The Burning Retina

I wasn't nervous about the procedure until Tuesday (the day of). Everyone at work was saying, "Good luck! I hope you don't go blind!", etc. One (extremely friendly) co-worker went as far as to email me a very negative article about all of the understated risks. Upon arrival at the slaughterhouse surgical facility, tremblings of fear began crawling through my as-of-yet unscathed optical sockets. The first symptom was that my hands felt like a block of slowly melting ice... Freezing to the touch, but perspiration nearly dripping from them. Clammy doesn't begin to describe them. My mind tried keep its calm, but it had already been shattered. Had I not already paid to have this unorthodox procedure, second thoughts would have circumvented this situation altogether.

My name was called, and I was escorted to a dark room labeled "Exam 2". 'Why did I skip Exam 1?', my mind asked. But, my lips remained sealed. Fear of upsetting the staff that would soon be penetrating my body in the most unlikely of places forced my questions to remain under wraps. The evil lady pointed to a chair and urged me to take a seat. A device was placed in front of me that resembled a concave, circular checkerboard with hundreds of tiny black and white squares. There was a small hole in the center with a small red light staring back at me. I felt as if I were staring into the eye of a satanic cyclops. The menacing old lady told me to place my chin in the holster and stare into the light. As soon as I complied, she started moving the whole device with a few mouse clicks. It positioned itself so that the light was directly in the middle of the hole and then snapped a picture using a red flash which would have frightened God. She repositioned the monstrosity so that it was staring at my left pupil and took another picture. When I looked at the computer screen she was playing with, I didn't see my own eye, but rather an odd kaleidoscope-looking drawing filled with hundreds of colors in a shape roughly resembling an eyeball.

They then directed me to another room labeled Exam 8. At this point, my brain was spinning in circles in my head (quite an uncomfortable experience on it's own) trying to ascertain this office's method of incrementing numbers... It obviously wasn't single digit counting, even numbers, or exponential. I began to worry that they practiced an entirely different form of mathematics than the rest of the world, and that their chaturbate procedures might not be valid with the physics of my own universe. I was told to sit in another chair and stare into another Star Trekian machine. The one was closer to my eye and when I first stared into the (again, red) light, it was just a blurry red star. A new lady operated this device - she seemed nice enough, but I could tell she was also just as evil as the rest of them. She must have been their public relations committee, because she disguised her intentions much better. All of the sudden, the devil-red star began moving away from me, then spiraling away in a clockwise motion. An image started to form which brought my emotional state to a new level of fear and anxiety... I was looking at a tunnel... with a bright red light at the end of it... I had died... and I was headed towards hell down a red tunnel with a passing lane... It was at this moment that the beast across the desk spoke, "Good, right on target". The machine began moving, which gave hope that death had not finished me off yet. It repositioned itself to my other pupil where it became another star, and the spiraling motion repeated. The tunnel appeared a second time, then I heard a number of mouse clicks and what I thought was a floppy disk being accessed. A few minutes later, I saw a 3.5" disk being removed from the computer and nearly passed out, thinking, "I'm trusting my vision to 20 year old technology with a ridiculously high failure rate?!?!"

The demoness ushered me to a new room labeled Pre-Op 1, which helped ease my fears regarding their counting abilities slightly. They cleverly placed a 3 ring binder on the table next to the chairs labeled "Thank you letters". Upon examination, I discovered they laminated a bunch of notes that seemingly praised their abilities and mentioned nothing negative. The first letter was obviously written by a political speech writer - filled with buzzwords, false promises, and the general faux feel-good sentiments of someone who is being overpaid to create a sense of hope to those who have none (nor should they). "Seeing right through them" would be an awful pun which cleverly takes advantage of a cliche and shouldn't be used at this juncture, but I'm going to anyway. Upon closer examination, I began to notice similarities between the signatures and handwriting used in the various (so-called) "Thank you" notes. My suspicions gained momentum up until the point when one of their male staff obviously noticed my intellectual prowess that I was on to their little game, so he came in and violently stole the glasses right off my face. That would be the last time I ever felt the comfort of those dual lenses resting gently along the curve of my nose. Fifteen years of an extra few ounces of external facial structure... gone...

