Laser Eye Correction#
This article records my experience going through laser corrective eye surgery. Typically folks get LASIK. I got PRK/ASA instead, which is slightly more involved. This will go through the following phases:
What made me decide to check it out
Doctors visits
The procedure itself
Recovery experience
I went from deciding to explore this procedure to having my eyes lasered in about two weeks (this felt fast). The procedure itself took only a couple of minutes. In general I have no regrets and my eyesight today is good.
This post is long, rambling, and has nothing to do with my usual topics of startups and tech. Most of my regular readers may wish to skip it.
Motivation#
I’ve been wearing glasses since I was 10 years old. I wore contacts for much of my twenties, but found them tiresome and switched back to glasses. I’m 37 today. I mostly wear contacts when I’m in a highly social situation, going on a long drive and want sunglasses, or doing something physical where glasses are not advised, like swimming in the ocean. When I wear contacts they eventually irritate my eyes, and so avoid wearing them.
LASIK / corrective eye surgery always felt weird, and I am risk averse, so I never considered it. However, I have a few friends who recently underwent the procedure and spoke highly of it. I also had a couple weeks where work wasn’t as engaging, and so I decided to ask my optometrist. He said “Yup. We recommend this group. They’re quite good.”
Day 0#
The doctor’s visit was fine. They measured my eyes, took scans with half a dozen different imaging devices, and said that I was a good candidate for ASA, which I liked anyway. My corneas were thin and so LASIK wasn’t a good choice. This is fine with me because the idea of having a corneal flap made me a bit anxious. ASA has arguably better results with fewer complications, at the cost of a longer recovery time (about a week or two).
ASA vs LASIK#
I am not a doctor
Your cornea is like clear skin with an epidermis and dermis. Myopic eyes have corneas that are too pointy. The solution is to laser down the dermis so that it’s less pointy. What to do with the epidermis? (actually called epithelial tissue)
LASIK: let’s cut open a flap, fold it to one side to the side, laser down the inner part of the cornea/dermis, and then fold back the epithelial tissue flap when we’re done, sealing up the raw dermis so things heal within a day
PRK/ASA: let’s just laser the outer tissue too. It’ll grow back and we won’t have to fuss with cutting or flaps.
PRK/ASA have fewer complications (no flap, no dry eyes, …), but you endure feeling your epithelial tissue grow back over your cornea for about a week, which is an interesting experience (more on this below).
Personally, ASA spoke to me more. My epithelial tissue was also thin, and so I wasn’t a good candidate for LASIK anyway 🎉.
Valium#
The doctors prescribed 20mg of Valium for the procedure and Tylenol-3/Codeine for comfort after the procedure. The need of these drugs freaked me out.
My family has a history of substance abuse, and I’m hesitant around any habit forming drug. Of course no drug is likely to introduce a habitual risk after a single dose, but still, these drugs caused me non-trivial anxiety, much more anxiety than having my eyes lasered, for example.
I asked the doctor about it and he was pretty firm. “You need to have Valium because we need all of your muscles relaxed, also we’re going to need to manipulate your head and such prior to the procedure and don’t want you fighting us”. I asked about a lower dose and he said “usually we give 25mg, but for you 20mg probably makes sense” “How about 10mg or 15mg? “ “No, that wouldn’t really have any therapeutic effect”.
OK, I went home, got the drugs at the pharmacy, and predictably, went on a web search spree about LASIK, Valium, and dosage. After consulting the internet, my Ex (also a physician), well-respected medical databases like UpToDate, commercial sites for other laser eye centers, and peers who had undergone the procedure without Valium. I decided that my doctor was overly-cautious / wrong.
On the day of the surgery I made a mild fuss and became their second patient to undergo the procedure without Valium. I felt much better.
Surgery itself#
Fifteen minutes after having the Valium conversation I was in the operating room, doing my best to be super relaxed.
This is the experience as best as I recall it a few days afterwards:
I lay down on a table with a neck rest and optical equipment that swung over to be maybe 4-12 inches above my face
I asked them to tell me what was going to happen and they gave a good description that helped me to anticipate everything, which helped a lot with any stress.
They put drops in my eyes, presumably to anesthetize them
They put a cover over my left eye and then a metal thing to keep my right eye open
They told me to look at the flashing light at the center of the device above me, which I did
I saw a little cotton swab come into view and, presumably, touch my eye (although it was hard to feel at that point).
