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.