My Experience With LASIK Surgery as a Patient

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My Experience with LASIK Surgery As a Patient

by Robert A. Hendrix, M.D.

copyright March 30, 2004
Updated April 9, 2004

DEFINITION: LASIK surgery = laser surgery on the cornea of the eye to correct the vision

How I came to seek LASIK Surgery
On Thursday afternoon, March 18, 2004, I had LASIK surgery on both eyes by ophthalmologist, Dr. Shawn Putman of Rocky Mount, NC. This entry is presented to describe how I came to this moment of having LASIK surgery. I am not describing events as a physician giving advice and information to patients, but rather as a physician patient describing my own personal experience undergoing the popular LASIK surgery for vision correction.

During my childhood, I had lots of collections: arrowheads, coins, stamps, leaves, insects, feathers, turtle shells and snakeskins, rocks and crystals. In retrospect, it seems that I concentrated on things that I could visualize by direct handling - I do not know when the growth of my eye resulted in poor distant vision.
I have worn glasses for nearsightedness (i.e., poor vision at a distance) since I was 11 years old. It was first documented in grade school when a volunteer mother with an eye chart tested me and immediately started sympathetically calling me 'honey' - she seemed not only to feel sorry for me, but also was quietly excited as in "I found one who can't see!". A note was sent home to my parents and my mother quietly made an appointment for an eye exam with Dr. McClure and ended up with a prescription. We went to pick out frames and the order for my lenses when out. One week later, we got the call that my new specs had arrived.
One of the most amazing memories from my childhood was walking out of Southern Optical in spring of 1963 in St. Matthews, Kentucky as a school child wearing my new, little gray plastic eyeglasses - I looked up at trees and was stunned by the detail. I never before remembered seeing the leaves on the trees. After I got home, my dad saw me with glasses and told my mother she had condemned me to wearing glasses lifelong there was also some other relatively restrained discontent expressed - both my parents and my sister had normal vision. The truth of it is that without my glasses, I was blind as a rhinoceros (known for nearsightedness and a short fuse). For the next 41 years, my glasses were the first thing I sought when I got out of bed every morning.

Now, LASIK surgery offers the promise of clear vision without glasses or contact lenses. Still, I am dependent on my vision for my livelihood and LASIK, like any surgery, has real risks that the patient must accept. With my work doing microscopic ear surgery, it would be a disaster to lose my vision or depth perception. I never minded wearing glasses, however, since I turned 50, my close-up vision changed and it was more work to read. In other words, I found it quite inconvenient to have to deal with two prescriptions. Despite the risks, I was interested in the idea of being able to see clearly at a distance, to wear cheap sunglasses, and use store-bought, close-up glasses for detail work and reading.

One day as I was scrubbing in to perform a surgery, I spoke with my friendly colleague, Shawn Putman about LASIK surgery - he has a good reputation and is well-trained, having gone to Case Western Reserve. Since I moved here, he has always been quite amicable toward me and I trust him enough to be my surgeon. He said to come and see him - and so I did.

Pre-operative evaluation for LASIK Surgery
A number of tests were performed during my first visit with Dr. Putman, including:

a standard refractive exam (for how the eyes focus)
my preoperative vision was 20-400 in each eye
by definition, anything over 20-200 is legally blind...

the EyeSYS device to map out the shape of my corneas
- a scan of the printout is shown below from this automated procedure.

Tonometry to measure intraoccular pressure (to rule out glaucoma).
My pressures have measured from 12-17 (normal is less than 22 mm Hg).
This measurement is repeated on the first day after surgery as well as 3 weeks postoperatively.

"Pachymetry" with an ultrasonic probe to measure the thickness of the cornea. The average cornea is about 540 microns thick. For me, the center of my cornea measured 505µ in the right eye and 498µ in the left.

One micron (µ) is one millionth of a meter or (about 39 inches divided by a million. A single red blood cell is typically about 10 µ in diameter).

From this information, it was determined that I was a good candidate for LASIK surgery.

Incidentally, there are no pre-operative restrictions regarding eating prior to surgery, taking aspirin, non-steroidal anti-inflammatory drugs, vitamin E, fish oil, or taking any medications prior to the procedure - bleeding is not really a concern and the procedure is done awake in the doctor's office, both eyes at once - should any problem arise in the course of the first eye procedure, the second eye would not be operated on. One can have the operation done with light sedation, as with an oral valium but in any case, the patient needs someone to drive them home.