Eventually the laser came on and the flashing light started going out of view. I heard one of the operators say “ten seconds”, “5, 3, 2, 1” and then it turned off.
During that period the light went entirely away, presumably because my cornea was now a puddle of occluding goo.
The swab came back, wiped my eye, and things looked sharp
Also during that period the laser moved a bit side to side and I was told to track it.
The swab happened once again, this time maybe with some pressure.
They flushed my eye out with water, and things looked very sharp
That eye was done
Wash, rinse, repeat.
The doctor then said “huh, that was fine without the Valium. We didn’t have any issues at all” to which I felt a stab of glory.
During the procedure the operators are also constantly saying “you’re doing a very good job”, which I know is silly, but helped a lot. During the procedure you’re trying hard to keep looking at the flashing red light, hoping that you’re doing a good job. Having someone say, even by rote “you’re doing a good job” is calming. From time to time while watching the red light your attention gets pulled over to one side or the other and you say “oh crap, did I just burn my eye in a wrong way?!” but now, apparently things were fine? Let’s hope so.
They told me to get up. I walked back to the waiting room, got my stuff, and was told that I was free to go. I called a Lyft and headed home with instructions to sleep as much as I could, or at least keep my eyes closed. (The Valium genuinely would have been helpful here).
My vision was better. I wouldn’t have been safe to drive in that state, but certainly safe to navigate my home, read clocks, and generally be ok. It’s supposed to improve to the point where I can drive in about a week.
After care#
I left with instructions on how to care for my eyes over the next week. These include:
Eye drops each hour to keep things moist, help them heal, and reduce discomfort
More eye drops three times a day to keep things from getting infected. These sting a bit.
Goggles to wear when sleeping (mildly annoying) so that I don’t accidentally rub my eyes against a pillow
Sunglasses to wear anytime when outside for the first week
My eyes also had bandage contact lenses in them which I was supposed to leave in for five days, and then go to my optometrist to take them out.
Day 1 recovery#
I listened to podcasts, took a nap, and then did normal activities around the house the first day. Everything felt pretty chill “This is recovery? Piece of cake!”
I had been told that discomfort would peak around day three.
I went to bed with my fancy new goggles feeling pretty good
Day 2: 2am#
There is very clearly a thing in my right eye. It feels like a grain of sand. No wait, they warned me about this. There’s going to be lots of fluctuating and discomfort over this week. This is in the set of things that they said could happen. Time to try to go back to sleep.
Day 2 morning#
I woke up and the feeling of a grain of sand in my right eye was gone 🎉. Maybe things felt a little more irritated, but the eye drops helped. I spent the day being pretty bored. I took short walks outside but the wind felt not great (dry). I did a little work, listened to TV / movies while giving my eyes a rest. At one point I took a walk to the grocery store (25 minutes away) Once I got there I decided that I wouldn’t do that again, and took a Lyft back.
Throughout the day discomfort rose to the level of chopping onions or bad seasonal allergies. Annoying enough that I didn’t want to start any serious pieces of work, but generally not bad. I was able to read and write e-mails, but not many. I took a couple of video calls.
Day 2 sleep#
Totally fine. I’m used to the goggles now.
Day 3 morning#
Waking up my eyes feel slightly glued shut, as though there is some mucus that has been generated and dried. There’s definitely a sense of mild burning. We’ve graduated from “chopping onions” to “lemon juice”.
Worst of all, my eyes are very light sensitive. It’s difficult to open them with the windows open. I crack open my eyes, go find my sunglasses, and proceed to close all of the blinds in the apartment. I like the sunlight. I’m in a corner unit with tons of windows, and I definitely don’t invest in good blinds, which I now regret. I write this now with my eyes closed typing blindly into google docs. (I followed up afterwards to clean up all the typos)
The lemon juice burning is still there, and the light sensitivity gets increasingly more uncomfortable when I keep my eyes open for any length of time.
It’s now that I appreciate / understand a little bit of vision-impaired assistive technology (or lack thereof) in society. My google home assistant is suddenly quite valuable for routine queries like “what time is it”. Of course, when I ask it “any tips for light sensitivity” it answers “I’ve sent some articles to your phone” which is not at all helpful. My vision, when I use it, is also worse than yesterday. It’s hard for me to read text on my phone or the computer.
Voice typing is disabled on my phone for some reason. After a while of trying I give up and switch to my laptop. There’s no way I can navigate a settings menu in this state.
