Sunday, November 18, 2012

Laser Eye Surgery

In my zombie pondering post I mentioned that I have had laser surgery on my eyes and a commenter asked if I could write a post about it.  When I was considering the surgery I found it frustrating that for all the reasoned medical information I could get about the process the only things I could ever read from people who had the procedure was that the results were great.  There was nothing about what the actual process is like.  So just a few days after I had the surgery I sat down and wrote in detail about what it was like for me.   
So if you are looking for a first hand impression of what it is like to have laser surgery on your eyes, please read on.  For my usual lighthearted happiness, come back in a day or so.  This is going to be a little dry.  Also please bear in mind these are my experiences and I had the surgery about 9 years ago so things, including prices will have changed. 

First a bit about laser surgery. Laser surgery is used to treat short-sightedness, astigmatism and long-sightedness by reshaping the cornea. Unfortunately it can’t be used for age related eyesight problems as they are caused by the deterioration of the muscles around the eyes rather than a problem with the eye itself (actually I believe there is a procedure that can help some people, probably best to talk to your optometrist about that). While it has now been around for a long time, when I had it done health funds still regarded it as ‘experimental’ meaning that they didn’t cover it at all and I don't know if this has changed. As it cost around $2300 per eye this was a major factor to consider, however you can claim it on your tax and get something back. There are two types of laser surgery, Lasik which is what I had and another kind that I can’t remember what they call. With the second kind they just cut the top of your eye which leaves nerves exposed (very painful) and your vision can be bad for quite some time. With Lasik they cut a flap (described further) which covers the laser site so it is much less painful and you can see straight away, however, it is also slightly more risky. The clinic I went to specialise in Lasik, it is all they do and I believe very few places offer the first type of surgery these days.

Ever since I heard about laser surgery I have thought it sounded like a great thing but I knew that I had to wait till I was of an age where my skull had finished forming (basically your early 20s) because that can affect your eye sight. In the couple of years before I had the surgery I had heard heaps of great success stories but was reasonably happy with how my eyes were being managed. I used othokerotology (OK), a system where you wear rigid contact lenses at night that shape your eyes so that you can see during the day without need for lenses or glasses (basically what the laser surgery does but not permanent). I was one of the first people to use it in Canberra and in fact my optometrist had to talk to the developers in the USA to develop a system for me. I have always been lucky in that I have a great optometrist who is right up on all the latest techniques. OK was great for me for around 7 years, however wearing contacts at night eventually had a negative effect on my eyes. While the contacts are gas permeable, they do limit the oxygen access to your eyes which resulted in me getting eye infections and my eyes getting increasingly light sensitive. It is also very expensive with the contacts costing around $220 each.

I went and spoke to a laser clinic and was quite impressed so went to my optometrist to discover what would need to happen to wean me off OK. It took about 3 weeks and multiple pairs of soft contact lenses before my eyes were nearly at their natural state at which point I began wearing glasses. Also in speaking to my optometrist he told me that he had sent a difficult patient to the LaserSight clinic in Parramatta and perhaps it would be worth me going up to see what I thought of them.

I made an appointment and accompanied by my Mum, who was brilliant throughout the long process, I went up to Sydney. Unlike the previous clinic where the initial appointment was free, I had to pay $75 for a consultation but it was also 1.5 hours long and they did multiple eye tests, I watched a video of the actual procedure and spoke to both an opthomologist and the surgeon who would be doing my procedure. I really felt that they had assessed my eyes to ensure that I was a good candidate for the surgery. They told me many times all the things that could possibly go wrong and the likelihood of them happening, it was certainly a scary list, however I was pretty determined that this was what I wanted to do. In the end I felt really comfortable with them and was happy to go ahead. To ensure that my eyes were 100% their original shape the surgeon recommended I wait at least another month, however it was nearly 2 months before I could get an appointment.

Because the clinic is in Sydney it meant at least one night’s stay (it turned out to be two). The clinic had an arrangement with the Carlton hotel (just a couple of blocks from the clinic) which meant that we could get a corporate rate and they also had a shuttle bus that would take me to and from the clinic. Mum and I chose to get adjoining rooms which turned out to be really good after the procedure when I slept in the dark for hours and Mum was able to do her own thing in the other room. I would recommend spending the previous night in Sydney as well as all that driving is quite stressful for the eyes and you definitely want them to be relaxed.

