I. THE “WHY NOT”
I’ve been considering corrective eye surgery for years. It’s been a “one of these days” thing for me for over a decade. The reason I always gave myself for waiting was that it was an expensive surgery. But until this year I never looked at what it would actually cost me, evaluated whether that cost made sense, researched how the process actually works, or weighed the risks and benefits. When I get serious about a decision like this I become pretty analytical. I’m the kind of guy that takes forever in the grocery store to decide which type of cereal to buy because I have to consider all factors including but not limited to the cost per unit, the cost vs. the overall value to me, the fiber-to-total-carb ratio, the protein-to-fat ratio, and the ingredient list (literally standing in the cereal isle and googling potential health risks associated with each preservative used). Then I’ll change my mind at checkout on a whim and stick the cereal box on a magazine rack.
I think the real reason I waited until now is that I have some apprehension about someone messing with my eyeballs. I really don’t like anyone or anything tampering with the inside of my body. I rarely even take over the counter pain killers regardless of how much pain I’m in, and I certainly don’t like the idea of anyone else cutting on my flesh unless it’s absolutely necessary.
II. THE “WHAT THE HECK?”
I think I first got glasses when I was in fifth grade. It was awesome. I remember putting on my glasses the first few mornings while looking across my bedroom at the sign taped to the door that said “KEEP OUT” with a Microsoft Word ’95 clip art military helicopter underneath it.
“The world IS beautiful,” I would literally exclaim.
It was the realization of a dream for me. In my younger, ever-so-slightly-more-foolish years, I would stare out the car window directly into the sun because they said it was bad for your eyes. I wanted to wear glasses.
I don’t regret doing this because that would be pointless, nor do I now believe there’s actually a correlation between staring at the sun and “getting” to use corrective lenses. However I did later decide glasses weren’t as much fun as I hoped they’d be. So just a few years later, I tried contacts instead.
I started out wearing contacts I was supposed to soak in solution every night and change every other week. It sucked, but it sucked less than dealing with fingerprints and scratches on my lenses. Over the years I have tried different brands and types of contacts, eventually deciding a few years ago that it was worth the additional premium I would have to pay to use DAILIES TOTAL1 contacts from Alcon for a slight boost in comfort and convenience. These stupid things cost me like $800 a year. When you tack an eye exam and other miscellaneous costs on top of that, I am pushing $1000 per year in total cost to give my otherwise-blind eyes the luxury treatment they “deserve”. Even then, I regularly deal with minor annoyances like dry eyes if I intentionally or unintentionally fall asleep with my contacts in, a slight irritation in at least one eye every two or three days that feels like a really tiny eyelash in my eye all day, the occasional cloudy contact that I can’t ever manage to get completely clean, the inconvenience of eye exams and ordering contacts, having to always make sure I have what I need for my eyes when I travel or go camping, and frustration from my wife when she finds dried-up used contacts and contact packaging left in a variety of nonsensical places around the house.
It’s not all that bad once you get used to it, honestly. And considering the alternative of being essentially blind, it’s a pretty sweet deal. But as I approached the end of my contact supply this year and realized my most recent prescription had probably expired, I began thinking about the $1000 I was about to spend to order another year’s supply of contacts after getting an eye exam just so they can tell me my eyes are no different than they have been for like fifteen years. I searched for “lasik” on Google Maps, found a place with lots of awesome reviews (LasikPlus in Altamonte Springs, FL), then called to get an idea of how much corrective surgery would cost.
III. THE “IS THAT IT?!”
On the phone I was told they had a promotion running where you could get LASIK done for $250 per eye, so I should go ahead and book a free assessment now. At most it would cost around $2200 per eye, she said.
$250 per eye?! That’s a deal! (They got me.) And even at $4400 it seemed pretty reasonable compared to some completely baseless $6000+ cost I had in my head.
I later found out that this promotion only applied to certain people who have different eyes than I do and don’t mind having an inferior laser used in their procedure. Seriously, why would anyone do this? This is your freaking eyesight we’re talking about here. Usually what seems too good to be true, is. After the most extensive eye exam I’ve ever gotten, they recommended LASIK and I was quoted a total cost of about $3600 (or the same price for PRK which at the time I knew almost nothing about).
