Unfortunately, the blurriness began today. It's irritating because while it's bad enough that, say, a computer screen is hard to see without putting my face very close to it, the prescription on my old glasses is too strong to clear anything up, so I just have to tolerate fuzzy vision for a while. The strangest part is that pre-PRK, my left eye was a good amount worse than my right eye. Right now, I'm definitely leaning on my left eye when I need to see things more clearly, which is something I've never done since I was--what, 8 years old? My optometrist told me that one eye got worse more rapidly than the other because I had a habit of leaning on my left hand while I read, putting my left eye that much closer to the book and compounding the damage done to my left eye because of close reading. Either way, guess that side is getting its chance to lead for the first time in my life!
All the markers of clarity that I used in my previous post (the TV at 8 feet, the door at 15 feet, etc.) are blurry like they were when I was myopic. Obviously, this is part of the healing process, but it reminds me of the reason why I wanted to get LASIK in the first place. I'm not the most patient person at the best of times and I love instant gratification, so it feels like a tease to be able to see so well for a few days (especially since was lucky enough to bypass the terrible pain that most PRK patients experience), and then be able to track it exactly as it leaves again. To be fair, though, I knew that this was coming and, honestly, it just helps to be able to whine about it a little.
I've been reading up on some medical studies about post-PRK epithelium healing (studies done on children, actually, which found that for the kids studied between the ages of 5 and 9, it took an average of 3.5 days for their epithelium to heal completely--damn age onset!) and it really seems like a good deal of lubrication plus resting the eyes (that is, not using the computer as much as I do despite the dryness and irritation it causes) really helped the patients' eyes to heal faster. So now, in addition to the regular anti-inflammatory and anti-bacterial drops I'm putting in every 6 hours, I'm going to try to use the lubricating drops regularly in between as well. I have another appointment tomorrow--lets see how it goes!
Today, on a pain scale, was only a 3 out of 10 at most (when I woke up from a nap and my left eye was so dry it wouldn't open).
Monday, May 31, 2010
Sunday, May 30, 2010
Day Four
So while today, I would say, is the same amount of discomfort as yesterday, my sensitivity to light is pretty substantial. The brightness on my computer screen is turned very low and even that sort of strains my eyes. I felt like a rock star wearing a friend's borrowed sunglasses indoors (because I've obviously never had a reason to buy sunglasses in the last couple years--I could never pull off the glasses over glasses look) but opening the fridge was like looking into a small supernova.
Unfortunately, the pressure of a sleeping mask on my face is also pretty unpleasant, so I've closed all my blinds, turned off all my lights, and I'm planning on spending most of the day with my head under my covers, sleeping again.
There's also a marked difference in vision with my left eye now, which has gone blurry. Luckily, I haven't noticed any haziness or glare otherwise.
My attempt to hang out with friends had to happen in the darkest part of the apartment, and I felt a bit like a shady drug deal was going down. We decided to watch a movie--Ip Man 2--and while I can happily report that I could read the subtitles more often than not, I did spend most of it looking away from the screen at the darkness beside the TV. Suffice to say I have no idea what this movie was about.
Maybe as a result of pushing my light-sensitive eyes to do much more than they wanted to, at night I had a bit of a headache and that onion-burning feeling in my eyes again. I popped a Vicodin and went to sleep (on my own--sleep debt is its own Valium) and when I woke up a couple hours later everything felt normal again. I broke into my audiobooks at this point, which have been sitting on my ipod for years as I've really had no use for them, and an hour and a half later, I have to say they aren't so bad at all.
Overall, today was a 4 out of 10 on the pain scale, dropping to maybe 2 out of 10 when I was just relaxing in the dark not doing anything (i.e. bored) and rising to a 4 out of 10 when I was trying to entertain people who'd come over.
Unfortunately, the pressure of a sleeping mask on my face is also pretty unpleasant, so I've closed all my blinds, turned off all my lights, and I'm planning on spending most of the day with my head under my covers, sleeping again.
There's also a marked difference in vision with my left eye now, which has gone blurry. Luckily, I haven't noticed any haziness or glare otherwise.
My attempt to hang out with friends had to happen in the darkest part of the apartment, and I felt a bit like a shady drug deal was going down. We decided to watch a movie--Ip Man 2--and while I can happily report that I could read the subtitles more often than not, I did spend most of it looking away from the screen at the darkness beside the TV. Suffice to say I have no idea what this movie was about.
Maybe as a result of pushing my light-sensitive eyes to do much more than they wanted to, at night I had a bit of a headache and that onion-burning feeling in my eyes again. I popped a Vicodin and went to sleep (on my own--sleep debt is its own Valium) and when I woke up a couple hours later everything felt normal again. I broke into my audiobooks at this point, which have been sitting on my ipod for years as I've really had no use for them, and an hour and a half later, I have to say they aren't so bad at all.
Overall, today was a 4 out of 10 on the pain scale, dropping to maybe 2 out of 10 when I was just relaxing in the dark not doing anything (i.e. bored) and rising to a 4 out of 10 when I was trying to entertain people who'd come over.
Saturday, May 29, 2010
Day Three
I woke up today because of the "pain" in my eyes, although it wasn't excruciating as I thought it would be. Instead, the sensation is persistently annoying and absolutely comparable to the feeling you get when cutting onions, except that blinking doesn't make it go away. I took a Vicodin and it seemed to make even the sensation go away enough that I'm on a computer typing this entry up right now.
Although I prepared for severe light sensitivity by putting up temporary curtains, the light of my slightly dimmed computer screen or the not-dimmed television screen doesn't irritate my eyes. At first, when I woke up because of the onion-eyes feeling, the bright sun bursting through the windows was terrible, but that could also be just because I woke up and then stared directly outside. Mild artificial light in the room felt fine as well, and so, just to test, I opened one of my blinds to let natural light in and only after about half an hour to an hour later did the light begin irritating my eyes enough that I needed to close them.