Mostly I spend the day with my eyes closed, puttering about the apartment. It’s a consistently mildly uncomfortable day. Not bad. Not enough to regret the procedure, but certainly an interesting day.
Day 3 night#
I invited a couple of friends over to make pizza (I recently bought a pizza oven). It was an interesting challenge to engage socially with folks. We were inside with the lights on and I wore dark sunglasses, both to shield my light sensitive eyes, and to not give off any clues that actually I was keeping my eyes shut 90% of the time while looking in folks’ general direction.
It was a good time though, and nice to normalize into social behavior. I went to bed happily, and curious to see what the next day would bring
Day 4 morning#
I can see! Well, for five minutes anyway. Waking up I gently test my eyes against the morning sunlight coming in the window and it … doesn’t hurt. As the sun rises though, and as my eyes fatigue I do learn that I’m not out of the woods yet. The burning is mostly gone, but there’s an interesting fatigue/light sensitivity that persists when I use my eyes for any length of time.
I go out on an adventurous walk. It works as long as I keep my eyes shut 80% of the time, blinking them open frequently to avoid hitting things. At one point before crossing a busy pedestrian bridge I have to stop and rest my eyes for a minute before the daunting task of keeping them open during the crossing (a full ten seconds). Over the day my eyes get better, and I’m more able to keep them open for longer without fatigue.
I download audible and start an audiobook. My podcast reservoir was running low. That, combined with late afternoon walks in the low light (but when sunglasses don’t seem entirely strange socially) make me feel almost normal.
It’s hard to focus on things. At some point enough trying results in my eyes just giving up, and entirely refusing to coordinate. The solution appears to be to just rest them for a period of time (a few minutes). Burning is gone mostly, I still use the drops, but it feels not quite as necessary, especially given that my eyes are closed probably 70% of my day (at least).
I have work tomorrow and the bandage contact lenses are supposed to come out the next day. I’m curious to see how things progress over the next 48 hours.
Day 5 morning#
Waking up things feel about like they did last night. Pretty good, but still easy to fatigue. I can read text, but only for 5-10 seconds at a time. I successfully go on an enjoyable walk. It was a bit challenging first getting into the light, but eventually my eyes did adjust (at least to the shaded and occluded light provided by my hat and wraparound sunglasses).
I get on a work call and, within a couple minutes of focusing I am drawing shades and donning sunglasses.
I spend most of the morning laying down outside in the sun with covered eyes listening to an audiobook. Coming inside in the afternoon, I discover that I can look at documents and e-mails for longer, perhaps looking away every 5 seconds, but staying with eyes on screen for quite a while in that manner.
I have to remind myself to use lubricating eye drops. The burning sensation is present if I go and look for it, but doesn’t distract me.
Day 5 evening#
I can now focus on screens without effort. I actually watch a bit of a movie. Distance reading and text still isn’t great, but there’s no stress to looking at things now, even if I can’t read them.
Day 6 morning#
My vision is still blurry, but I wake up and get to work right away, reading a backlog of e-mails. Today I see the optometrist to get my bandage contacts out. I’m curious to see what he thinks about my current recovery. There’s this fear in the back of my head that I’ll plateau at a not-great state and still need corrective lenses or another surgery.
Day 6 afternoon#
My vision maybe got a little blurrier? Who knows 🤷
I went to the optometrist this afternoon. He said “You’re doing great 👍” which is good to hear. There’s some mild constant background concern that my vision will plateau at its current state, which wouldn’t be crushing, but would be sad. He took out my bandage contact (weird having someone else poke at your eyes) and said that recovery should accelerate now that it’s out of the way.
Day 8#
Vision is getting clearer. It’s still not perfect. I think I could probably drive if I wanted to. I’ll wait a couple more days though.
Day 10#
I’m good. My vision seems as good as it has ever seemed. Discomfort is gone. I’m driving again. I play ultimate frisbee in my weekly game.
Presumably my vision will continue to improve slowly over the next few weeks, but if it didn’t and things stabilized at this point I’d be fine with it.
Conclusion#
Eye surgery is weird in theory, but apparently quite routine in practice. I suspect that many people should get it but don’t because, well, it’s weird to laser your eyes.
I felt more comfortable with the idea after hearing from friends that it was ok (as you are now doing) and after going in to talk to my optometrist and a laser eye center. I’m glad I did it and recommend that others consider it as well