From a financial perspective, that $3600 saves me $1000 I would otherwise have to spend in the next 2 months, plus about $1000 annually. That’s like a 38% ROI (return on investment) that is practically guaranteed if the surgery is completely successful. (If only I could sell investments that good to my clients!)
Thus began my research into the risks and options associated with the surgery. I found out about three main procedures that are used to correct nearsightedness like mine.
IV. THE “SCIENCE”
I used to think bad eyesight was some issue buried deep within the darkness beneath your pupil. It’s not. At least the nearsightedness I had isn’t. The surface of your eye is designed so that it allows particles (or waves or whatever) of light to pass through, redirecting them like a prism to some spot at the back of your eyeball that collects information about the light. Your brain then uses that information to determine the nature and origin of the light, which it converts into a continuous live feed. Some eyeballs like mine have really bad aim. Glasses and contacts are designed to change the light’s trajectory before it reaches your eye to account for that.
Technically my “bad” eyesight is a trade-off. Without a corrective lens, the world around me has always just been blurs of color (and not great color either, since they also tell me I am color blind, which mainly just affects my ability to distinguish between red shells and green shells while playing Mario Kart). I can’t even see the big ‘E’ on the very top line of a vision chart. However they apparently call it “nearsightedness” for a reason, because I have been able to hold things like 5 millimeters from my eye and see them with perfect clarity. My doctor informed me that by surgically correcting my vision, I will unfortunately loose this useless superpower, and I will likely need to use reading glasses someday like everyone else.
Eyes are like ogres. You’ve seen Shrek – you know what I’m talking about. They have layers. The cells in the top layers regrow and heal. If you scratch the surface of your eye, it hurts for a bit, and it fixes itself. Go just a little deeper and you’ll find a layer of cells that doesn’t regrow. These are the cells that surgeons must laser-chisel your prescription into. Instead of using an external source like glasses or contacts to redirect the light coming into your eye, they reform the actual eye surface itself. That’s freaking cool.
Here’s the dilemma. The cells that heal and regrow are in the way of the layer of cells that need to be reformed. There are three methods used to overcome this I considered utilizing.
V. THE “ANALYSIS”
ReLEx SMILE (which stands for Refractive Lenticule Extraction SMall Incision Lenticule Extraction – a bit redundant if you ask me) was just introduced into the USA a few years ago, but has been used overseas for longer. They focus a laser beneath the surface of your eye, leaving the top layer completely in-tact initially. The laser cuts out a design within your eye which becomes the “lenticule”, then a little slit or “small incision” is cut near the edge of the linticule through which the tissue is “extracted”. It’s a pretty neat procedure that I decided against for three reasons.
- There is not as much (any?) data available on the long-term effects of this procedure compared to PRK or LASIK since it hasn’t been around as long.
- It was only approved by the FDA a few years ago, meaning most surgeons over here that do it only have a couple years of experience with it compared to many surgeons who have decades of experience with LASIK and PRK.
- I watched videos where they cut a little slit in a person’s eye, then stick a pair of tweezers in to extract the tissue. It raised a bunch of questions for me about whether it might be possible to leave remnants of tissue behind, and whether I really felt comfortable with someone sticking tweezers into my eyeball.
ReLEx SMILE is a pretty awesome procedure made possible by even more awesome technology, but my perception of the risk compared to the other types of surgeries available to me led to my decision to eliminate this option from consideration first.
LASIK and PRK (which also stand for things acronymically) approach the top cells differently than ReLEx SMILE. Rather than finding a way around them, they just get the cells that heal out of the way. PRK does this by taking what looked to me like an electric toothbrush and lowering it straight down onto your eyeball to brush away the cells that will eventually regrow. LASIK slices into your eyeball right at the front with a laser to cut a nice flat flap made up of mostly the outer cells that will heal, but also including a disc of the cells that don’t heal, which is peeled over out of the way. (If you ever get LASIK, be thankful this isn’t done with a blade anymore.) With PRK, the cells removed grow back over your surgeon’s handiwork, leaving your eye as durable as before. With LASIK, the only cells that grow back are along the edge of the flap, resealing your existing outer layer of cells with scar tissue.
Comparatively, the results and success rates of these two options are not substantially different enough for that to be the deciding factor. There is really just one main disadvantage I considered with each method.
