My Lasik Diary

Background:

Lasik eye surgery has the chance to give you 20/20 vision without glasses. The Lasik procedure utilizes an Eximer laser, which is a computer controlled ultraviolet beam of highly focused light that reshapes the cornea in order to focus more directly on the retina. Each pulse of the laser disrupts the molecular bonds between corneal cells with an accuracy of 0.00004th of an inch.

The normal eye

In order for vision to be clear, the eye must focus light onto a precise spot on the retina. This spot is called the macula, and is located straight back through the eye on the inside back surface of the eye. This has been compared to the film in a camera. When light first encounters the eye, the cornea is the first surface that is reached. The simple curvature of the cornea accounts for about 80% of the focusing that the eye does. Light then passes through the pupil and comes to the lens of the eye. The lens does the rest of the focusing. The lens is also able to change the amount of focusing that is does, so things at different distances can come into focus (like an auto-focusing camera). The closer that an object is to the eye, the more focusing the lens has to do in order to make the image clear. In this depiction of a normally focusing eye (below), the image of the red cross is shown focused directly onto the retina.

Nearsightedness (myopia)

With nearsightedness or "myopia", light is focused in front of the retina rather than directly on it. This leads to a naturally closer point of focus. Depending on how nearsighted the eye is, a close object comes into focus without the lens in the eye having to work to bring it into focus. Unfortunately, the lens in the eye cannot "defocus", so the distance vision will always be blurry (without optical correction) for a nearsighted eye. There are several reasons why an eye may be nearsighted. If the curvature of the cornea is too much (or too steep), the light will be focused in front of the retina. Some eyes grow abnormally long, which can lead to very high levels of nearsightedness. Nearsightedness is corrected optically with a minus powered lens (glasses or contact).

Farsightedness (hyperopia)

Farsightedness or "hyperopia" is a somewhat misunderstood term. It implies that the distance vision would be clear, but the near vision would be blurry (the opposite of nearsightedness). However, this is not necessarily true. With farsightedness, the eye does not focus light strongly enough to reach the retina. Instead, light is focused behind the retina. But for many people, the lens in the eye is capable of adding extra focusing (usually for focusing on near objects such as reading). Thus, if an eye has enough focusing ability, it can focus away farsightedness, and the distance vision will be clear without glasses. However, this can take away from its ability to then focus on a near object. There is a natural decline in the ability of the lens to focus as one ages. Someone may be unknowingly farsighted and have clear distance vision at age 30. However, by age 50, the lens in the eye can no longer focus well, and the person may need glasses for distance vision. There is no refractive surgery procedure which can reliably correct farsightedness.

Astigmatism

Astigmatism occurs when the curvature of the cornea is not perfectly round in all directions. In one direction (or axis) the curvature is greater (steeper), and in the opposite direction is lesser (flatter). This can be compared to the curvature of a spoon. In a round soup spoon, all of the curvatures are the same, and there would be no astigmatism. However, in a teaspoon, the spoon is curved more gradually along the length of the spoon, and more steeply along the width of the spoon. The direction of astigmatism is measured in degrees from 1 to 180 (like degrees on a protractor). 180 degrees is perfectly horizontal, while 90 degrees is straight up and down. Glasses correcting astigmatism add extra power in the direction needed to equalize the difference in curvature of the cornea. Most people would not notice a change in axis of 5 to 10 degress, unless the cylinder power is fairly high (say, over +2.00). Many people do not tolerate glasses with high cylinder due to distortion.

Measuring your vision

The notation of visual acuity is written as a fraction, with normal vision being 20/20 (twenty twenty vision). At a 20 foot distance, (the top number in the fraction, or testing distance), a person with normal vision should be able to read the small 20/20 line on an eye chart. The smallest line that an eye can read is its visual acuity. If larger lines than the 20/20 line are all that can be read, the visual acuity may be 20/30, 20/60, etc. The larger the second number is, the worse is the vision. A person with 20/200 vision would have to come up to 20 feet to see a letter that a person with normal vision could see at 200 feet! Similarly, if the vision is 20/10, it means that the vision is better than normal. A person with 20/10 vision can read a letter at 20 feet that a person with normal vision would have to come up to 10 feet to read.

20/20 vision is considered normal vision
20/40 vision uncorrected in at least one eye is the vision required to pass many driving tests (for driving without glasses)
20/50 vision or worse is required for many insurance companies to cover cataract surgery
20/200 vision is considered legally blind (a person is not legally blind unless both eyes are 20/200 or worse).