This is the EYESYS Printout - this is a PRE-OPERATIVE topographical mapping of the surface of the cornea.
OD refers to the right eye and OS refers to the left eye.
The thickness of the cornea is also measured.
This is important because there must be sufficient thickness to allow a surface flap of the cornea to be raised. The thickness of the cornea is then altered by Apex Plus Excimer laser.
The excimer laser uses a mixture of argon and fluoride gas - when the gas atoms are excited, they release high energy pulses at a fixed frequency in the ultraviolet part of the spectrum (wavelength centered around 193 - 193.2 nm). One nm = nanometer or one millionth of a millimeter.
The laser beam vaporizes the underlying cells very precisely, bringing the total thickness and refractive properties of the corneal surface to the intended specifications.

Surgery Day Arrives
On Thursday afternoon, March 18, 2004, I would normally have gone to Roanoke Rapids. However, I had LASIK surgery scheduled for 3 P.M. - we were unable to adjust the schedule to put me to work earlier so I ended up with a free day. After taking Scott to school, I jogged a bit over 8 miles, then showered, dressed and drove to pick Erika up from school for a doctor's appointment. She and I had a quick lunch at Subway before I dropped her off. It was a pretty ordinary day except that I did not work - that always gives me a strange feeling...
Finally, I took my car to be serviced and my office manager picked me up and dropped me off at
Shawn Putman's office
3044 Sunset Avenue
Rocky Mount, NC 27804
Phone: (252) 443-6129
Fax: (252) 443-6013

Details about the LASIK Surgery Procedure for me as a Patient
The LASIK procedure took about 7-8 minutes per eye.

First, they obtained informed consent with verbal explanation of what to expect and written documentation about risks of the procedure.

Antibiotic drops, and then topical anesthetic drops were then instilled into each eye

They offered an optional 5 mg Valium should I want it. Although I was not anxious, my corneas are 'touchy' so I decided to take it. I wanted to do anything necessary to help the doctor do his best possible work.

Next, I was led to a room with a slit lamp and a purple surgical marker was used to mark the edge at two spots (3:00 and 6:00) where cornea meets sclera

Then I was taken to the room where the Excimer Laser is kept. The procedure was carried out first on the right eye, and then the left.

Dr Putman placed a "speculum" (a spring contraption to hold the eyelids open) on whichever eye was undergoing the procedure.

- this reminded me of "Stanley Kubrick's movie, "A Clockwork Orange".

Next, a 'vacuum ring' (like a suction cup) was placed over the cornea

During this time, I was lying back facing up and I was instructed to watch a green blinking light the whole time. With the suction cup on, they pretty much "have you by the (eye) ball". The pressure of the suction cup increases the internal (intraoccular) pressure of the eye quite a bit. The suction cup increases the pressure to the point that blood flow ceases through the retinal artery - then you temporarily loose sight in the eye. I observed this as a PAINLESS darkening of my vision, lasting for just a matter of seconds

During those seconds, I hear a whirling instrument that ran for a second or two. That was the "microkeratome" which cuts a thin slice of cornea, lifting a flap of the surface of the cornea I felt something painless during this on the right, but felt noting associated with the noise on the left. I must emphasize, that throughout the procedure, I felt absolutely no pain and really, I found the whole process to be easily tolerated.

Then Dr. Putman inspected the flap.

The flap is a surface layer of cornea raised but that is attached to the eye at one edge.
If the flap where avulsed (ripped free), then the doctor would suture it back on and stop the whole operation.
If the cornea had been cut through and perforated, then you might have to wear a hard contact and hope it would heal - I was told that in such a situation, the cornea might scar to the point that you could need a corneal transplant to be able to regain clear vision. In that case, the procedure would also be stopped at that point.
Such complications were said to occur in less than 1/10 of 1 % or less than 1 in a 1000

At any rate, my flaps looked fine as each eye was done, so the procedure proceeded....

As the suction cup was relaxed and the vision quickly recovered in my eye. At this point, however, the green blinking light was totally blurred and cloudy.

Then with the flap laid back, they take a laser, which is driven by a computer program and the parameters or numbers they have entered into it. The laser passes over the inner corneal surface and vaporizes micro layers of cells to thin the cornea to the prescribed or planned thickness. This whole step seemed to require only a few seconds.

For my eyes, Dr. Putman removed 37 microns (µ) from the right cornea and 46 µ from the left. This resulted in a thinning of my

right cornea from 498µ to 452µ
and the left cornea from 505µ to 468µ.

After thinning the cornea as planned, the flap is laid back and we sit quietly for about 5 minutes, letting it 'stick' down. The speculum was loosened during this time but left in place to prevent blinking.