The mysterious man in white came back into the room and started pouring a deluge of chemicals into my, now, unprotected eyes. He started with a mere drop, then another, then another, until I felt as though Niagara Falls had been relocated to mid-Michigan and I had just been granted a first row seat beneath them. The world began to glaze over, and everything appeared through a thick haze. They offered me half a Valium to "ease the nerves", which I took to mean, "dull the senses so they can have their way with me without a fight". With trepidation, however, I partook of the offered drug. Sadly, I felt no effects. I was still shaking harder than a paint mixer.

After 20 minutes of this Guantanamo Bay-style torture, I was lead to the final room. At this point, there was no turning back. I had survived the preparation, but only barely. Their mind games had forced all my remaining logic and reason to a recessed corner deep into the dark black region of my cerebral cavity. It took most of my energy to stand upright, and the rest of my will power to walk towards the machine that would soon be slicing its way through my cornea at its own leisure. The 80's beige that engulfed everything electronic during that decade still lingered on this machine. Trusting my life to more technology that resembled my 1989 dual-5 1/4" floppy drive computer sent what remaining faith I had straight to hell. Satan himself was laughing at me, and I no longer had the strength or stamina to do anything about it.

They made me lie down on their dentist-like chair. I was relieved to see there was no mechanism attached that would strap me down against my will. The first evil woman returned to the room, this time donning full doctor garb, complete with the white facemask. It finally occurred to me that she still wore glasses... This brought tears to my eyes. I was trusting a staff that didn't even trust this procedure themselves! But, I had already crossed the threshold of going back. I would not come this far just to run away screaming. The spawness of Lucifer handed me a toy alligator stuffed with beans. She said, "Hold on to this, and squeeze it if you get nervous." Are you @#$!ing kidding me?! That's your only solace? A damn toy?! But, I said nothing. This alligator would be lucky to make it out of here with any of its beans after I was finished "getting nervous".

Then came the absolute worst portion of this entire event... The "doctor" approached me with a roll of thin masking tape. WTF?! I was afraid this was going to turn into some kinky experiment with footage that would end up on some obscure fetish site that night, but then he made me open my eyes wide and placed two pieces of tape near both of my upper eyelids. Shortly thereafter, he placed something under my lower eyelids which prevented me from being able to shut my eyes at all. I have no idea what it was, but I'm guessing it was some sort of plastic.

I don't know if anyone else has seen Fire In the Sky, but I saw it when I was younger, and therein contains a scene that has haunted me to this day. Short version: Aliens abduct the guy, he gets strapped to an operating table by some sort of strong cellophane-like substance that wraps his entire body down, then a metal device pries open his eyelids and a two-foot needle comes down from the ceiling directly into his eyeball. Ever since viewing that atrocious scenario, I've had an uncontrollable fear of things touching my eyes. Eye drops make my whole body convulse when the liquid hits the eye. So, to have a piece of plastic holding my eyes open is enough to make my heart speed up to the point of bursting. Luckily for me, that's just the beginning of the procedure. Mind you, nothing about any of this physically hurts (some of the drops were numbing drops), but mentally, I'm 3/4 of the way to absolute insanity.

The chair I was [un]willingly sitting in began to swivel itself directly beneath a portruding portion of the antique excimer laser machine. Lights immediately fired themselves on - lights that rivaled staring directly into the sun with a Hubble-powered telescope. Since I was unable to close my eyes (but I tried my best - nearly shattering the plastic restraining device in reflex), I started to turn my head away. The aforementioned demoness "kindly" dimmed the setting on the lights a bit to a mere 100x-telescope-towards-the-sun brightness level. When my eyes finally adjusted, I noticed that in the center of this death-trap was a black eye with a red pupil looking at me hungrily. It was ready to either unleash a two-foot needle or devour my soul in some ancient ritual involving chanting and mad doctors dancing around in a circle with me as the focal point (still madly gripping a stuffed alligator).

