Well sort of.
I have been wearing corrective eye wear since I was in either first or second grade. As a point of oddity, my first glasses were bifocals. Lenses with embedded lenses for a different prescription for near vision. I didn’t think anything really odd about it at the time, but then I was 6 or 7 at the time, not exactly the most experienced glasses wearer at the time.
About 10 years ago I commented that I was going to hold off on getting Lasic done until I had 10 times the cost of the procedure saved up. Might have bee 100, I don’t know. At the time the procedure was going for around $1500 give or take a bit, and they really were only talking about one procedure as being available.
The first variation of Lasic that I saw documented didn’t even involve lasers. It was a procedure where they actually sliced off a portion of your cornea, froze it with nitrogen, then used a lath to sculpt the inside of the portion they had removed, and actually stitched it back into place with one or two stitches. I forget what the procedure was called.
Another procedure that was done was called Radial keratotemy. (sp) For this they did not remove the cornea, they simply placed a guide over the cornea and either excised portions of the cornea, or put slices in the cornea. Either way the procedure involved a time of healing where the result was corrected vision, though not always down to 20/20. I would actually suspect that it was usually not even at 20/40, but for many people it was sufficient to either reduce their dependence on glasses, or if they were lucky get them to a ‘normal’ vision state. Whether it is fortunate or not, the limits on the procedure amounted to a fairly middle of the road prescription. If you had a correction in the -2 to -5 diopter range, it might have worked for you, however the amount of work to correct vision for someone with a stronger correction was beyond what vision professionals would feel comfortable doing.
Following that was some of the first generation Lasic procedures. One of those is actually the procedure that I am going to have done, but more on that later.
The basic process for Lasic has been to cut a flap of the cornea away, similar to the earliest procedures, but the cut does not completely remove the piece of the cornea. It simply provides a sufficiently large area for the laser to re-sculpt the exposed portion of the cornea (not the flap) and the flap is lain back over the re-sculpted area, sealing it in a new shape. The new shape corrects for the distortion of an elongated eyeball so that the lens of the eye can correctly focus. In early procedures the shape of they cornea was taken and a calculation was made as to how much of the cornea had to be removed to correct that to ‘normal’ vision. The more recent versions can actually correct for more distortion, removing astigmatism, and correcting for other issues. In theory corrections could be made in such a way that if you have a bad spot of vision on your retina that can be taken into account and corrected around to give you nearly complete vision after your brain has re-trained itself to the way that light is received.
In one of Spider Robinson’s books or book series, possibly written with his wife, which suggests possibly the StarDancer series, he has a character who has decided to ‘improve’ his vision by giving himself special goggles that increase his peripheral vision. It starts with just increasing it beyond the near 180 degree peripheral vision we often see, perhaps to 270 degrees, then he moves on to full 360 degree vision with a full wrap around appliance. There isn’t a lot of explanation of how that’s accomplished, but I suspect that it’s essentially distorting the full circumference into a patch that fits within the retina. There isn’t a lot of explanation of how to do that, and what we know of vision at the moment suggests that having a ‘screen’ within an inch of they eye isn’t going to do the trick. If I recall he may have extended the vision beyond 360 to include full overhead, as well as something on the order of 50% of what is below your horizon. Makes it tough, but not impossible to sneak up on the character, but that was not the part that I found interesting.
The suggestion was made that there was about a 2 week retraining period at each stage. There was some ‘common’ material that existed, but since it was in a smaller area than before, it may have seemed ‘less important’ and over all the new material that the brain had available to process. That said the brain was mostly just adapting remembered experiences to new perceptions. It never happens all at once, and for some people it never happens completely at all, but if you are comfortable with relearning how to perceive, it can work out. I’m not sure that I would go that route. Sure it’s nice to know if there is a threat approaching from behind, but it seems a bit much.
Back to where I am going. One of the problems with the ‘standard’ Lasic procedure is that it leaves a ‘flap’ that could be disturbed. If you are interested in being a pilot in the Air Force, do not get this done. First of all you are young enough that you will probably have to have the procedure re-done at a later date. Secondly the fact that there is a flap that could be disturbed by high speed winds and such will leave you with the potential problem of not being able to see in an emergency situation. Not the time to start learning how to perceive the world in new and wonderful or not-so-wonderful ways.
