing time is usually reduced by a day (from 3-4 days). Apart from the healing time, the final results are the same.
How soon will I be able to see clearly?
There will be minor discomfort and blurry vision for a few days after surgery until the epithelium (skin) of the eyes grows back and is fully healed and smooth. The blurry vision is nothing to do with the reshaped cornea, and is just down to the fact that the epithelium is growing back.
What are the chances of scarring?
Chances of the eye scarring after the surgery are virtually zero as long as the patient follows the medication instructions properly, and takes the prescribed steroid pills and uses the steroid eye drops for as long as instructed.
What happens if the eye scars?
Scarring of the eye will make vision cloudy, like a dirty glass. If caught early, it can be reversed using prescribed medication.
How long will the actual lasering take?
For my prescription, it will take about 45 seconds in each eye. It's less for lower prescriptions.
Those were the main questions I wanted to know and that I needed to be reassured about. Some other bits I learnt that I hadn't picked up in my mammoth research session on the internet were:
The prescription for glasses and contact lenses go up and down in increments of 0.25, meaning if you're somewhere in between, your glasses are going to either undercorrect or overcorrect your vision. Some "hi def" laser vision technologies can correct vision in much more precise increments of 0.01, meaning that you may actually achieve sharper vision after laser eye surgery than you had previously wearing glasses or contact lenses.
The night glare and halos that are common complaints from LASIK patients are most commonly caused by the eye and flap being two separate planes stuck together, which make light refract in two places rather than one (i.e. it has to pass through the join as well).
There is a LOT of medication to take before the surgery and after the surgery. This really scares me because it suddenly makes me realise that the surgery is no small deal and I'm messing around with nature. I was given a (literal) stack of prescriptions to take to the pharmacy for various medications such as antibiotic drops, anti-pain drops, weak steroid drops, strong steroid drops, steroid pills, valium, drops to increase tear production. Some of these meds need to be taken/used for several months after the surgery.
For one to two weeks before the surgery, contacts cannot be worn because time needs to be allowed for the cornea to get back to normal "topography" (i.e. get back to a normal shape). Contact lenses can warp the cornea, meaning that the laser correction won't be as accurate.
Starting at least one week before the surgery and continuing for three months afterwards, vitamin C tablets need to be taken to help prevent scarring, and aid healing.
In preparation for the surgery, preservative-free artificial tears eye drops (in vials) need to be used frequently in the days/weeks leading up to the surgery, to get the surface of the eye as smooth and healthy as possible so that the laser can achieve more precise results.
During the laser surgery, the laser tracks the eye's movement and stops if the eye moves too much. But results are much more accurate if the patient fixates fully on the red dot of the laser. I'm really worried that I might not be able to fixate the whole time. What if some strange reflex makes my eyes dart around? I do find it really hard to focus normally...
It's not physically possible for the cornea to regrow or retreat to its previous shape. The laser has reshaped it permanently. Any minor changes in prescription in the years to follow are due to other issues, like age.
It is common for surgeons to purposely overcorrect a patient's vision to account for future degeneration of sight due to age. For example, they plan to slightly overcorrect my vision, because they expect it to then be perfect in three years time. At first it will feel like wearing glasses that are a tiny bit too strong, but just like glasses, the eyes adjust and vision feels normal quickly.
It's a requirement (not a suggestion) to have a friend there with you during the surgery, and to take you home as you'll be all drugged up. If you can't bring a friend, this particular centre charges $100 for the use of an intern to be your "friend" (it's kind of depressing to have to resort to that, so I'm having my surgery next week when my husband is in town).
What next?
I was given a choice of five different "tiers" of surgery packages during my consultation, ranging from I think $3,000 to $7,000. I definitely wanted the "hi def" procedure, which strives to correct eyes to 0.01 of my prescription, so that left me with the packages from $5,000 upwards. I had gone in with a price in mind of $5,000, but I hate that there are tiers of healthcare. They make me feel like I am compromising on my health if I don't get the top package.
The next tier up ($6,000) was Epi-LASEK, which was why I asked them whether it was worth paying extra for. I was told that the surgeon has performed the LASEK procedure so many times (over 15,000 patients), that he can lift the epithelium almost as cleanly as a blade and the healing time is thus sped up anyway. So I went for the $5,000 "Gold" LASEK package. If you're wondering what the top package included, it was just loads of extra drugs thrown in, plus free "enhancements" over a longer period of time (the lower packages included free "enhancements" required in just the first year).
I had to read and sign a consent form of about 20 pages long. It was very scary reading. As with any surgery, you have to accept that there are small risks of infection, blindness, death etc. Horrible.
I've swapped my contact lenses for glasses since Saturday, which is the longest period I've ever worn glasses for. It actually feels really good to let my eyes breathe. I've started taking vitamin C tablets and these smelly "fish, flax and borage" oil tablets which I've heard help with tear production. I'm also using eye drops throughout the day and before I go to bed.
I've booked Friday and Monday off work, to give myself four days of recovery. In that time, I have to keep my eyes closed as much as possible because the eyes won't heal if they're open. It's going to be booooooring!
I have a bit of a phobia of medical stuff, so I felt slightly nauseated leaving the centre on my second appointment there. I'd had countless drops put into my eyes, including numbing drops to stop me blinking so much when they were trying to take scans of my eyes. That was a yucky feeling, having numb eyes. It's like when the dentist anaesthetises your mouth and everything feels numb and big, but it's your eyes instead... *shudder*
So wish me luck! If I felt like that after just the tests, what will I be like when I'm having my eyes clamped open and someone poking at my eyes...? I have to keep reminding myself that millions of people have had laser eye surgery and recommend it! Thank you to everyone who left comments on my blog post, Facebook and Twitter with your testimonials!