So on September 12 (yes I did have my eyes lasered on Friday the 13th) Mum and I headed up to Sydney. We had nearly arrived in Parramatta when my mobile rang. They asked if my procedure, which was scheduled for 8.30am the next morning, could be moved to 12.45pm. The reason was that there was a problem with the laser and that it was going to be fixed in the morning, not something that inspires a lot of confidence but I do think that it demonstrates how careful they are with their testing of the equipment. During the actual procedure there were also two technicians from the laser company supervising so I was happy with the level of attention being given to me.

Unfortunately this did leave me with a whole morning to contemplate what was going to happen to me. We went shopping as a distraction but I got increasingly nervous. Because the anaesthetic and sedation is very mild I was able to have lunch which I did before changing into a tracksuit and heading off to the clinic.

I arrived at the clinic and filled out a scary release form then was taken into the procedure room where under the laser they took photos of my eyes. I went back into the waiting area where I was given eye drops to dilate my pupils, antibiotic eye drops and anaesthetic eye drops. After letting those start to work I was also given valium and two painkillers. About an hour after having the photos taken, they dressed me in a gown and hair net, painted the area around my eye with betadine (which made the skin around my eyes feel very tight) and took me in.

I lay on a table with a roll under my knees to make me more comfortable, was told to relax and before I had a chance to think about it they had moved me under the laser and were beginning.

They begin by moving your eyelashes out of the way with an adhesive drape (a tip here for the girls, you aren’t able to wear makeup for a while after the procedure so I had my eyelashes tinted before hand). Once that is done a speculum is used to widen your eyelids apart. After they have widened them, they then insert anaesthetic eye drops which they make sure cover the whole eye by moving them with a squeegee type thing. At that point they widen the speculum more, it kind of feels like the side of your eye is going to split, not very pleasant. That done your cornea is marked so that the laser can be guided. You don’t really see any of this as you are focused on a red flashing light above you and also (obviously) you don’t have glasses on so everything is fuzzy anyway.

The next bit is the worst part of the procedure. A suction ring is placed on your eye and pushed on very firmly. They told me that it would be very uncomfortable, I found it quite painful. When it is on your vision kind of blacks out. It is more like you are looking though a black curtain because you can still sort of see shapes moving. At that point a flap is cut in the top layer of your cornea, you don’t feel a thing. When the flap has been cut they remove the section ring and you can see again although everything is very fuzzy.

They then lift the flap at which point everything is completely blurry. I compared all the blurry lights above me to how they tend to show alien spacecraft in the movies. You hear a few things going on in the background as they test the laser before they begin. You can’t feel the laser but you can smell it burning your eye. It kind of smells like a hair being singed. The laser takes about a minute after which they irrigate your eye to remove the dead cells then they lower the flap and continue to irrigate the eye for three minutes. I should say that although I know the timing, I had no conception of it during the procedure. That done they remove the speculum and the drape, you close your eye and they wipe it down and a minute or two later they begin again with the second eye.

During the procedure they talked me through everything they were doing. I coped really well with the first eye, focusing on my breathing and relaxing my shoulders like they told me, however during the second eye I began to have a panic attack. I started to shake and was not handling it well but a nurse held my hand and talked me through it. Afterwards I continued to shake and felt very emotional but they calmed me down very well. There were three of us done that day, all were girls about my age. The first girl handled it really well and just found it uncomfortable but the other girl who went after me also had a bit of a panic, I guess it just means that everyone reacts slightly differently.

When they were done I went into an exam room where a nurse put antibiotic drops in my eyes before taping clear plastic shields over my eyes. I should emphasise at this point that you really need to have someone with you after the procedure because immediately post the procedure, you just want to keep your eyes closed. At the clinic I went to, Mum was able to watch the whole procedure on a big monitor as well as through a window in the room next door.

They sent me back to the hotel and told me to sleep for 3 to 4 hours**. On the way back my eyes where quite painful, sort of hot and burning gritty feeling and I didn’t like opening them so we closed all the curtains, turned off the lights and I slept for around 4 hours (it is very easy to sleep because of the valium you have been given). When I woke up my eyes still felt gritty but not at all painful. Mum helped to wean me onto light until I was quite comfortable in full light. At that point it was about 7.30pm and I was hungry so still wearing my plastic shields Mum and I went to the hotel restaurant. We sat down and I began to read the menu without even thinking about it, it was Mum who pointed out that my vision was already so good I could read! I was still a bit dopey from the valium so we had a short dinner then went back to the hotel room and watched TV for a few hours. Before I went to bed I had to put in more eye drops (2 kinds of antibiotics which I put in 4 times a day for 5 days and 1 lot of anti inflammatory drops which I also put in 4 times a day but for the next 10 days) made sure my plastic shields were taped securely (I did that for the next few days) and to make sure I slept really well I took a sleeping pill that they gave me. They had also given me pain killers but I didn’t need to take any at all.