One of the asylum attendants doctors covered my left eye with a large black eyepatch. This marked the beginning of the end of my vision. I saw blurry tools pass by my remaining eye - long, slender, metallic objects resembling scalpels and assorted dentistry items. They made mention that I would soon be losing all of my vision and that this was normal... I'm sorry... Blindness is not normal regardless of what anyone tries to tell you. They covered my visible pupil with some sort of suction cup device which is when the world went black. The darkness only lasted a few seconds, then a vision straight out of The Ring unfolded. I was watching them cut my eye open with some device that I couldn't feel... quite possibly a scalpel, but I had no idea, being pseudo-blind and all. The suction cup was removed, and then I watched them peel a layer of my own eye away. The experience of watching your own eye be operated on ranked up there with someone pulling out your intestines while you watched in horror (I only vicariously know how this experience feels - don't ask). As frightening as it was, the peeling away portion was probably the most enjoyable portion. The black eye surround by lights above me was all of the sudden digitized and embossed. I felt like I was seeing the world in its pure Matrix form (as 1's and 0's, but enclosed in a digitally embossed photograph, not a green monochrome display). Things were much blurrier than before, but still visible through a newly applied digital filter.

The doctors then mentioned that the machine had to find my eye, so stop moving around. Apparently my eyes were dancing around in their sockets, uncontrollably looking for a way out. I tried to focus on the black eye, but my body refused all attempts at control. One of the doctors held my head still because my eyes' frantic dance contained enough force to move the cranium that held them captive. Finally, one of them yelled, "Got it! Try to stay still for the next 30 seconds", then a countdown began. The demoness changed her tone to one of salivatory anticipation and proved her decremental counting skills worthy of a math degree. "30... 29... 28...", with the occasional, "He's moving around all over the place... but the tracker still has him... 18... 17..." The reference to a "tracker" felt even more like the Matrix. All the while, the buzzsaw-sounding machine was making a very audible clicking noise every second. During each click, my vision changed. First, it made things sharper, then dimmer, then sharper again, over and over until the countdown had completed. I realized that during the last 30 seconds, a non-visible laser had just penetrated my eyeball and destroyed my existing lens shape simply to form a new one of its own liking. This idea made me queasy, but just then the part of my eye that had previously been removed was being placed back into position. They were "patching me up". The doctor took some type of plastic brush type thing and smoothed out the re-positioned cornea with another type of liquid - eyeball glue, maybe?

I couldn't tell if I could see better yet, but I didn't have much time to think about it. They removed the patch from my left eye and placed it over my right eye instead. The procedure was only halfway over, and I had already squeezed the artificial life out of the alligator. Everything repeated itself. Another 10-20 seconds of blindness, followed by another Ring, then one more encounter with the Matrix and the Black Eye of Death. The clicking laser only took 15 seconds this time around, for reasons I dared not venture to ask. Suffice it to say, I was extremely grateful for the shortening of this event. The doctor brushed my left cornea back into place, then removed my plastic eye holders and masking tape. I was told I could sit up, but that I had to give back my new masochistic friend, the Alligator. I was blinking like crazy and my vision appeared as though I were swimming in a murky lake with my eyes open.

I was led to a dark room labeled Exam 7 (I was extremely thankful that I was able to read this - yay, not blind!). I sat alone for about 5 minutes staring in awe that, although murkily, I could read a sign across the office. That had never been the case prior to this encounter with Satan's minions. Selling my soul had apparently paid off, at least thus far. I was given a packet of eye drops and a set of fancy, thin ski goggles and told to use these goggles for the next week while asleep and to not, under ANY circumstances, rub my eyes. They also said to sleep as much as possible for the next 24 hours. I was driven home by a friend and went directly to sleep for most of the next 18 hours.

At 8:00 the next morning, I woke up and was quite amazed. Things were still a bit hazy, but I was definitely able to see nearly as well as before. There were halos around lights, but I could still see things. I drove myself to my normal eye doctor, and he tested me out as having 20/15 vision. Since then, it's only gotten better. I still have a bit of a halo around headlights at night, and it's kinda weird in dim lighting situations, but it's not debilitating at all, and I no longer need glasses. Absolutely amazing.