Hopefully, as this is supposed to be the worst day by other accounts, this is as bad as it gets because, really, it's not bad at all. By about 10pm I've slept most of the day (Vicodin plus a student's regular amount of sleep debt around thesis time made this easy). Dr. Manche did warn me that the blurriness I'm experiencing is going to increase in the next few days and if this is the extent of the pain, I know what it is that I'll be more irritated by (blurriness after a few days of good vision? Gah!).
Overall, today felt like a 5 out of 10 max on a ten point pain scale, and only at the points where I had that persistent onion fumes feeling.
Although I prepared for severe light sensitivity by putting up temporary curtains, the light of my slightly dimmed computer screen or the not-dimmed television screen doesn't irritate my eyes. At first, when I woke up because of the onion-eyes feeling, the bright sun bursting through the windows was terrible, but that could also be just because I woke up and then stared directly outside. Mild artificial light in the room felt fine as well, and so, just to test, I opened one of my blinds to let natural light in and only after about half an hour to an hour later did the light begin irritating my eyes enough that I needed to close them.
Hopefully, as this is supposed to be the worst day by other accounts, this is as bad as it gets because, really, it's not bad at all. By about 10pm I've slept most of the day (Vicodin plus a student's regular amount of sleep debt around thesis time made this easy). Dr. Manche did warn me that the blurriness I'm experiencing is going to increase in the next few days and if this is the extent of the pain, I know what it is that I'll be more irritated by (blurriness after a few days of good vision? Gah!).
Overall, today felt like a 5 out of 10 max on a ten point pain scale, and only at the points where I had that persistent onion fumes feeling.
Day One
(This is the day of the procedure.)
Afterwards, I immediately felt like I was seeing better (and still do). While there are some spots that were blurry and a bit of haze, everything was much clearer than it had been for a long time. I could see the things on my desk from my bed (about 8 feet away); I could see the clear outline of the door to my room (about 15 feet away). Standing in the aisle of Walgreens, I could read the labels of all the medicine on the shelves.
I did start feeling discomfort though, but definitely not "pain", the day of the procedure. My eyes felt dry and grainy, like there was something stuck in them--but I'm not sure this is any worse than how it was when I was wearing contacts as a sleep-deprived student though (although I guess I still am a sleep deprived student wearing [bandage] contacts). I'd say on a pain scale, I was a 3 out of 10. My eyes were irritated and the right one kept wanting to close but, again it's more discomfort than pain.
I was very anxious to bear with the painful part that, according to accounts by the doctor and people who have gotten PRK before, would be coming in the next two days.
Afterwards, I immediately felt like I was seeing better (and still do). While there are some spots that were blurry and a bit of haze, everything was much clearer than it had been for a long time. I could see the things on my desk from my bed (about 8 feet away); I could see the clear outline of the door to my room (about 15 feet away). Standing in the aisle of Walgreens, I could read the labels of all the medicine on the shelves.
I did start feeling discomfort though, but definitely not "pain", the day of the procedure. My eyes felt dry and grainy, like there was something stuck in them--but I'm not sure this is any worse than how it was when I was wearing contacts as a sleep-deprived student though (although I guess I still am a sleep deprived student wearing [bandage] contacts). I'd say on a pain scale, I was a 3 out of 10. My eyes were irritated and the right one kept wanting to close but, again it's more discomfort than pain.
I was very anxious to bear with the painful part that, according to accounts by the doctor and people who have gotten PRK before, would be coming in the next two days.
The Procedure
On May 27, 2010, I went into the clinic to have the actual PRK procedure done.
Payment was taken care of at the front desk and I didn't have to wait more than a minute before a medical resident (I'm assuming that's who they were) came to get me prepared. I was take to a regular exam room where I was given the consent form that I'd already read over at home. I skimmed it again to make sure it was the same document and signed it. Then, we went over all the different drops that I would be needing post-procedure, what they did and how I should apply them, and I was given a bag of them to take with me. I was asked if I wanted a Valium to calm me beforehand and I yes so they opened a pill packet onto my hand and got me a cup of water. I have to say that I didn't really notice the effects of the Valium at all though. Even after the procedure, I couldn't tell that there were any lingering sedative affects.
Let me note here that while I, having worn contacts, wasn't normally queasy at all with things being around or in my eye, the amount of involvement around the PRK procedure was on completely different scale (that is, surgery does not equal daily contact use or, I don't know, removing lashes form your eye, etc.) so I was glad to have something to calm me down at least psychosomatically.
Anyway, the technician asked if I had any further concerns and I mentioned that since I'd only been getting one or two hours of sleep a night for at least two nights before, that my eyes were already very dry and that it was very important to me that Dr. Manche was very liberal with the re-wetting drops. I'd watched Youtube videos of LASIK and PRK procedures prior to this (not recommended for the faint of heart, but it gave me a great sense of how long the actual procedure would take--not very long at all). This very popular video in particular (a recorded LASIK procedure with the patient commenting via video comments on their experience as it was happening) made me concerned because they do mention that their eyes were getting extremely dry between re-wettings and that at one point the doctor took so long that the dryness was "unbearable": http://www.youtube.com/watch?v=O4kDC4sZ5Jg The technician assured me that Dr. Manche would definitely make sure that wasn't a problem.
Then, I was taken into the room where the laser was, put into a terrible shower cap with gauze squares tucked underneath on the sides of my face in order to keep my hair out of the way and, as I would later learn, to soak up the torrents of drops that Dr. Manche would put into my eyes. They positioned me on a chair. My one gripe was that it seemed the chair wasn't made for someone as small as me (I'm 5'2"), but that's how most things are in my life. So I had to scoot myself up higher on the chair in order to look into the laser machine.