Understanding your prescription

Glasses prescriptions are not difficult to understand. First of all, the right eye is usually listed first, and is noted by O.D. The left eye is O.S. The prescription has mainly three parts: the sphere, the cylinder and axis, and the add. The sphere determines nearsightedness or farsightedness. No sphere is noted as "plano". If the power is a minus, it is a nearsighted prescription. If it is a plus, it is farsighted. Mild prescriptions are in the range of plus or minus 1 to 3, while high prescriptions are over plus or minus 5 to 7. The cylinder and axis represent the astigmatism correction. Cylinder is power in a certain direction, and can be written as a plus or a minus power (ophthalmologists usually use plus, optometrists use minus). The axis is the direction of the power. It is measured in degrees, from 1 to 180. Axis 180 is perfectly horizontal, while axis 90 is straight up and down. This is like the degrees on a protractor. Most people would not notice a change in axis of 5 to 10 degrees, unless the cylinder power is fairly high (say, over +2.00). Many people do not tolerate glasses with high cylinder due to distortion.

My vision over the course of Lasik treatment

Date	Right Eye Vision	Left Eye Vision	Eye chart Right	Eye chart Left
Dec 28, 1999 (Pre-Lasik)	-5.25 +1.50 x 73	-5.5 +0.75 x 110	20/20 w/glasses 20/400+ without (can't see largest letter on eye chart!)	20/20 w/glasses 20/400+ without (can't see largest letter on eye chart!)
Feb 1, 2000 (The Day after)	+1.5 +0.50 x 135	+1.5 +0.75 x 30	20/30	20/30
Feb 7, 2000 (7 days)	+0.25 +0.75 x 111	+1.00 +0.75 x 34	20/30	20/25
Feb 22, 2000 (22 days)	+.25 (no astig!)	+.5 +0.5 x 055	20/20	20/20 (not right away)
May 9, 2000 (99 days)	plano +.25 x 110	plano +0.5 x 055	20/20 -1	20/30 -2
Dec 26, 2000 (330 days)	plano +.50 x 110	plano +0.25 x 035	20/20	20/20 -3
	Final result: 20/20 vision with both eyes open!

** plano means that there is neither myopia nor hyperopia present - the curve of the lens is 'perfect'.

Monday Jan 31, 2000 (The day of the surgery)
I got Lasik eye corrrection surgery at about 8:30 am fropm St Paul eye clkinic. I paid $3034 for bopth eyes. I had one valuim bablet first 5 minutes not hurt to open eyes Hourt to open eyes on way home - teary couldnt open eyse sting stayed up late night before - tht an val9um gelped me to sleep from 9:30 3:30 woke up no more stinging. Cant see blury have to lean in to monitor to write this. supposed to be bettewr 1 2 days. Using two kinds of drops plus have artiificial tears if need. Dorve to video stoe to return movies without glasses. Some halo around streatlights and car headlights. probalby 300% of lights - could live with that if vision sharpesn.

Addendum: I typed the above the same day as the surgery - you can see that I could NOT see clearly. The procedure itself went quickly. The valium definitely helps. Like most people, I was concerned that I might look away from the red light. There was a quick flash of pain when they put the "eye opener" on my left eye, but it was momentary. The nurse said lots of people report pain with the left but not the right. Its weird when your eye is open but you can't see - this happens for a short period while they make the flap. I remember them putting a drop in my eye after the flap was cut. My focus was pretty bad, the drop reflected the bright light and looked like a huge atom with electrons flying around it. Neat. I asked Dr. Rice if I every took my eye off the red dot and he said no.

Tues Feb 1 (1 day post Lasik)
Woke up but couldn't see clock clearly from 15 ft. Its like the lighted digital numbers are smeared together - I can make out the time but it takes some thought. I'm older(42), so it's supposed to take more time to see clearly. At the doctors today I have 10/30 vision. They gave me a pair of cheap reading glasses to use - that's how I can type this. Otherwise I can't read the paper or see the computer screen. Street lights have big hairy halos around them. like on a really foggy night. I have used glasses since 3rd grade, about 32 years ago, I should be happy I can see this well without them. But you get spoiled with 20/20 from glasses and contacts. I am not bummed out yet - I know that it is going to take a while. I can drive safely, but can't read all the smaller signs. It's the end of a long day and my eyes are pretty tired. I have been putting in the anti-swelling and anti-infection drops four times today, plus the artificial tears a few times. I went to the Eye Doctor and now I am farsighted.

Wed Feb 2 (2 days post Lasik)
Woke up and still cant' see the clock as clearly as I would like. I had the feeling as I left for work that maybe this was a mistake. I broke my cheap reading glasses while walking into work - the act of putting my keys in my coat pocket. I could see the 17" computer screen at work without the reading glasses, but scrunching up my eyes to do it was more than I could bear for long. I have the sensation that my contacts have been in my eyes too long, or that I need to put my glasses on to see clearly. My eyes kind of ache. I am keeping up with the drops. If I think about it, I do see pretty good for a guy blind as a bat all his life. I am telling myself to be patient and see how good my vision can get. My best vision seems to be while driving and with my sun glasses on. Still, I can't read all but the largest signs until I get close to them.