The number of scientific disciplines that had to come together to create this procedure is astounding. Imagine being the first person to say, "Hey, I wonder if I could see better if someone cut open my eyes and rearranged the lens with a scalpel [which is what they used before lasers]? There's probably an exact method of doing it, but let's just slice and dice until I can see." Gah! Anyway, I'm thankful to those idiots pioneers in this field. 3 cheers for science and technology.

On the length of the piece

I think we should keep in mind the psychological implications of such a procedure. while the piece if lengthy it does capture the sense of fear of the unknown and of many medical procedures.

maybe those of us with more training can do some cursory analysis of the account. of note are references to demons and aliens. what is it about our psyches that reach out to God or Aliens? another important factor is fear and what it does to us and its uses in conjunction with our imagintation...or perhaps it ability to bypass so-called higher brain functions that are necessary for logic and reason. given the scope fear has on our lives maybe it is not so much an evolutionary mistake that it is located where it is in the brain. could it be that fear or its abilities have much more important uses?

anyways a lot of speculation can be drawn from this piece. and this relates in more ways that one to culture and technology....from the trenches

I'm supposedly a pretty good candidate for LASIK, because I have severe myopia to the point where I'm nearly blind without corrective lenses (9.5 diopters), but it's been at a fairly constant level for some years now. I haven't gotten it done so far though, because I suppose I don't see why it would be a huge improvement.

Unlike nearly everyone, it seems, I am not really inconvenienced in the least by my contact lenses. I have soft, extended-wear contacts, which I sleep in. This used to be the recommended thing to do (wear them 2 weeks, day and night, then throw them out and use the next pair for another 2 weeks, etc.—they cost about $2 a pair). Sometime in the last few years they've become paranoid about that and started recommending you not sleep in them, but now they've come out with some silicon-based ones that are much more permeable, so if you opt for those (which are more like $6 per pair) you can sleep in them again, and they last for a month to boot (although you should probably take them out and clean them more often than that).

The upshot of it is that, for all practical purposes, I have 20/20 vision 24 hours a day. The only difference is that every 2 weeks or so I throw the contacts away and then sleep without any in for a night. So for about 1 out of every 14 days I can't see when I wake up until 30 seconds later when I've put a new pair of contacts in.

All in all, I don't see why I would want to have LASIK done? It certainly isn't cheaper than paying $180/year for contacts for nearly forever, it seems riskier, and it doesn't seem like it would buy me much at all as far as convenience goes, unless you want to work in a profession where contact lenses aren't acceptable (e.g. fighter pilot).

Some people do have eyes that seem to dry out very quickly or are very infection-prone, such that they can't sleep in even extended-wear soft contacts, in which case the calculus might be different.

I'm on my second day

I had the procedure around 7 years ago, when it was still fairly new. I started at -9 to -10 in each eye. My best vision came about 2 or 3 days after. Then I had very crisp 20/20 vision. There were pronounced halos at night and considerable dryness.

After several months I noticed that the crispness was gone; edges were no longer as precise as before (not so much out-of-focus as a reduction in contrast, I guess describes it best). My eye exam at one year showed one eye was now 20/40 but the other eye was still 20/20. I got a contact lens for the right eye, which I wore only occasionally (going to the jasminelive movies, playing tennis, that sort of thing). I also got a pair of glasses which I also wore only occasionally (mostly for driving, so I could take them off when I got to work, since it's easier to see up close without 'em). At 20/40 I don't really need either glasses or contacts to drive, but it helps, especially at night.

I've noticed that I see better with glasses than contacts, whereas previously it was the reverse. This could be because (1) I now have a little bit of astigmatism where I had none before and (2) I used to wear the semi-rigid gas-permeable contacts whereas now I wear soft lenses.

A few years ago I went in to see about an adjustment to the right eye but I wasn't a good candidate since the thickness of the cornea remaining after the second procedure would have been just below the recommended guideline. Also I was advised that the margin of error for the procedure is pretty large compared to the small amount of adjustment I was going for, so the risk of overcorrection was there. I decided then that I was happy with what I had.