Dr. Manche came and helped me position myself so that I could stare into the red light that the laser would be using to track my eye (it's a red dot with a ring of light around it). He then began taping my eye lashes out of the way and applied anesthetic drops to my eyes. At this point everyone in the room was making casual conversation to keep me at ease and this continued through the maybe 10 minutes it took to do everything. Part of me realized that it was to keep me calm or distract me, but another part of me wished that he was giving me technical explanations of what he was doing as he did it. As I was laying down, I asked that they think of a time when they were on a flight where the pilot landed the plane so skillfully, so beautifully that they didn't even feel the landing and everyone broke into applause--and told them that I expected the same (including the applause) at the end of this procedure because it was going to go so smoothly. They laughed and put in the instrument that would keep my eye open the whole time. I have to say that this thing made me pretty nervous because it reminded me of the torture scenes in A Clockwork Orange, but I actually only felt the tiniest pressure once they were in. My eye kept trying to blink and, I think because Dr. Manche was re-wetting my eyes so often as the muscles in my eye were trying to blink, it just felt like I was actually blinking so it wasn't uncomfortable at all.
Now, the actual procedure began and it all happened very quickly. Overall, I have to say it was very disconcerting to be able to see all these things happen to my eye, and to feel a bit of pressure and (thankfully) no pain. Like I mentioned before, I'm not easily grossed out but the experience of this made me a little queasy to think about. I don't know the names of the instruments, so my descriptions will be pretty plain, but there was some kind of cylinder that was used maybe to mark where the epithelium was going to be removed. Then, Dr. Manche warned me as some kind of spinning, whirring flat, disc-like thing removed the epithelium from my eye. This was nerve-wracking because you can hear it do its work, but your eye sort of blacks out as it's happening. There was some fiddling around with sponges and scraper-like things probably to remove the leftover pieces epithelium. Then the laser treatment started. I was told to look at the red light and to move as little as possible. I could hear the zapping sound and actually smell something burning. I don't know if that was the smell of disappearing eye tissue since the laser is a cold one, or the smell of the laser itself. It was nice to know how the laser worked beforehand so that even though I tried to stay as still as possible, I know that involuntarily moving my eye wasn't going to destroy my eyesight forever.
When the laser finished, Dr. Manche doused my eye with some kind of liquid and BAM! the world (or rather, the laser instrument and the red light) looked instantly clear! Dr. Manche removed the thing holding my eye open and then started removing the tape. He explained that the tape is made so that it doesn't take any lashes with it when it's ripped off (thank god). He put something over that eye, taped it shut, shifted me over, and repeated the entire process for the other eye. I do have to say that I could feel more pressure with the left eye than the right eye, which made me really nervous that the anesthetic drops hadn't kicked in completely (especially when the spinning sandblaster-like thing removed the epithelium), but as the procedure kept going things started feeling the same again. Everything actually happened so quickly that, I told him later, I didn't even realize when he put the bandage contacts in. When everything was done, I could look around and instantly tell that the world was much clearer than I'd seen it for a while without the use of glasses or contacts.
I walked out to the waiting room on my own where a friend was waiting to drive me back. I was definitely feeling a little loopy from the Valium (which had finally kicked in during the procedure) and my newfound vision and I couldn't stop staring at everything outside the window was we drove back.
Payment was taken care of at the front desk and I didn't have to wait more than a minute before a medical resident (I'm assuming that's who they were) came to get me prepared. I was take to a regular exam room where I was given the consent form that I'd already read over at home. I skimmed it again to make sure it was the same document and signed it. Then, we went over all the different drops that I would be needing post-procedure, what they did and how I should apply them, and I was given a bag of them to take with me. I was asked if I wanted a Valium to calm me beforehand and I yes so they opened a pill packet onto my hand and got me a cup of water. I have to say that I didn't really notice the effects of the Valium at all though. Even after the procedure, I couldn't tell that there were any lingering sedative affects.
Let me note here that while I, having worn contacts, wasn't normally queasy at all with things being around or in my eye, the amount of involvement around the PRK procedure was on completely different scale (that is, surgery does not equal daily contact use or, I don't know, removing lashes form your eye, etc.) so I was glad to have something to calm me down at least psychosomatically.
Anyway, the technician asked if I had any further concerns and I mentioned that since I'd only been getting one or two hours of sleep a night for at least two nights before, that my eyes were already very dry and that it was very important to me that Dr. Manche was very liberal with the re-wetting drops. I'd watched Youtube videos of LASIK and PRK procedures prior to this (not recommended for the faint of heart, but it gave me a great sense of how long the actual procedure would take--not very long at all). This very popular video in particular (a recorded LASIK procedure with the patient commenting via video comments on their experience as it was happening) made me concerned because they do mention that their eyes were getting extremely dry between re-wettings and that at one point the doctor took so long that the dryness was "unbearable": http://www.youtube.com/watch?v=O4kDC4sZ5Jg The technician assured me that Dr. Manche would definitely make sure that wasn't a problem.
Then, I was taken into the room where the laser was, put into a terrible shower cap with gauze squares tucked underneath on the sides of my face in order to keep my hair out of the way and, as I would later learn, to soak up the torrents of drops that Dr. Manche would put into my eyes. They positioned me on a chair. My one gripe was that it seemed the chair wasn't made for someone as small as me (I'm 5'2"), but that's how most things are in my life. So I had to scoot myself up higher on the chair in order to look into the laser machine.