PRK’s disadvantage is that it puts you out of commission for a few painful days after surgery and then takes weeks and several months before your vision is very good, compared to very minimal discomfort with LASIK which gives you good next-day vision and your final vision within like a week.
LASIK’s disadvantage is that it leaves you with the potential for very rare “flap complications”. If you get punched in the face really hard, it could sever the edge of your flap and cause it to lift up from your eye again. Freaky, huh? Any substantial facial impact, including an airbag exploding into your face from your vehicle’s steering wheel, puts you at a theoretically greater risk for a very uncomfortable eye issue than you would have been before the surgery. I read that the flap can usually be reattached. Isn’t that reassuring?
I’m not an MMA fighter (yet), but there are three reasons I chose PRK over LASIK:
- When walking through the wilderness, if I ever come across a 30-foot-high cliff above water deep enough to jump into, there is a reasonably high probability that I will jump off of it.
- When playing basketball, my lack of sufficient depth perception has more than occasionally resulted in a ball that has been passed to me slamming into my face.
- I generally like the idea of keeping as much of my body in tact as I can, and PRK affects fewer cells in that under layer of cells that don’t regrow (since a slice of them is cut off as part of the LASIK flap).
I primarily just didn’t want to have to take my LASIK flap into consideration in making any life choices in my future.
VI. THE “EXPERIENCE”
The PRK procedure freaked me out more than I expected it to. Note that I’m a wimp with this sort of thing. This place didn’t offer Valium like many other places do, and I would have tried to refuse it even if they did. I was fully conscious as I had my eye pried open, then watched and felt (not painfully thanks to the numbing drops they used) that electric toothbrush tool lowered onto my eye. They put cold water drops in to reduce inflammation and manually wiped the surface with a little cue-tip-like tool. The laser was okay, just a little circular dim light show lasting a few seconds, then more drops, more wiping, and the last contact lens I will (hopefully) ever wear placed carefully by my incredible surgeon on that eye. Only halfway done.
I got up from the procedure disturbed and disoriented, but not in pain. My wife took me home. They gave me Tylenol PM to take, but I just swallowed a couple Benadryl instead. I still couldn’t make myself go to sleep in the middle of the day. I was prescribed mega-strength Tylenol or something as well to help with the pain, but I figured I wouldn’t need it and didn’t fill the prescription. The surgeon told me if I could take the pain, to just take some over-the-counter ibuprofen to reduce inflammation so my eye could heal faster, which I did. Last year I got knee surgery and was prescribed my choice between hydrocodone or oxycodone. I didn’t fill that prescription either. I didn’t even take an over-the-counter pain killer, just turned on the TV and ignored the pain. But I couldn’t use the TV to distract me this time. My eyes were very light sensitive, and I could barely see anything. The pain I felt for the next day and a half was like two dozen eyelashes floating around in each eyeball all at once. It itched, and it burned and I wasn’t allowed to touch it. It was one of the worst days of my life. By the end of the day after surgery, I was literally praying that God would take my suffering away. That night I had trouble sleeping again because it burned so much to keep my eyes closed. I just forced myself to lay there with my eyes shut while water squeezed its way out from underneath my eyelids. I kept waking up, blinking my tear-filled eyes once or twice, then holding them shut again through the burn.
They say the pain continues, maybe even gets worse, on days three and four, but when morning finally came on day three, my pain was gone for good. After the contacts were taken out by my doctor at my follow-up visit on day five (which I actually was able to drive myself to, even though I probably shouldn’t have) most of the slight discomfort I still had left was gone. They told me my vision was improving faster than average. I’m 15 days out now and my vision continues to improve. It’s actually at a point now where I’d be okay if it didn’t get any better, though I don’t think it’s finished changing. I’m going to see Avengers: Endgame in IMAX tomorrow, and I think I can see well enough now to fully enjoy that. (Thank goodness!)
On day two, I thought I might end up regretting my decision to do PRK over LASIK. But the pain only lasted a relatively short time, even though it felt like forever while I was suffering through it. As of right now, so far, I think PRK was the best choice for me. It would have probably been easier if I had taken all the medicine I was prescribed.
That’s it so far! Maybe someday I’ll come back and update this post on how my vision changes from here.