The next day I was able to take my shields off at which point I discovered how bloodshot my eyes were. This was caused by the pressure of the suction ring breaking small blood vessels and it took about 2 weeks to fade. Also my eyelids were slightly swollen from the pressure of the speculum.

Before breakfast we went back to the clinic where they checked my eyes. My vision was one line better than 20/20 and they were so happy with how my eyes were looking that I didn’t have to go to Sydney for another checkup, my regular optometrist looked after me for post op checkups. Even though I went to someone other than the clinic for my checkups, they still covered my fees as part of the cost, my optometrist just billed them. It took a couple of weeks for my eyes to settle down so that I could see the final outcome and during that time the quality of my vision did fluctuate slightly. Also at night, lights had a slight ‘halo’ effect so I avoided driving at night for a while but this did disappear when the cut in my cornea healed. I had to be very careful with my eyes for the first couple of weeks making sure that nothing, including me, touched them. I took things very cautiously because I figured a bit of conservatism then would certainly pay off in the long run.

Given that I had all my checkups, the clinic had a ‘clear-vision’ guarantee which meant that if I had any problems in the following 5 years and needed to have it done again, they would do it free of charge.

Overall it is certainly not a procedure I would be in a hurry to do again but the result was so brilliant it really weighed out the 20 minutes or so of discomfort and the odd bit of pain. Everyone I know who has had it done as said the same thing. As my neighbour who has had the procedure said, it divides your life into pre and post procedure because it is just so liberating not to have to worry about glasses, contacts etc. In fact one of the worst things about it is the eye drops you have to use because they taste awful (please no jokes about how I should have been putting them in my eyes not my mouth, I have heard them all) when they run down the back of your throat but as I would say that it is one of the worst bits, you can see that the whole procedure isn’t that bad. My sister has also had it done and has some slight dry eye issues as a result, but she is still very happy with being able to see.  The only other tip I could give if you wanted to have it done was do it in Winter when the light is not so bright and you don’t want to be doing things like swimming as you are limited about that and other outdoor type activities for quite some time.

If you are interested in having laser eye surgery,  I would suggest to start by speaking to your optometrist and to a couple of laser clinics because one of the most important things is that you are comfortable with the people who will be performing the surgery and you are really sure that it is what you want to do. If you have any questions about my experiences please leave me a comment, I would be only too happy to answer your questions. 

** Even if you live in Sydney I would recommend staying in a hotel close to the clinic like I did unless you live really close because straight after the operation you just want to lie down in a dark place and the next day you have to be in very early in the morning to have your eyes checked. One of the girls who had her eyes done on the same day had about a 40min drive home and she said it was agony.


  1. Lisa
    Thanks for sharing your experience. It was really helpful to read your tips too.

    SSG xxx

  2. I found your reflections on the process so helpful when you sent them to me so I'm glad you have done this post - I am sure many others will find it a great resource too.

    1. Good to hear it was helpful for you Kari. I'm so glad I wrote it all down because I've forgotten most of it now. I just enjoy the being able to see side effects!

  3. Oh dear holy god. I've recently begun thinking that this is something I want to get done at some point in the future, once my eyes are stable enough (and I guess I'm back in Canberra), but I feel quite nauseous after reading your description. Thank you for writing it... but I kind of wish you hadn't written it *quite* so well ;)

    1. I was thinking about the whole experience again this morning. Reading back, I don't remember most of it. What I do remember is the joy of not wearing contacts or glasses. It is truly awesome and totally worth it. My sister hates anyone coming near her eyes, she used to freak out at eye exams and couldn't wear contacts and she managed to get through the surgery just fine. So you will too. I definitely recommend it.

    2. The benefit of busy lives is how quickly I'll forget the level of detail in your post. It's not like I thought it would be rainbows and fairyfloss, after all ;)

  4. Wow thank you so much for writing this it's very helpful :) (I was the original anon).

    1. No problem, I hope it gives you a bit more insight into what the procedure is like from a patient's perspective. The results are certainly worth it!

  5. Laser Eye Surgery has become popular throughout the world and is understandly widely available also. Thanks for your good information.

  6. Good info!! Lasik referred to laser eye surgery which is commonly used to reshape the cornea in order to improve visual acuity. It is similar to other surgical process but it provides quick recovery.