Dr. Manche came and helped me position myself so that I could stare into the red light that the laser would be using to track my eye (it's a red dot with a ring of light around it). He then began taping my eye lashes out of the way and applied anesthetic drops to my eyes. At this point everyone in the room was making casual conversation to keep me at ease and this continued through the maybe 10 minutes it took to do everything. Part of me realized that it was to keep me calm or distract me, but another part of me wished that he was giving me technical explanations of what he was doing as he did it. As I was laying down, I asked that they think of a time when they were on a flight where the pilot landed the plane so skillfully, so beautifully that they didn't even feel the landing and everyone broke into applause--and told them that I expected the same (including the applause) at the end of this procedure because it was going to go so smoothly. They laughed and put in the instrument that would keep my eye open the whole time. I have to say that this thing made me pretty nervous because it reminded me of the torture scenes in A Clockwork Orange, but I actually only felt the tiniest pressure once they were in. My eye kept trying to blink and, I think because Dr. Manche was re-wetting my eyes so often as the muscles in my eye were trying to blink, it just felt like I was actually blinking so it wasn't uncomfortable at all.
Now, the actual procedure began and it all happened very quickly. Overall, I have to say it was very disconcerting to be able to see all these things happen to my eye, and to feel a bit of pressure and (thankfully) no pain. Like I mentioned before, I'm not easily grossed out but the experience of this made me a little queasy to think about. I don't know the names of the instruments, so my descriptions will be pretty plain, but there was some kind of cylinder that was used maybe to mark where the epithelium was going to be removed. Then, Dr. Manche warned me as some kind of spinning, whirring flat, disc-like thing removed the epithelium from my eye. This was nerve-wracking because you can hear it do its work, but your eye sort of blacks out as it's happening. There was some fiddling around with sponges and scraper-like things probably to remove the leftover pieces epithelium. Then the laser treatment started. I was told to look at the red light and to move as little as possible. I could hear the zapping sound and actually smell something burning. I don't know if that was the smell of disappearing eye tissue since the laser is a cold one, or the smell of the laser itself. It was nice to know how the laser worked beforehand so that even though I tried to stay as still as possible, I know that involuntarily moving my eye wasn't going to destroy my eyesight forever.
When the laser finished, Dr. Manche doused my eye with some kind of liquid and BAM! the world (or rather, the laser instrument and the red light) looked instantly clear! Dr. Manche removed the thing holding my eye open and then started removing the tape. He explained that the tape is made so that it doesn't take any lashes with it when it's ripped off (thank god). He put something over that eye, taped it shut, shifted me over, and repeated the entire process for the other eye. I do have to say that I could feel more pressure with the left eye than the right eye, which made me really nervous that the anesthetic drops hadn't kicked in completely (especially when the spinning sandblaster-like thing removed the epithelium), but as the procedure kept going things started feeling the same again. Everything actually happened so quickly that, I told him later, I didn't even realize when he put the bandage contacts in. When everything was done, I could look around and instantly tell that the world was much clearer than I'd seen it for a while without the use of glasses or contacts.
I walked out to the waiting room on my own where a friend was waiting to drive me back. I was definitely feeling a little loopy from the Valium (which had finally kicked in during the procedure) and my newfound vision and I couldn't stop staring at everything outside the window was we drove back.
Consultations
At the Stanford Eye Laser Center, the initial exam is free and the second "Full exam" (during which they do the corneal mapping, in depth measurements, and dilated exam, etc) cost $205, which was deducted from procedure fee if you ended up getting the procedure done by Dr. Manche.
At the initial consultation, I was given a regular eye exam by a technician. I already knew that my prescription hadn't changed for some years, but I learned that my corrected vision (with glasses) was around 20/25 or 20/30. The under-correction was because of my tendency towards getting headaches with stronger prescription glasses. The technician mentioned the potential that, post-procedure, I could be seeing even better than I did on a daily basis because of this (no laser eye surgeon aims to correct only to 20/25, I would think). However, afterward, we did a test for my corneal measurements and I found out that my corneas were too thin for LASIK (they were at approx. 450 microns and the average is 550 microns) because LASIK requires the removal of around 160 microns (because of the flap) to PRK's 70 microns (just the removal of the epithelium). This was an issue for me because 1) I was aware of the fact that healing from PRK involved pain and 2) many of my questions were LASIK specific because I hadn't anticipated needing PRK instead.
So, I was apparently getting Wavefront PRK.
A little explanation of the differences between LASIK and PRK: with LASIK, a flap is cut in the cornea and it's flipped back so that the Excimer laser can treat the deeper parts of the cornea to correct your vision. This method allows for more rapid visual recovery and substantially less pain (if any at all), but does create a flap on the cornea that never completely heals. However, I'm a pretty impatient person and the idea of being able to see instantly after the flap was reapplied and avoid pain sounded great. However, PRK was my ony option. With this method, a brush is used to remove the epithelium of the cornea (just the first layer) and the laser treats the outer surface of the cornea. Afterwards, a contact is put over your eye because that epithelium needs to heal before your eye can focus completely againm, essentially acting like a bandage over the 9mm open wound that will be on your eye--otherwise every blink would be excruciating. The need for the epithelium to heal is also the reason why people with LASIK can start seeing clearly again right after the surgery and people with PRK cannot (though my vision had definitely improved, but more on that later). Again, with PRK, the integrity of the eye is more solidly preserved, but I don't fight for a living and presume I'd have bigger things to worry about if I was being attacked.
The wavefront part of this procedure is the second coolest part (right behind the whole perfect-vision-again thing), in my opinion. I'm a television and movie fanatic and the first article that I read about Wavefront (which I can't seem to locate again) compared it to HDTV versus standard definition technology in terms of looking at the aberrations in your eye causing your flawed vision. This easily cinched the deal for me (although I think that the Stanford Laser Eye Clinic doesn't do procedures without Wavefront technology).
