do it yourself lasik

A friend of mine referred me to this site today. It's too bad I didn't find it before I had a professional surgeon do my lasik surgery. I could have done it at home in the kitchen.

Lasik at Home

When you go there, make sure you click on the tab that says "Four Easy Steps."

I Didn't Think I'd be Nervous

For the most part, thinking of having major surgery performed on my eyes didn't phase me. Through all the pre-surgery meetings and tests, I stayed pretty calm and could even joke about it. It wasn't until I entered the cold operating room and laid down on the table that I began to get a bit nervous. As I was waiting for Dr. Motwani to arrive, all these thoughts of "it's now or never", "what if I sneeze" ... all those crazy thoughts began to race in my mind and I started to shake a bit. I think I actually surprised myself.

All the Tests

To determine if I was a prime candidate for Lasik surgery, Dr. Motwani and his staff ran me through several different exams and tests. Not only did they test my prescription (which I knew was way high), they also tested to see how much tissue I could afford to lose and what the topography of my eye looked like.

One of my favorite tests was the Wavelength test and having to focus on the hot air balloon. Then the lights flashed red and it felt like a flashback to the 1960s. Of course, I only lived for about eight weeks during the 1960s but you get my point :-)

Prolate Ablations

The original corneal shape is prolate, i.e. a dome like the side of a ball. When you re-shape a cornea for myopia, you create a bucket or divot like shape in the cornea, causing it to become oblate. This creates a completely different light entrance pattern at the periphery, causing night glare/halos and contrast sensitivity loss. Even if a wavefront laser pattern perfectly smooths the center cornea, the oblate overall shape of the ablation can still lead to contrast sensitivity losses and night glare/halo issues. A prolate ablation much more closely resembles the dome like shape of the natural cornea, especially in the area of pupil dilation, and therefore acts much like the normal eye with the additional advantage of corneal smoothening by the excimer laser. That is what accounts for the high 20/15 rate of this procedure. Further advantages are less central tissue removal, and excellent overall regression rates.

Source: Dr. Motwani San Diego Lasik Surgeon

Custom Ablations

These are various forms of laser ablation patterns that allow for a higher degree of 20/20 visual results, and a higher amount of better than 20/20 results (usually measured as 20/15 vision rates). Many of these use wavefront analysis to determine how to shape the cornea. Since 2002, Dr. Motwani has pioneered a custom system that allows for more prolate cornea, Aspheric Ablation. This was originally intended to decrease night glare and halos, and to decrease losses in contrast sensitivity, but this procedure also gave some of the highest 20/15 rates from any custom excimer laser system. Since then, a 68% 20/15 rate has been achieved for single eye visual acuity, a more rigorous test than bilateral visual acuity. Most other custom systems have 30-40% 20/15 rates.

Source: Alpha Laser Eye Center, San Diego Lasik.

Laser vs. Blade Microkeratomes

The micro-keratome is a device used to make a flap in he cornea. Over the past few years, a laser micro-keratome, the Intralase, has been introduced and heavily marketed as “All Laser LASIK.” The Intralase still makes a flap, usually has longer healing times (as much as 24 hours of discomfort vs. 3-6 hours), and longer visual rehabilitation (as much as 48 hours instead of overnight), and is also more expensive. Furthermore, the Intralase does not make a smooth cut, but actually makes multiple perforations in the flap, and the flap has to be raised forcefully with a forceps.

For the past several years Dr. Motwani has been using what he considers the most advanced blade micro-keratome, the Moria M2. This device makes very smooth, quick, reliable, corneal flaps with a flap complication rate of 1-2 flaps per year. Because of the extreme reliability of this device, the extremely smooth flap beds, and the faster rehabilitation times, Dr. Motwani continues to recommend blade over laser micro-keratomes until such day as the discomfort and rehabilition times can be brought on par with the Moria M2.

Source: San Diego's Alpha Laser Center.

Laser vs. Blade Microkeratomes

The micro-keratome is a device used to make a flap in he cornea. Over the past few years, a laser micro-keratome, the Intralase, has been introduced and heavily marketed as “All Laser LASIK.” The Intralase still makes a flap, usually has longer healing times (as much as 24 hours of discomfort vs. 3-6 hours), and longer visual rehabilitation (as much as 48 hours instead of overnight), and is also more expensive. Furthermore, the Intralase does not make a smooth cut, but actually makes multiple perforations in the flap, and the flap has to be raised forcefully with a forceps.