Finally, the speculum was removed and the procedure began on the left eye. After surgery was completed on the left, plastic shields were placed over my eyes and taped to my face (to prevent me from rubbing them inadvertently).

The Post Operative Experience with LASIK Surgery

This whole procedure was different from anything I had ever experienced (or performed myself). Immediately afterwards, with the plastic shields on and the effects of the surgery and the drops, I couldn't even read the numbers on the cell phone. I sped dialed my Frau but I had to ask the ophthalmologist’s secretary to help me find the right buttons to push it was like being legally blind for just a short time - but things got better very quickly...

The procedure completed, I sat in the waiting room, leaned my head against the wall and fell asleep. At some point, my Frau showed up and drove me home. I had been instructed to sleep afterwards - if one remains awake following the operation, there is apparently increased chance of pain in the eyes from "ciliary spasm".

The ciliary body is composed of radially oriented strands of muscle (like spokes on a bicycle wheel) oriented around the perimeter of the lens for focusing.

Once home, I had a mug of decaffeinated green tea to wash down the 30 mg Dalmane that was prescribed - my first sleeping pill ever... I also took a Bextra, a non-steroidal anti-inflammatory that works very well for me in dealing with "running pains". The Bextra seemed to relieve some of the sense of having something in my eye - I was never able to tolerate contact lenses in part due to corneal sensitivity. Then I had a small glass of red wine followed by a cup of herbal "Sleepy Time Chamomile Tea with Valerian" to help me sleep (something that often eludes me) - all that was my idea and yes, it is not generally advised to mix alcohol and sedatives. Anyway, I slept until 10 pm, then turned over and slept until past 7 am. I never felt any pain in the eyes after LASIK surgery.

The next morning, a neighbor lady who gave my son a ride to school also dropped me off at the ophthalmologist’s office. There I got to take the shield off and straight away, they determined my vision was down to the 20-20 line in the right and nearly so in the left. I was instructed to use antibiotic (galaxofloxin) eye drops and Sterapred steroid drops four times daily for the following four days. I then walked home. I was also instructed to wear the eye shields every night for about four nights so as not to rub my eyes in my sleep, which might mess up or raise the flap. I have been exceedingly careful...

I started back working out on Saturday, 2 days postoperatively with a four-mile run. I had asked Dr. Putman about when I could once again go jogging. His main concern was that I not rub my eyes should I wipe my brow if I sweated profusely.

My Outcome from LASIK Surgery

Like Seeing the World With New Eyes

My vision noticably improved further as my tearing gradually improved. At my visit with Dr. Putman 3 weeks postoperatively, my vision measured 20-20 in each eye. THIS COMPARES VERY FAVORABLY WITH MY PRE-OP VISION OF 20-400 IN EACH EYE.