This equipment is capable of making 200 unique measurements that create a 3D topographic map of your cornea (compare this to only three measurements made using traditional LASIK equipment) based on your eye's ability to focus light rays, demonstrating irregularities in the way your eye processes images. This info in the "map" guides the laser in customizing the treatment to reshape your eye's cornea so that these irregularities can be corrected. It scans the eye 4000 times a second to identify the exact positioning of your eyes and then tracks and adjusts the laser itself 100 times a second in order to align with your eye's involuntary movements. There's also a failsafe within the system so that if it scans and the layout of your eye has changed within some measurement that I'm not really sure of (meaning, you looked away and, to the machine, the landscape of your eye has totally changed), the machine will turn off and wait until it has been cued to continue its work (presumably after your doctor reminds you to stay still and repositions you for the laser). Naturally, it records the point right before it stops so that the laser can begin scanning again and continue right where it left off. The most interesting part of this, I learned from watching one of Dr. Manche's lectures at some medical school, is that the level of detail that Wavefront tech provides actually allows for vision to be fixed in more terms than just acuity. There's also the potential that Wavefront can assist to the point where contrast perception and night vision can also be improved.
Aftwards, Dr. Manche came in personally to answer any questions I had and my questions were pretty generic. Here is a good list if you're looking for a place to start: http://www.usaeyes.org/lasik/faq/lasik-tough-questions.htm.
I told him that I was a full-time student and I'd already decided that I wanted to do both eyes at once, but I also wanted to have the worst of the healing period done before my graduation ceremony in mid-June. In addition to that, I told him I'd be traveling abroad in mid-July and wanted the probability of complications to be as low as possible by that point. With these two things in consideration, he suggested a date on the last week of May for the actual procedure.
I went and booked my full exam for later that same week. When I came for it, it was much of the same as the initial consult, but repeated many times in order to make sure of the results. Also, the measurements requiring dilated pupils were done during this exam (unfortunately, since it was a spectacularly sunny day and the world was so painful to look at afterwards). They sent me home with some Rollens (some of the least-cool pseudo-sunglasses you will ever see) and I booked my PRK for May 27, 2010.
I was told to arrive 15 minutes early to take care of paperwork and that I would need to pick up some prescriptions for Vicodin and Valium at a pharmacy before or after the trip. Luckily, there is a small Walgreen's right inside the Stanford Cancer Center right across the walkway from the Blake Wilbur Clinic (where the Stanford Eye Laser Center is located). I asked the to call in the prescription the day of my procedure so that I could just pick it up right afterward and they put a note in my file to do so. They set me home with a copy of the consent form I would be looking at and signing on the day of the procedure and a list of instructions.
I liked this site's definition of the breakdown of the costs of a laser eye procedure (if you're curious where your money is going): http://www.solveyourproblem.com/lasik-eye-surgery/wavefront_technology_and_lasik.shtml
Just a note that even after this consultation, I called them twice afterward to answer more questions I had and both times I was able to get the person who picked up the phone to ask Dr. Manche himself to confirm the answers.
At the initial consultation, I was given a regular eye exam by a technician. I already knew that my prescription hadn't changed for some years, but I learned that my corrected vision (with glasses) was around 20/25 or 20/30. The under-correction was because of my tendency towards getting headaches with stronger prescription glasses. The technician mentioned the potential that, post-procedure, I could be seeing even better than I did on a daily basis because of this (no laser eye surgeon aims to correct only to 20/25, I would think). However, afterward, we did a test for my corneal measurements and I found out that my corneas were too thin for LASIK (they were at approx. 450 microns and the average is 550 microns) because LASIK requires the removal of around 160 microns (because of the flap) to PRK's 70 microns (just the removal of the epithelium). This was an issue for me because 1) I was aware of the fact that healing from PRK involved pain and 2) many of my questions were LASIK specific because I hadn't anticipated needing PRK instead.
So, I was apparently getting Wavefront PRK.
A little explanation of the differences between LASIK and PRK: with LASIK, a flap is cut in the cornea and it's flipped back so that the Excimer laser can treat the deeper parts of the cornea to correct your vision. This method allows for more rapid visual recovery and substantially less pain (if any at all), but does create a flap on the cornea that never completely heals. However, I'm a pretty impatient person and the idea of being able to see instantly after the flap was reapplied and avoid pain sounded great. However, PRK was my ony option. With this method, a brush is used to remove the epithelium of the cornea (just the first layer) and the laser treats the outer surface of the cornea. Afterwards, a contact is put over your eye because that epithelium needs to heal before your eye can focus completely againm, essentially acting like a bandage over the 9mm open wound that will be on your eye--otherwise every blink would be excruciating. The need for the epithelium to heal is also the reason why people with LASIK can start seeing clearly again right after the surgery and people with PRK cannot (though my vision had definitely improved, but more on that later). Again, with PRK, the integrity of the eye is more solidly preserved, but I don't fight for a living and presume I'd have bigger things to worry about if I was being attacked.
The wavefront part of this procedure is the second coolest part (right behind the whole perfect-vision-again thing), in my opinion. I'm a television and movie fanatic and the first article that I read about Wavefront (which I can't seem to locate again) compared it to HDTV versus standard definition technology in terms of looking at the aberrations in your eye causing your flawed vision. This easily cinched the deal for me (although I think that the Stanford Laser Eye Clinic doesn't do procedures without Wavefront technology).
This equipment is capable of making 200 unique measurements that create a 3D topographic map of your cornea (compare this to only three measurements made using traditional LASIK equipment) based on your eye's ability to focus light rays, demonstrating irregularities in the way your eye processes images. This info in the "map" guides the laser in customizing the treatment to reshape your eye's cornea so that these irregularities can be corrected. It scans the eye 4000 times a second to identify the exact positioning of your eyes and then tracks and adjusts the laser itself 100 times a second in order to align with your eye's involuntary movements. There's also a failsafe within the system so that if it scans and the layout of your eye has changed within some measurement that I'm not really sure of (meaning, you looked away and, to the machine, the landscape of your eye has totally changed), the machine will turn off and wait until it has been cued to continue its work (presumably after your doctor reminds you to stay still and repositions you for the laser). Naturally, it records the point right before it stops so that the laser can begin scanning again and continue right where it left off. The most interesting part of this, I learned from watching one of Dr. Manche's lectures at some medical school, is that the level of detail that Wavefront tech provides actually allows for vision to be fixed in more terms than just acuity. There's also the potential that Wavefront can assist to the point where contrast perception and night vision can also be improved.