For the past several years Dr. Motwani has been using what he considers the most advanced blade micro-keratome, the Moria M2. This device makes very smooth, quick, reliable, corneal flaps with a flap complication rate of 1-2 flaps per year. Because of the extreme reliability of this device, the extremely smooth flap beds, and the faster rehabilitation times, Dr. Motwani continues to recommend blade over laser micro-keratomes until such day as the discomfort and rehabilition times can be brought on par with the Moria M2.

Source: San Diego's Alpha Laser Center.

E-LASIK or Epi-LASIK

E-LASIK or Epi-LASIK. This is a newer, advanced procedure in which a special micro-keratome is used to make a flap of only the clear outer skin layer (the epithelium). This exposes the stroma, the excimer laser is used to re-shape the cornea, and the epithelial flap is replaced and a contact lens is placed as a bandage. This procedure is used wherever a LASIK flap is not appropriate or desired, such as with thin corneas, corneal dystrophies, or where the patient does not want a LASIK flap. It has also been used very successfully by Dr. Motwani in cases of high prescriptions, which require high amounts of tissue for re-shaping. Since the entire stromal depth is available for the re-shaping, it creates a higher margin of safety also.

Source: Dr. Motwani.

LASEK

LASEK. This is a procedure where the outer clear skin layer (epithelium) is weakened with alcohol, and removed carefully in whole form to expose the stroma. The excimer laser is used to re-shape the cornea, and the loosened epithelium is replaced with a contact lens as a bandage. This procedure usually takes 5-6 days to heal, has a significant amount of epithelium loss due to alcohol being toxic to epithelium, and has been largely supplanted with Epi-LASIK.

Source: Dr. Motwani, San Diego Lasik Surgery.

PRK - Photo Refractive Keratectomy

PRK- Photo Refractive Keratectomy. This is the original laser procedure where the outer clear skin layer of the cornea is scraped away and the cornea is re-shaped using the excimer laser. The amount of skin scraped away depends on the type of re-shaping being done, and usually takes about 2-4 days to heal. A contact lens is used as a bandage lens to aid healing and decrease discomfort. Modern PRK post-op care limits pain to mostly the day of the procedure, with little to no pain after day one. PRK is used in cases where a LASIK flap is not appropriate or not desired.

Source: Dr. Motwani's Alpha Laser Center in San Diego.

Different Types of Laser Eye Surgery

There are many different types of laser eye surgery. I thought I'd post a few definitions (borrowed from Dr. Motwani's website -- the San Diego lasik surgeon who performed my surgery).

LASIK- Laser Assisted In Situ Keratamileusis. This is a procedure where a corneal flap is made consisting of the outer clear skin layer (epithelium) and a small layer of the stroma of the cornea. This allows the stroma to be exposed, and the excimer laser is used to re-shape the cornea. With hyperopia, the laser removes tissue from the outer part of the cornea, with myopia, it is removed in the inner part of the cornea, and with astigmatism tissue is removed preferentially along one axis of the cornea. With Dr. Motwani’s techniques, discomfort and visual rehabilitation take 3-6 hours after surgery.

My First Visit to Doctor Motwani

My first visit to Dr. Motwani was to see if I qualified for lasik surgery. His staff ran me through the same types of tests that I had undergone previously at Dr. Kawesch's office. Though both seemed professional, I felt much more comfortable with Dr. Motwani than I did with the other office. During my consultation, I had a chance to visit with Dr. Motwani -- I never even saw Dr. Kawesch the day I went into his office. In fact, I was never told that it was a different Dr. Kawesch who was now running the clinic. I only found out when I noticed that the picture on the folder didn't match the picture on the website. From there Google took over ...

What I enjoyed the most about Dr. Motwani was that he was both professional and personable. When you're considering having laser surgery peformed on your eyeballs, it's important to feel that the person is competent; it's also nice to have a good feeling about them. I was fortunate in that I had both.

Learning New Things

Now that I'm on the post-side of Lasik surgery, I'm having to learn things that people with good eyesight have known all along. Case in point: Never leave your black sunglasses in the car when it's 100 degrees outside and then put them on!

LIke Silly Putty, Part Two

One of the consequences of having eyes shaped like Silly Putty meant that when I decided to try contacts in high school, I had to wear hard contacts. They would pop out, get stuck up in my eyelids, cause my eyes to get all red. All in all, it was a fun experience. Not nearly as fun, however, as I remember Silly Putty being.