While I don’t expect to get going at the speeds that the Air Force is concerned about, I do ride a motorcycle at times, and I can very easily see the potential for something like that to be an issue. There is a solution however. It’s just not quite as ‘fast’ or simple. As an alternative to slicing a flap and lasing the inner surface, an approved solution is what is called PRK. In this procedure they actually use the laser to sculpt the outside surface of the cornea. There are some issues with this. The first is that the outside surface of your cornea is a coating that protects the inside of your eye from infection and related effects. Since the standard PRK procedure destroys this layer there are two solutions. The first is to cut and peel this surface and re-lay it back into place after the lasing is done. This takes longer and is potentially prone to some of the same issues as the flap produced in the Lasic procedure. The other solution is to place a zero correction contact lens over the lased area for a week to give this layer a chance to regrow. Not protecting the lased area can lead to infection and scarring. Neither of which is good for your long term vision health.
The other down side to PRK is that the recuperation time for your eye is longer. With standard Lasic you can essentially walkout of the procedure and you see ‘normally’ again. With PRK it takes about a week or two for your vision to stabilize. As a result Lasic can be done to both eyes the same day, but they prefer to do PRK one eye at a time, with a recuperation period between the two events.
That actually works to my advantage. You see I don’t have 10 or 100 times the cost of the procedure saved up in my retirement fund. Oh, I’m closer than I was back when I made that suggestion, but no, I”m not there yet, and don’t really expect to be there for a couple more years, at least. However I do have a medical spending account that I work from. The last couple of years I under-estimated the amount I needed to set aside for various procedures. This year I set aside the maximum amount that I was allowed to, and I have sufficient available to have the PRK procedure done to one eye this year, and plan to have sufficient to get the other eye done early next year.
Does it pay for itself? That’s a good question. First of all I do not expect to have to go without vision screening in the future. I’m diabetic and one of the ways that early awareness of issues can be spotted is through vision screening. However my requirement for glasses should be vastly decreased. I will need reading glasses. I already use them when I wear contacts. However I can pick up reading glasses that provide sufficient assistance almost anywhere for less than $20. If I break them, or discover I need stronger or weaker correction it’s not going to break the bank.
Compare that to the alternatives. First up glasses. Whether I add in contacts or not, I still need to have a pair of glasses in my current prescription. Fortunately this doesn’t change significantly on a yearly basis, because my insurance coverage only provides for new lenses every two years. There is also an allowance for frames then. (Most companies that will grind lenses will not put new lenses in old frames, because the fit is important, and the effort involved in cutting lenses to an old pair of glasses is often as expensive as new frames anyway.)
With my correction I’m spending about $500 on a pair of glasses every two years. A lot of that is covered by my insurance program, but not all of it. Some of the expense is due to the fact that normal glass or plastic lenses for my prescription would be uncomfortably heavy, so I use one of the high index plastics. There are a couple of coatings, but I don’t do tints at this point.
Add to this an annual expense of about $300 for contact lenses. Let’s be generous and say that it’s $250. (makes the numbers easier to remember) So every 2 years it’s about $1000 just in glasses. That turns the return time for Lasic or PRK to be between 10 and 15 years. If I just gave up contacts, we’re looking at a return time of 20-30 years. However ‘giving up contacts’ is really the purpose of the procedure as far as I’m concerned.
So from my estimates a 15 year payback time is more than sufficient.
Adverse reactions. As with any medical procedure, there are potential and likely adverse reactions. A complaint to Lasic that is not entirely uncommon is the ‘sands of the Sahara’ infection. This feels like there is sand in your eye. It’s usually a result of an infection that is preventable. A side effect to this, and some other infections can be scaring which may need to be corrected for down the line.
The first few hours after the procedure is very uncomfortable for many people as well. This is understandable, you’ve just had something done to your eyeball, and your eyelid needs to learn the new contour of your eye. Oddly enough, that is an ‘overnight’ resolution procedure. Because of the fact that there is so much that you do have to recover from, the procedure involves taking a Valium, which means _NO DRIVING_ to and from the procedure. That’s what cabs are for, right? Well, that or friends who are willing to suffer the imposition of an hour of their time at some ungodly time of the day. (I’m planning on taking a cab.)
One of the things I’m doing that is a bit different is that I will be having the procedure done just before I go to bed. With the odd hours that I work, being up overnight on a non-work day is not that big of a variation from my normal schedule. A side effect is that I will be immediately sleeping with the correction done, and be waking up having an eyelid that has recovered for the most part from the change in eyeball shape.
Next stop on this journey is the 22nd of December. Sort of a Christmas present for myself. Oh a couple of things that happen before that, eyedrops and lid wipes on the 21st, no contact in that eye from the 8th (2 weeks before) so I’ll be wearing glasses I suspect. All in all we’ll get things worked out. I’ve got just over a month before I have the other eye done, so I’ll have some time where I can wear a contact lens in one eye and nothing in the other, but I’ll also be wearing glasses without one lens for a couple of weeks as well. That or go with single eye vision for some parts of the day.
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