Aftwards, Dr. Manche came in personally to answer any questions I had and my questions were pretty generic. Here is a good list if you're looking for a place to start: http://www.usaeyes.org/lasik/faq/lasik-tough-questions.htm.
I told him that I was a full-time student and I'd already decided that I wanted to do both eyes at once, but I also wanted to have the worst of the healing period done before my graduation ceremony in mid-June. In addition to that, I told him I'd be traveling abroad in mid-July and wanted the probability of complications to be as low as possible by that point. With these two things in consideration, he suggested a date on the last week of May for the actual procedure.
I went and booked my full exam for later that same week. When I came for it, it was much of the same as the initial consult, but repeated many times in order to make sure of the results. Also, the measurements requiring dilated pupils were done during this exam (unfortunately, since it was a spectacularly sunny day and the world was so painful to look at afterwards). They sent me home with some Rollens (some of the least-cool pseudo-sunglasses you will ever see) and I booked my PRK for May 27, 2010.
I was told to arrive 15 minutes early to take care of paperwork and that I would need to pick up some prescriptions for Vicodin and Valium at a pharmacy before or after the trip. Luckily, there is a small Walgreen's right inside the Stanford Cancer Center right across the walkway from the Blake Wilbur Clinic (where the Stanford Eye Laser Center is located). I asked the to call in the prescription the day of my procedure so that I could just pick it up right afterward and they put a note in my file to do so. They set me home with a copy of the consent form I would be looking at and signing on the day of the procedure and a list of instructions.
I liked this site's definition of the breakdown of the costs of a laser eye procedure (if you're curious where your money is going): http://www.solveyourproblem.com/lasik-eye-surgery/wavefront_technology_and_lasik.shtml
Just a note that even after this consultation, I called them twice afterward to answer more questions I had and both times I was able to get the person who picked up the phone to ask Dr. Manche himself to confirm the answers.
Finding the Right Surgeon
Being a child of the internet generation really affected the way that I went about choosing my doctor.
In my experience, the "best" people for a given service are the ones who don't really have to advertise because word-of-mouth referrals bring in enough business on its own. With this in mind, I didn't look for ads for laser eye clinics. I'm especially wary of anyone who advertises in newspapers because not only is that where those "One eye for $500!" ads proliferate (and nothing says 'butcher' more to me than doctors pushing factory-style discount eye surgery), but I'm also wary of any doctor or clinic that uses such an outdated medium to find clients. This may sound unfair, but let me explain my rationale in more detail.
Newspaper advertising, almost more than any other medium, is used by people trying to cast a wide net because they're not positive exactly who or what their desired audience is. In addition to this, the way advertising mediums have changed almost guarantees that the audience reached by news ads are older as we've mostly moved on to consuming news media online. What this says to me is that these eye clinics are trying to reach a market segment that may not necessarily have the access to information provided by the internet, and I'm not interested in a surgeon who is banking on their patients being less informed.
Further, I wanted a surgeon--and a clinic--that was modern, smart, and up to date. I might be biased, but any place sinking money into newspaper ads are probably not making the best decision regarding their advertising budgets--not smart. Anyone who wasn't accustomed to online advertising probably also wasn't as accustomed to the internet as a medium, and considering how online medical databases are essential for medical professionals to access the most recent and relevant research in their fields, I saw this as another warning sign. Further, considering that laser eye surgery depends on doctors staying at the cutting edge of their industry's technology, anyone who was hesitant to utilize new technologies in other areas of their life also gave me pause.
I was lucky enough to be close to the Stanford University Medical Center, which, by reputation, housed many well-praised medical practices. I found out that the Stanford Eye Laser Center was part of this group, led by Dr. Edward Manche, who also happened to be a Professor of Ophthalmology in the Stanford University School of Medicine (not a bad resume). Again, being a Google junkie, I immediately set out to research him specifically.
In all my hours and hours of searching, I found only one negative experience--on Yelp and from a person who had obviously not done their own due diligence before the procedure (complaining that Doctor Manche never warned them about the possibility of chronic eye dryness or increased potential of complications if you have large pupils, which I find questionable as, in my own experience, we discussed it in detail). What I did find was an enormous amount of articles quoting him as an expert in the field, many articles congratulating or recognizing him for certain achievements, and even articles warning about the dangers of laser eye surgery where Dr. Manche fixed other people's botched surgeries. In addition to this, there were a solid amount of related medical publications with his name listed as an author and a good number of lectures from various speaking opportunities at conferences and medical schools around the United States (which, of course, I watched in order to get a feel of how he comported himself--in my opinion, he seemed humble, but definitely aware of his expertise).
One of the things that impressed me most was his listing on Trustedlasiksurgeons.com. Though I'm not overly familiar with the site, their criteria for choosing to list a surgeon seems pretty stringent (including years of experience, publications, FDA studies, personally doing the laser procedure, personal meetings with the patient during consultations, etc.) and they seemed to do so by region (that is, listing a single surgeon to a single region) and Dr. Manche covered basically all of Northern California. Also, when comparing Dr. Manche with some of the surgeons listed for Southern California and Oregon, I took note of the sheer difference in experience in terms of numbers; many other surgeons were listed as having performed 3k-9k procedures personally and Dr. Manche was listed at 28k procedures completed. When taking into consideration that his wasn't a factory-style clinic and that he was the go-to guy not only for other people's botched laser surgeries, but for other medical professionals looking for laser eye surgery, I was very impressed. It is very important to note that all this information that I found on him was cross-referenced with other sources to ensure that what was said on this one site wasn't fabricated (obviously, this strategy isn't perfect, though).