Thur Feb 3 (3 days post Lasik)
Vision still blurry. It feels like my contacts have been in too long. I had 20/20 vision with my glasses and it feels funny not to see well. I can drive a car okay but I don't read smaller signs until I get close to them. The lighted digital clock has "hairy" numbers, I can make it out but it's not instantly clear what time it is from 15 feet.

Fri Feb 4 (4 days post Lasik)
I have the sensation that I am staring past the things that I want to see. My eyes no longer feel like I have had my contacts in too long. I have been using all three kinds of drops regularly. Went to the Minnesota Timber wolves professional basketball game, sat in the lower level, and had a couple of flashes where I saw very clearly. I had trouble making out the player names. I could make out Minnesota Governor Jesse Ventura's face clearly though. He has season tickets and sat maybe 15 yards away from us.

Sat Feb 5 (5 days post Lasik)
To focus my eyes to see clearly I have to "look hard" at things and that causes discomfort. I have decided that part of the problem is that a haze exists within my vision. I seem to remember this in the documentation I read.

Sunday Feb 6 (6 days post Lasik)
I can read the computer screen as well with my +3.0 reading glasses as with just my eyes. This makes me feel pretty good. I didn't have to wear glasses to read before Lasik, I wouldn't want to have to wear them as a result of having had it.

Monday Feb 7 (1 week post Lasik)
The Eye Clinic let me sneak in and get my vision measured. It appears in the chart at the top of the page. I am less farsighted than the day after Lasik. My right eye is 20/30, but actually I had trouble focusing and it should probably be 20/40. The left eye actually focused in better, although really good vision came in and went out. I was struggling to read one line from the eye chart, and suddenly the line below it came into sharp focus, then in the space of a few seconds went away. I am having a mild "contacts in too long" feeling, and there is a slight haze and blurriness, but I am typing this without reading glasses and having no problems. If my vision keeps improving I will be pretty happy. Today the lighted cable box display 15 feet from my bed was on the number "5" - I was pretty confident it was "5" but there was a hint of "6" to it. Lighted numerals on digital clocks and cable boxes have what amounts to a rectangular box around them larger that the numeral display. I hope that's a good description for you. I have trouble making out the "EXIT" signs at the end of long corridors at work. Its very nice to get up in the middle of the night to check on my kids and not fumble around for glasses. This may well turn out okay!

Tues/Wed Feb 9 & 10 (9 & 10 days post Lasik)
I was kind of alarmed to notice that my left eye seems really blurry. I cover my right eye and read things 15 feet away so much clearer than with my left eye. I can't even make things out with the left. Thinking about it, it's the case that my right eye has improved so much, not that the left has gotten worse. Idiot. I can read the newspaper and use the computer without even thinking about using the reading glasses.

Feb 17 (17 days post Lasik)
My eyes feel pretty good most of the time. Just in the last few days I lost that feeling that I had a contact in. I still don't read smaller signs well while driving around. My nine year old can read a sign on a store about 100 yards away that I cant. The cable remote lighted display 15 feet from my bed is pretty clear in the morning, It's still a little fuzzy but there is no doubt what the numbers are.

Feb 22 (22 days post Lasik)
Surprise surprise - I have 20/20 vision! Had an eye exam today (see the table at the very top). I could read the second line from the bottom of the eye chart right away with my right eye. With a little bit of staring I could read the bottom line. With the left eye I could read the second from the top right away, but the next three lines were fuzzy. I stared some and suddenly the next line came into focus, stared some more and got the second from the bottom, and I'll be darned eventually I could read the bottom line.

Dr. Rice said that dryness in the eye can cause that "blurry suddenly can see" phenomenon. I have had periods in the last few days where my eyesight has been spectacular. I have been thinking about it. The world is no longer "framed" by my glasses - I see my whole range of vision. I see best when I am outside with sunglasses on. I guess now its a matter of time for the occasional blurriness to give way to 20/20 sight. Next week: Jamaica!

Mar 7 (36 days post Lasik)
Went to Jamaica last week. It sure was nice to sit out in the sun and go in the pool and run around and not have to worry about glasses or contacts. My vision generally is pretty good. Some of the blurriness I still experience has dissipated. I see fine detail everywhere.

Mar 21 (50 days post Lasik)
I have forgotten that I ever wore glasses. How quickly that happened! My eyes don't get dry very often. When I need to, I can stare at things and get sharper vision. I am glad I had this done now instead of waiting.

June 30 (151 days post Lasik)
It's been quite a while since I added to this Lasik diary. That should indicate I never even think of it. I consider myself fortunate. My wife is going to have it done next January. I will get my eyes checked in December 2000.

December 26, 2000 (330 days post Lasik)
My final eye check is posted in the table at the top of this page. My final vision is 20/20. I have some halo'ing at night, but not enough to cause any problems. I have heard of others who still had to wear glasses after having this surgery, or have had to use reading glasses afterwards, but I can only say my experience with Lasik has gone very well. The good news is the price will only go down.

Return to informationhighwaytohell.com Return for more Monologue