Now at seven years my eyes have stayed almost the same as at one year. I probably wear the contact lenses and glasses even less than ever, in part because of the onset of presbyopia and in part just from laziness and the fact that I see well enough without them for 98% of everything I do. My eyes get dry from time to time, still, but it is a mild dryness and much less of an irritation than I would sometimes get from contact lenses. The halos are much less noticeable. If I look at a point source of light, such as a bright star, I often see a double image, with the fainter image just to the right of the main image. Other than that, I have no complaints at this stage.

Almost right...

I had the surgery 2 years ago, and you nearly described it perfectly. However... You forgot to mention the part about smelling your own eyeball burning. After they started the countdown (They started around 26 for me) I slowly started smelling something awful! After a few seconds I realized... "That's my *&^%$ eye burning" EEk!! After they finished my first eye, I was unscrupulously relieved.. I thought wow, 1 down, now I can take a break and smoke a cigerette. But no, they whipped me around and switched eyes faster than I could say "TEDDY!!!!!!!!!!" (yes, I had a teddy bear.) Oh, and as for the device that cut your lens from your eyeball. I believe it was shaped more like a cigar cutter. I took special notice to that. All in all, within 2 minutes of my surgery I noticed that I was seeing better than I was before the surgery. The next day when I went for my follow up, sure enough, I had perfect 20/20 vision. I was also given a 1 year warrenty with my surgery, (as if my eyes just can break and be replaced). Now that it is nearly 2 years later, I'm starting to notice a little difference in my vision. I believe that slowly, with time, your vision will worsen and you will have to revisit your demons. But all in all, for $4000.00, it's worth 10-15 years of glassesless/contactless vision.

So -- how's your dark adapted vision then?

As anybody who knows anything about optics knows, it's easy to make a good lens if the ratio of focal length to lens diameter ( the f- number) is high. During the daytime, when your pupils are constricted to tiny diameters, your lens has in effect a very high f number, so aberrations of various sorts are unlikely to bother you. This is one reason why it's easier to see in bright light.

At night, however, your pupils dilate (get larger) so the f-number is smaller, and optical aberrations can come into play if they don't get it right. People's maximum dilation runs from around 5mm to 7mm, depending partly on age (it tends to go down as you get older). If you are at the low end of the range, then laser surgery is probably a safe bet. If you are at the high end of the range, you'll have to consider a possible loss of nighttime acuity. If you are one of the freaks who can dilate to 7.5 or 8mm, I'd positively avoid it.

I've been interested in laser surgery, but I'm waiting for a decade or so more on the theory that when I'm in my fifties, I will probably only dilate to 5mm or so, and by then the technology will be better.

I won't get destructive laser surgery

Removing part of the eye to cure it sounds like a bad idea to me. There are downsides and risks to laser surgery, and I'm not willing to accept them. My night vision is dear to me and the possible complications of the microkeratome cut scare me.

However, there is a technology which I am considering: intra-ocular implants. While still in its infancy, it is very promising. The success rates appear to be higher than those of LASIK, and the procedure involves no destruction of eye tissue (apart from the slit through which the implant is inserted). There is no degradation of night vision, and the procedure is reversible, since the implant can be taken out or removed.

But laser surgery has become, in North America, the leading form of sight correction surgery. It will take a long time before implants gain momentum - even if they come to be proven safer and more effective. For now, implants may be 5 to 10 times more expensive than laser surgery.

Hopefully, this cost will fall and the implants will be proven to be a safer alternative to LASIK. For those whose eyes have been damaged by destructive surgery, the implants can be used to correct part of the aberrations. Also, the implants, adding to the eye rather than taking from it, can correct a wider range of conditions; there are even multifocal implants that correct both near and far-sightedness.

We have already developed prototype implants that contain a tiny LED array; right now it's an 8x8 array, but the construction of a 64x64 (kilopixel) array is underway. Those implants receive signal and power wirelessly, and are intended for use in those whose cornea is opaque. However, once the technology improves, these intra-ocular implants that both correct vision and provide a computer display will be a great leap towards the cyborgification of the willing. I for one cannot wait for megapixel implants in each eye that correct my vision and let me be connected to the internets in permanence. I suppose I'll have normal, non-display implants for a few years before those are availaible, though.