I went to his website (http://eyelaser.stanford.edu) which was informative and well-constructed (for many of the same reasons listed above, I'm not sure I would trust a clinic that didn't have a web site). I also noted that his prices were definitely higher than most other locations I'd looked at peripherally ($2,950 per eye for Wavefront LASIK with Intralase or Wavefront PRK), but taking his stellar resume into account, I was willing to consider the higher price for the higher quality.
After this research, I scheduled a free initial consultation for May 17, 2010.
In my experience, the "best" people for a given service are the ones who don't really have to advertise because word-of-mouth referrals bring in enough business on its own. With this in mind, I didn't look for ads for laser eye clinics. I'm especially wary of anyone who advertises in newspapers because not only is that where those "One eye for $500!" ads proliferate (and nothing says 'butcher' more to me than doctors pushing factory-style discount eye surgery), but I'm also wary of any doctor or clinic that uses such an outdated medium to find clients. This may sound unfair, but let me explain my rationale in more detail.
Newspaper advertising, almost more than any other medium, is used by people trying to cast a wide net because they're not positive exactly who or what their desired audience is. In addition to this, the way advertising mediums have changed almost guarantees that the audience reached by news ads are older as we've mostly moved on to consuming news media online. What this says to me is that these eye clinics are trying to reach a market segment that may not necessarily have the access to information provided by the internet, and I'm not interested in a surgeon who is banking on their patients being less informed.
Further, I wanted a surgeon--and a clinic--that was modern, smart, and up to date. I might be biased, but any place sinking money into newspaper ads are probably not making the best decision regarding their advertising budgets--not smart. Anyone who wasn't accustomed to online advertising probably also wasn't as accustomed to the internet as a medium, and considering how online medical databases are essential for medical professionals to access the most recent and relevant research in their fields, I saw this as another warning sign. Further, considering that laser eye surgery depends on doctors staying at the cutting edge of their industry's technology, anyone who was hesitant to utilize new technologies in other areas of their life also gave me pause.
I was lucky enough to be close to the Stanford University Medical Center, which, by reputation, housed many well-praised medical practices. I found out that the Stanford Eye Laser Center was part of this group, led by Dr. Edward Manche, who also happened to be a Professor of Ophthalmology in the Stanford University School of Medicine (not a bad resume). Again, being a Google junkie, I immediately set out to research him specifically.
In all my hours and hours of searching, I found only one negative experience--on Yelp and from a person who had obviously not done their own due diligence before the procedure (complaining that Doctor Manche never warned them about the possibility of chronic eye dryness or increased potential of complications if you have large pupils, which I find questionable as, in my own experience, we discussed it in detail). What I did find was an enormous amount of articles quoting him as an expert in the field, many articles congratulating or recognizing him for certain achievements, and even articles warning about the dangers of laser eye surgery where Dr. Manche fixed other people's botched surgeries. In addition to this, there were a solid amount of related medical publications with his name listed as an author and a good number of lectures from various speaking opportunities at conferences and medical schools around the United States (which, of course, I watched in order to get a feel of how he comported himself--in my opinion, he seemed humble, but definitely aware of his expertise).
One of the things that impressed me most was his listing on Trustedlasiksurgeons.com. Though I'm not overly familiar with the site, their criteria for choosing to list a surgeon seems pretty stringent (including years of experience, publications, FDA studies, personally doing the laser procedure, personal meetings with the patient during consultations, etc.) and they seemed to do so by region (that is, listing a single surgeon to a single region) and Dr. Manche covered basically all of Northern California. Also, when comparing Dr. Manche with some of the surgeons listed for Southern California and Oregon, I took note of the sheer difference in experience in terms of numbers; many other surgeons were listed as having performed 3k-9k procedures personally and Dr. Manche was listed at 28k procedures completed. When taking into consideration that his wasn't a factory-style clinic and that he was the go-to guy not only for other people's botched laser surgeries, but for other medical professionals looking for laser eye surgery, I was very impressed. It is very important to note that all this information that I found on him was cross-referenced with other sources to ensure that what was said on this one site wasn't fabricated (obviously, this strategy isn't perfect, though).
I went to his website (http://eyelaser.stanford.edu) which was informative and well-constructed (for many of the same reasons listed above, I'm not sure I would trust a clinic that didn't have a web site). I also noted that his prices were definitely higher than most other locations I'd looked at peripherally ($2,950 per eye for Wavefront LASIK with Intralase or Wavefront PRK), but taking his stellar resume into account, I was willing to consider the higher price for the higher quality.
After this research, I scheduled a free initial consultation for May 17, 2010.
Background
I'm a female in my twenties living in the Bay area who had mild-to-moderate myopia and astigmatism in both eyes (about -4 in my left eye and -3.5 in my right eye). Both my parents have pretty bad vision, so it was basically a given that my own eyes would become a problem.
I had reading glasses in elementary school when my vision was first starting to go bad, but they gave me headaches so I never wore them. I wore contacts through middle school, but being a night owl in addition to being a pretty serious student (studying!) meant that contacts were irritating at best and painful at worst. Lack of sleep caused serious dry eye problems for me; my optometrist told me that my tear break up time (TBUT) was 5-8 seconds (average is considered to be over 10 seconds) which meant that my tear film was evaporating more quickly than most, or maybe just not adhering to my eye as well as it would in the average person. By high school I gave up the pain of contacts for the inconvenience of glasses, and I've worn glasses through college and most of my first year of graduate school.
