My LASIK Experience: Intralase & Wavefront

Background

I grew up nearsighted pretty badly in my left eye (20/200, or -3.0) – my right eye too, but to a much lesser degree (20/35 or -1.0). I hated the idea of sticking stuff in my eye every morning and glasses didn’t appeal to me much as a kid, so I just went around with everything kind of in 2D. Sports like shotput and wrestling were obviously not too badly affected, and soccer even was not that bad (the ball is big and slow enough that parallax and ball size can give you enough cues with one eye to know where the ball is), but tennis didn’t work out so well for me. Around college I started wearing glasses as an experiment, mainly encouraged by girls who thought they framed my face nicely. And so it went for years – which mainly worked. But sometimes it’d be challenging – like when scuba diving, skydiving, snowboarding, or going to 3D movies and having to wear two sets of glasses at once. Sometimes I like to just let my nose rest and take my glasses off my face. So I started thinking about getting laser eye surgery.

Picking a Doctor & Procedure

After a lot of research, I found Dr. Craig Bindi of Laser Eye Center of Silicon Valley – he has a perfect 5-star rating on Yelp and heck, the center did Linus Torvalds’s eyes, so I figure it’s good enough for me. 🙂 I first went in for measurements in July of 2009 and mulled my options for some time.

You have two options, one for each step of the procedure: whether you want conventional microkeratome or IntraLase and whether you want Traditional LASIK or Wavefront. The first choice is what technology the surgeon will use to cut a hinged flap of your cornea (to give them access to where you are going to have the correction performed) and the second is what technology will be used to actually perform the correction. A microkeratome is a small, vibrating knife that allows the surgeon to manually “saw” through your cornea. This is the more traditional way of performing LASIK, so most surgeons have a lot of experience doing these. That said, most post-op complications occur because of issues with the corneal flap (such as skin cells accidentally lodging under your flap and starting to grow!). IntraLase uses a computer-controlled laser to cut the flap instead, which makes for many fewer long-term issues. Your cornea heals much more strongly long-term, which is why both NASA and the US Air Force have approved laser surgery only where IntraLase is used (under high-G forces, a traditional LASIK patient’s corneal flap might dislodge, but not someone who’s had IntraLase). IntraLase is a chunk more expensive (+$500), but given that this is a once-ever kind of a thing and you want it done right, it seemed pretty obviously worth it to me. What I wasn’t told up front was that the eye is a little more beat up in the short term with IntraLase – people who have a microkeratome surgery often wake up the next day with near-perfect eyesight, but it can take a little longer for those with IntraLase to heal and the redness in the eye persists for some time.

The other option is Traditional or Wavefront LASIK. This covers what technology is going to be used to actually perform the correction. My understanding of Traditional LASIK is that the eye surgeon manually operates the laser during the procedure. It’s very important that the patient keep their eyes precisely still during the procedure, since a quick dart of the eye could cause a mis-correction. Small, unavoidable errors often happen, causing “night halos”. With Wavefront LASIK, a computerized map of the exact shape of your eye is made and a computer-controlled laser that continuously tracks your eye’s movement makes the corrections. This enables a much more precise surgery that is customized to your eye. There are a lot fewer reports of night halos with Wavefront and generally speaking it seems as though people’s vision (and astigmatism) could be more precisely corrected with Wavefront. So I opted to add that as well (+$700).

Timeline

3/17/2010 Wednesday AM – I decide to go ahead with the surgery and schedule a Friday afternoon appointment.

3/19/2010 Friday AM – I’m feeling well-rested, calm, and confident going into the surgery. After doing some work, Anna drives me down to San Jose.

1pm – I arrive at the Laser Eye Center. They do some extra measurements, and offer people Valium. I decline since I’m feeling calm and don’t want to be drugged up. It turns out they’re running a 20% off “March Madness” special and the whole thing is going to cost substantially less than I thought. After a bunch of waiting, I’m guided to the IntraLase room and left to hang out for about fifteen minutes. I lay back on the operating table, alone, staring at the ceiling and meditating on health care that goes beyond just getting people back to a baseline of “not sick” but that focuses on helping people be as excellent as possible.

3pm – Dr. Bindi comes in with an assistant and provides extra-strength numbing drops. These ones tingle more than the earlier ones – it’s clear that these are the hardcore drops. A few seconds later, my left eye can’t feel a thing. The speculum (which keeps my eye open) is placed on my eye but I can’t feel it. Dr. Bindi walks me through what he’s doing and what I’m going to feel at all times, which is very helpful. The procedure is most uncomfortable because my eye is being pressed upon pretty hard for about ten seconds. (Or at least my eye felt pressed upon – turns out it was suction and not pressure!) I had originally thought that the corrective step would happen immediately thereafter – turns out, that was wrong! They give me a pair of sunglasses to wear and guide me to the Wavefront room. I’m really a little wigged out, knowing that my cornea is currently sliced in half as I’m walking around. I can’t see anything at all out of my left eye other than a vague sensation of light, which is pretty scary. I sit in the Wavefront room by myself as they wait for the swelling to subside.