Like Silly Putty

I once had an optometrist describe my eyeballs as something that resembled Silly Putty. As a child, I thought this was cool because I thought Silly Putty was cool. You could take Silly Putty and stretch it, wrap it, and use it to copy pictures from the Sunday comics. I never did figure out how my eyes might resemble Silly Putty.

For those of you who are interested, here's the history of Silly Putty.

A Stig What?

Prior to having laser eye surgery, I had a pretty severe case of astigmatism in both eyes. When I was in high school this kept me from being able to wear soft contacts, thus forcing me into the era of big glasses.

For those who aren't sure what astigmatism is, this blurb from wikipedia probably won't help :-)

Astigmatism is an optical defect, whereby vision is blurred due to irregular curvature of the cornea or lens. In corneal astigmatism, the cornea is ellipsoidal (like an egg) rather than spherical, which reduces the cornea's ability to focus light. In lenticular astigmatism, the curvature of the crystalline lens is not even, resulting in scattering rather than focusing of light on the retina. When light strikes the retina at multiple points, the result is blurred vision.

The refractive error of the astigmatic eye stems from a difference in degree of refraction in different meridians (i.e., the eye has different focal points in different planes.) For example, the image may be clearly focused on the retina in the horizontal (sagittal) plane, but not in front of the retina in the vertical (tangential) plane. Astigmatism causes difficulties in seeing fine detail, and in some cases vertical lines (e.g., walls) may appear to the patient to be leaning over. The effects of astigmatism of the eye can often be corrected by prosthetic lenses with a cylindrical lens (i.e. a lens that has different radii of curvature in different planes), contact lenses, or refractive surgery.

http://en.wikipedia.org/wiki/Astigmatism_%28eye%29

Wavefront Technology

More from Wikipedia, this time about Wavefront technology. My Lasik surgeon, Dr. Motwani in San Diego, used wavefront technology on me.

Wavefront-guided LASIK is a variation of LASIK surgery where, rather than applying a simple correction of focusing power to the cornea (as in traditional LASIK), an ophthalmologist applies a spatially varying correction, guiding the computer-controlled excimer laser with measurements from a wavefront sensor. The goal is to achieve a more optically perfect eye, though the final result still depends on the physician's success at predicting changes which occur during healing. In older patients though, scattering from microscopic particles plays a major role and may exceed any benefit from wavefront correction. Hence, patients expecting so-called "super vision" from such procedures may be disappointed. However, while unproven, surgeons claim patients are generally more satisfied with this technique than with previous methods, particularly regarding lowered incidence of "halos", the visual artifact caused by spherical aberration induced in the eye by earlier methods.

http://en.wikipedia.org/wiki/Lasik#Wavefront-guided_LASIK

Lasik - The Technology

From Wikipedia ...

The LASIK technique was made possible by the Colombian-based Spanish ophthalmologist Jose Barraquer, who, around 1950 in his clinic in Bogotá, Colombia, developed the first microkeratome, used to cut thin flaps in the cornea and alter its shape, in a procedure called keratomileusis. He also provided the knowledge about how much of the cornea had to be left unaltered to provide a stable long-term result.

Later technical and procedural developments included the RK (radial keratotomy) started in the '70s in Russia by Svyatoslav Fyodorov and the development of PRK (photorefractive keratectomy) in the '80s in Germany by Theo Seiler.

In 1968, at the Northrup Corporation Research and Technology Center of the University of California, Mani Lal Bhaumik and a group of other scientists, while working on the development of a carbon-dioxide laser, would develop the Excimer laser, where molecules that do not normally exist come into being when xenon, argon or krypton gases are excited. This would form the cornerstone for LASIK eye surgery. Dr. Bhaumik announced his discovery in May of 1973 at a meeting of the Denver Optical Society of America in Denver, Colorado. He would later patent it. [1]

The introduction of Laser in this refractive procedure started with the developments in Laser technology by Rangaswamy Srinivasan. In 1980, Srinivasan, working at IBM Research Lab, discovered that an ultraviolet excimer laser could etch living tissue in a precise manner with no thermal damage to the surrounding area. He named the phenomenon Ablative Photodecomposition (APD).[2]. Dr. Stephen Trokel published a paper in the American Journal of Ophthalmology in 1983, outlining the potential of using the excimer laser in refractive surgeries.

The first patent for LASIK was granted by the US Patent Office to Gholam A. Peyman, MD on June 20, 1989, US Patent #4,840,175, "METHOD FOR MODIFYING CORNEAL CURVATURE", describing the surgical procedure in which a flap is cut in the cornea and pulled back to expose the corneal bed. This exposed surface is then ablated to the desired shape with an excimer laser, following which the flap is replaced.