To describe my perceptions I will relate a few specific experiences

I had left my car off to be serviced immediately prior to the surgical procedure. The next day, I did not go to work but by afternoon, the assistant office manager came by my house to pick me up and dropped me off to get my car. My vision seemed quite good at that point. I drove to the North Carolina Dept. of Motor Vehicles and took the vision screening, whereupon they issued me a driver's license WITHOUT RESTRCITION TO CORRECTIVE LENSES. Thus, on Friday afternoon, March 19th, one day following LASIK SURGERY I was legally able to drive without glasses or contact lenses for the first time in my life.
During the past week, I worked performing surgery and seeing patients with close-up glasses. I am able to function very well working through a microscope without glasses, or viewing through an otoscope or performing surgery with close-up lenses. It seems to me that my vision is a bit better for detail clinical work using close-up lenses than it had been preoperatively.
I have always tended to avoid looking much at myself in the mirror. It seems that lifelong, I was almost startled by my actual appearance on seeing myself whenever I happened by a reflecting surface. Still, one of the most coolest things since LASIK surgery has been that looking now in a mirror, I can actually see clearly what I look like without wearing glasses. I still find my appearance surprising, almost as if it were someone else, but personally, seeing myself is definitely more interesting without spectacles.
Went to a movie Saturday night (2 days postoperatively) in the Cinema Grill Movie Theater at Golden Crossings. This theater is pretty hip in that one can have food (pizza, sandwiches, etc.) and beer, soda or water served to you in the theater while watching a movie for only 'a buck-fifty' per ticket. We saw "Mooseport" over a pizza - this movie was a bit of fluff with Ray Romano (From 'Everybody Loves Raymond") and Gene Hackman but I was happy not to see anything intense or emotionally demanding. During the movie, my vision was fine - I forgot that I was watching the movie without glasses on.
I used to be able to read in very dim light without glasses but that I can no longer do. If I am in a well-illuminated area such as a library, school, office, or outdoors in sunlight, I can still read newsprint and normal sized fonts without 'reading glasses'. My vision now is best in bright light - as for a pinhole camera which projects an image in focus without a lens, the smaller the iris (pupil), the more 'in focus' the image regardless of refraction. However, even in the dark movie theater, the brightness of the silver screen was quite adequate for easy and comfortable viewing.
Eight days after LASIK surgery, I drove to St. Andrew's College alone to visit my sophomore son. My driving during the day was absolutely GREAT. During the day, Andy and I watched a girl's fast pitch softball game - I was amazed at the clarity with which I could see the score board and the ball and all that happened on the field. I used to play baseball as a teenager and a baseball diamond never seemed so beautiful as I saw it yesterday. That night, I drove for 2 hours back to Rocky Mount - I noticed that I was getting minimal "halo effects". For the first week after the surgery, I noticed significant "blurry star effects" from streetlights and headlights when I drove at night. I expect that will continue to improve and to be totally cleared soon.
In fact, while I was visiting Andy, we looked up at dusk on Saturday, March 27, 2004 and were able to spot Venus, Mars, Jupiter and Saturn strung out across the sky with the moon near Saturn. The sky was a bit overcast initially and we missed seeing Mercury before it set in the southwestern sky just after sunset. Of course, this is a very good time for planet observation in that one can spot 5 planets at once in the early evening sky - it will be 32 years before these planets are visible this way again. I was pleased that I could see the planets without noticing fuzzy edges - that was the clearest indication that the halo effect from the surgery was clearing. I told Andy that I might be gone by the time these planets are back this way and if so, then perhaps he will think of me if he happens to look up at the night sky around 2036 A.D.
My vision seems a bit better each day. I went in for a check with Dr. Putman at 5 days postoperatively. At that time, my vision in the right eye was 20-20 and in the left, 20-30. After this kind of surgery, the eyes tend to be a bit dry for a while. This is in part because the nerves to the normally very sensitive cornea are cut when the flap is raised. This results in provoking less tearing. For the first week, it was a great relief to put in saline drops and it seemed to make the vision become more clear and sharp. Also, I would waken with the eyes feeling a bit dry. Nonetheless, I could look out the window from my bed and see the details on the pine trees with wonderful clarity. Now, just over a week since my surgery, I do not seem to have dry eyes anymore.

This has been a wonderful, life-altering experience, much like the day when I was 11 and suddenly saw the details in the trees when I walked out of the opticians with my first pair of glasses. People at work, especially in the Day Surgery area have been really complementary about my appearance without glasses. When I was a child, I remembered frequent comments about my eye color - surprisingly, that is happening again. It seems to have affected positively the way people respond to me, or at least, to my appearance. My glasses are just a souvenir for me now.

I tried my old prescription glasses on the day after LASIK surgery and I could not see anything - my old, metal frame glasses are worthless to me now. As an aside, an unexpected benefit of the LASIK surgery and not wearing my metal frame glasses is an improvement in my complexion. For nearly 20 years, I have had a periorbital rash with redness and peeling of the skin around my brow, nose and eyes. Within a few days of not wearing these glasses, my face seemed fairly cleared up. Since I had a history of dermatitis to nickel, I wear NO jewelry whatsoever. These glasses were supposedly made of hypoallergenic 'titanium frames' - still, I have to wonder if they might have had some component of other cheap metal which provoked a chronic facial rash. Furthermore, at the conclusion of my surgery, Dr. Putman's staff gave me a cool pair of studly, wrap-around, plastic shades. My kids are glad that I no longer drive around in large, boxy, geek sunglasses that fit over my glasses...

From legally blind without glasses to normal vision In conclusion, at 3 weeks following surgery, my eyes feel pretty comfortable, my vision improved from 20-400 to a normal 20-20 in each eye, and I found the whole process was painless and easily tolerated. Unexpected outcomes include: I am consistently performing my surgeries faster; and socially, I sense people regard me differently somehow - perhaps not having a device of metal and optical glass between my eyes and those of the individual with whom I am speaking takes away some sort of barrier. At any rate, I am glad I had LASIK surgery and I am amazed to see the world with normal vision without glasses after 41 years of dependence on glasses for nearsightedness.

If you would like to see the Coyote Chronicles 2004 from which this article originated, then click
http://members.aol.com/tiermensch/zzzpersonal.html
to view the complete Web Page