3:10pm – A technician comes in to calibrate the Wavefront machine. This part is pretty fascinating as they put a sheet of metal under the machine and a pair of lasers click as they zap perfectly round holes into the metal. My eyes are about to be zapped by a machine that just drilled holes into sheet metal. I was mildly intimidated/amused.

3:15pm – Dr. Bindi and his assistant come into the room and check on my eye; it apparently looks good, so I lay down on the bed, which rotates underneath the laser. A blinking red laser comes into view above and a green laser below. The speculum is put in again and I’m told to keep my whole body completely still and stare just above the red dot. After a short while, the laser starts tracking my eye movements and stays in a fixed position in my sight. The laser “sparkles” are providing me with a pretty incredible – and awesomely personal – laser show. When the lasers start blasting, I don’t see a big flash of light or anything like that – the sparkles just freeze in place for a second or two and then resume, well, sparkling. It does smell just a little bit like burned hair. After about 30 seconds or so, Dr. Bindi washes off my eyes and removes the speculum. I’m pivoted out from under the machine and get up. I walk out of the room and into the lobby – “You’re all set!”. Given all the setup, it’s kind of funny to be released into the wild less than a minute after surgery. Some people told me their vision was better right off the table, but that definitely wasn’t my experience: the world looked as if I was seeing it through ten sheets of saran wrap. I’m given three kinds of drops: fake tears, Omnipred (anti-inflammatory), and Vigamox (antibiotic). I’ll need to drop the Omnipred and Vigamox four times daily for a week.

5pm – Dinner with Anna. My eye has begun healing noticeably. We’re down to “three or four sheets of saran wrap”. My eye is very red around the edges and there’s a bright red blob in the corner of my eye.

8pm – A work-emergency puts me in front of my home computer working on a customer issue for a few hours. It feels a little awkward.

10pm – I go to the Groove Armada show with Anna. It’s amazing. We meet up with her friend afterwards at around 1am. He seems surprised that I’ve had surgery that day.

3/20/2010 Saturday 7:30am – My bright-and-early followup appointment. I didn’t wake up with clear vision, which was a mild disappointment. I’m down to two sheets of saran wrap. The world is hazy but not blurry. It’s more like there’s Vaseline on my eyes than it is that my eyes are defocused. Anna (bless her heart, on some four hours of sleep) drives me to San Jose. The doctor (not Bindi) checks on my eye and concludes I have a corneal edema (swelling with fluids) due to my eye’s reaction to the Intralase and my cornea is dry/irritated. The edema explains the haziness; as it heals up, my visual acuity will improve. He measures my eye at 20/60, which is already a lot better than it started at.

3/21/2010 Sunday AM – One sheet of saran wrap. I look at the fire escape of the building across the way and can make out more fine detail with my left eye than my right for the first time in my life. I wonder if my eye dominance is going to switch at some point.

Sunday PM – just for fun, I try on my old glasses. My eyes kind of wig out and the world rapidly goes in and out of very crisp focus. I take them off quickly. My eye is looking better – the dark red patch has become a light pink blotch.

3/22 Monday AM – Still at “one sheet of saran wrap”.

3/23-24 Tuesday & Wednesday – I go up to Tahoe for some snowboarding. Since I’ve never had prescription goggles, this is the first time I’ve ever really seen the mountain in 3D. It’s pretty crisp, though I definitely need to keep my goggles on outside to keep my eyes from hurting in the bright light. My snowboarding improves somewhat, notwithstanding an epic 100+ foot slide down a double-black vertical that was basically just a solid ice sheet. I should have known better when a row of expert snowboarders were lined up at the edge looking down nervously and waiting.

3/26 Friday – It’s time for my one-week post-operative checkup. My eye doesn’t hurt at all and the “saran wrap” is now more like a thin layer of Vaseline spread over my eyeball. My left eye’s vision is measured at about 20/15, though there are still mild halos around bright objects. My right eye’s vision is definitely better – I can make out the text on the 20/20 line – weird. I’m told by Dr. Bindi that the halos will completely go away in about the next week and I no longer need to take my anti-inflammatory and antibiotic eyedrops. My cornea is apparently healing very well with no wrinkles, abrasions, or infections and the flap is beginning to firmly reseal. My eye is self-lubricating well, so I’ve apparently dodged the common dry-eye syndrome. I get a copy of all my records from the office and am pleased to see I rated 5/5 on “patient cooperation”. There’s a huge amount of data on my eyes they’ve processed!

3/27 Saturday – Driving is pretty comfortable now day or night. Still very mild “glow” around bright objects. I’m pretty happy with how the surgery has turned out and would probably recommend it. If the halos do finish disappearing over the next week and I have totally clear vision  I’ll be pretty pumped!

4/1 Thursday – My left eye is still much more sensitive to small bumps / being pushed than my right eye.  My eye is lubricating well but still feels a little “different” than my right. There’s still a very slight halo around things. Sunlight doesn’t bug me so much anymore, but I do like wearing these cool shades. 🙂 I’m thinking about going into the DMV and getting my glasses restriction removed…