Now, I'm not positive that I would have gotten this procedure if glasses and contacts weren't physically a problem for me. I've described my issue with contacts above, but glasses came with their own issues. Being Asian, the bridge of my nose is relatively flat. I've worked with optometrists to try different nose bands to fit my glasses to my face and none of them could keep them from slipping. As a result, when I occasionally wore contacts (at the gym, going out with friends, formal events, etc.) and now, as I'm recovering from my PRK, I have a habit of trying to push up my non-existent glasses every 10-15 seconds. Further, my eyelashes are long, but they're pretty straight. Since they don't curl up and my nose bridge doesn't hold the glasses very far from my face, my eye lashes constantly brushed against my lenses, not only causing an almost constant annoyance, but also making sure that there was a steady deposit of oils from my lashes streaking across the lenses of my glasses. In addition to the pushing-up-my-glasses habit, I had a huge stash of microfiber cloths that I used to clean my glasses several times a day.
Without these constant problems, I'm not sure that I would have taken on the cost (more about this later) and risk of laser eye surgery. It's very important to note these potential downsides, which include (this is not an exhaustive list):
In any case, I decided that a free consultation wouldn't hurt and so I arranged one with my roommate, who was also considering laser eye correction. Next, I'll go into my process of finding the right surgeon.
I had reading glasses in elementary school when my vision was first starting to go bad, but they gave me headaches so I never wore them. I wore contacts through middle school, but being a night owl in addition to being a pretty serious student (studying!) meant that contacts were irritating at best and painful at worst. Lack of sleep caused serious dry eye problems for me; my optometrist told me that my tear break up time (TBUT) was 5-8 seconds (average is considered to be over 10 seconds) which meant that my tear film was evaporating more quickly than most, or maybe just not adhering to my eye as well as it would in the average person. By high school I gave up the pain of contacts for the inconvenience of glasses, and I've worn glasses through college and most of my first year of graduate school.
Now, I'm not positive that I would have gotten this procedure if glasses and contacts weren't physically a problem for me. I've described my issue with contacts above, but glasses came with their own issues. Being Asian, the bridge of my nose is relatively flat. I've worked with optometrists to try different nose bands to fit my glasses to my face and none of them could keep them from slipping. As a result, when I occasionally wore contacts (at the gym, going out with friends, formal events, etc.) and now, as I'm recovering from my PRK, I have a habit of trying to push up my non-existent glasses every 10-15 seconds. Further, my eyelashes are long, but they're pretty straight. Since they don't curl up and my nose bridge doesn't hold the glasses very far from my face, my eye lashes constantly brushed against my lenses, not only causing an almost constant annoyance, but also making sure that there was a steady deposit of oils from my lashes streaking across the lenses of my glasses. In addition to the pushing-up-my-glasses habit, I had a huge stash of microfiber cloths that I used to clean my glasses several times a day.
Without these constant problems, I'm not sure that I would have taken on the cost (more about this later) and risk of laser eye surgery. It's very important to note these potential downsides, which include (this is not an exhaustive list):
- Permanent dry eye
- Corneal haze
- Halos/Glare around lights
- Undercorrection, which may necessitate continued use of glasses or contacts
- Overcorrection
- Sensitivity to light
In any case, I decided that a free consultation wouldn't hurt and so I arranged one with my roommate, who was also considering laser eye correction. Next, I'll go into my process of finding the right surgeon.
Friday, May 28, 2010
Day Two
I woke up amazed that I could see everything clearly from my bed again (including my alarm clock--that old example all of us myopic people fall back on) and half expecting to experience that terrible feeling when your contacts stick to your eyelid, but had no such problems. I've set an alarm to go off every 6 hours so that I can apply the medicated drops to my eyes, even though the technicians told me that it was only important to do so if I was awake and not to worry about it if I was asleep. I'm glad that I was told that PRK patients didn't need eye shields because I hate sleeping with things on my face, but sunglasses definitely helped when I went outside as I was just a little bit (hardly, really) light sensitive. I'm surprised that I don't really have any problems using a computer for some amount of time as long as I enlarge the font enough--only my eyes get dry pretty easily (but I make a point to close them for a slow count every couple seconds and to take a lot of breaks). I'm seeing more clearly from my left eye than my right, I realized, which is odd because my entire life my right eye has been better than my left. However, my left eye is also the one that seems more affected by "negative" symptoms as well.
I'd been experiencing just a mild dry eye and the irritation that comes along with that but I don't know that it ever reached beyond discomfort and into pain today either. I went for my day-after visit and they told me that everything looked perfect. Again, I was warned that the painful days were going to be basically tonight and tomorrow, so I could start taking Ibuprofen every few hours just to get it in my body to start fighting the pain right when it started. I was also warned that the Vicodin would probably help with the pain tomorrow, but that it was important that I take it with food as people often get upset stomachs from it. I slept right after I got back and as I woke up around 6pm to eat dinner, I felt that twinge of the stinging lemon-in-eyes or cutting-an-onion feeling that I've been told is what the worst, third day is going to feel like but eventually fell asleep again before it manifested itself fully.
I'd been experiencing just a mild dry eye and the irritation that comes along with that but I don't know that it ever reached beyond discomfort and into pain today either. I went for my day-after visit and they told me that everything looked perfect. Again, I was warned that the painful days were going to be basically tonight and tomorrow, so I could start taking Ibuprofen every few hours just to get it in my body to start fighting the pain right when it started. I was also warned that the Vicodin would probably help with the pain tomorrow, but that it was important that I take it with food as people often get upset stomachs from it. I slept right after I got back and as I woke up around 6pm to eat dinner, I felt that twinge of the stinging lemon-in-eyes or cutting-an-onion feeling that I've been told is what the worst, third day is going to feel like but eventually fell asleep again before it manifested itself fully.
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