Using these advances in laser technology and the technical and theoretical developments in refractive surgery made since the 50's, LASIK surgery was developed in 1990 by Lucio Buratto (Italy) and Ioannis Pallikaris (Greece) as a melding of two prior techniques, keratomileusis and photorefractive keratectomy. It quickly became popular because of its greater precision and lower frequency of complications in comparison with these former two techniques. Today, faster lasers, larger spot areas, bladeless flap incision, and wavefront-optimized and -guided techniques have significantly improved the reliability of the procedure as compared to that of 1991. Nonetheless, the fundamental limitations of excimer lasers and undesirable destruction of the eye's nerves have spawned research into many alternatives to "plain" LASIK, including all-femtosecond correction (Femtosecond Lenticule EXtraction, FLIVC), LASEK, Epi-LASIK, sub-Bowman’s Keratomileusis aka thin-flap LASIK, wavefront-guided PRK, and modern intraocular lenses.

Wal-Mart and Eyeglasses

My last pair of glasses before having lasik surgery were purchased at Wal-Mart of all places. In fact, I had my prescription done by the eye doctor who has an office inside our local Wal-Mart. He turned out to be a super nice guy and good doctor -- and he wasn't wearing one of those blue vest with a yellow smiley face on it. He discovered that my previous prescription, which I had done while living in Atlanta, was actually too strong and that was I why I was experiencing slight headaches.

I will say that the selection of frames at Wal-Mart is not the most impressive in the world but they do know their market well. One wall of the display center had frames made by NASCAR. OK, I did try on a pair but decided I would have to scrape off the NASCAR logo and that might look kind of cheesy.

So, I settled on a pair of frames by Levi Strauss. Plastic, not denim.

Weighing the Costs and Benefits

Being a practical sort of person, I tend to try and weigh the costs and benefits of major decisions. Not all costs or benefits will be tangible. Sometimes the benefits can't be measured in terms of dollars but in terms of flexibility, freedom, or similar benefits.

As I thought about having lasik surgery done, I began to think about the costs and benefits. Having worn glasses for so long, I was well aware of the cost of prescriptions, frames, etc. I was also aware of the cost in terms of inconveniences such as walking in the rain or trying to watch tv while laying on your side! And having broken more than one pair of glasses while playing sports, I knew there was a cost involved there, too.

Lasik surgery, on the other hand, isn't cheap. So I began to weigh the cost of having it done with the benefits I would derive. Those benefits included:

• The freedom to move around without worrying about my glasses slipping or falling off.
• The ability to wake up in the middle of the night and to see clearly ... immediately.
• Being able to take a shower and see which bottle was shampoo without having to stoop over and hold it three inches from my face.

But did I tell you I'm a practical kind of guy? Assuming I had to buy a new pair of glasses every three or so years -- and that I live another 30 years -- that would be another 10 pairs of glasses I would purchase over the rest of my life. The last pair of glasses (including prescription, lenses, and frames) cost just under $300. Let's round it up to make the math easier.

That would work out to be a cost of $3,000 over the next 30 years, assuming that prices remained static. And you can still get gas for 75 cents a gallon!

But would cost alone be the determining factor or do certain benefits carry a "price tag" of their own? By choosing to have the surgery, I was deciding that those benefits are important and weighty enough to matter.

The Big Letdown

After sending my text message off during the Padres game, I felt pretty good about my odds of winning. Then again, I felt the same way when I purchased a one-dollar ticket for the super duper lottery back about 15 years ago. Missed it by just a few numbers.

The next day I receive a phone call from the doctor's office who had posted the ad at the game. We scheduled a time for my free consultation and I went. No mention of the contest was ever brought up until finally I had to ask. Did I win? Nope -- but if I signed up right then I would get a "huge" discount.

I left the office that day more than a bit disappointed. I really felt like it was a matter of bait and switch -- that no contest was ever held.

But that experience did start me down the road towards having my surgery done by Dr. Motwani ...

Phantom Glasses

Allow me to fast-forward a bit. One intriguing aspect of having Lasik surgery is what I call the phantom glasses effect. It's when I instinctively reach for my glasses or try to push them up when I speaking in public.

That Night at the Padres Game

My wife and I took our two daughters and my in-laws to see the San Diego Padres play last summer at Petco Park. During one of the breaks between innings I noticed an advertisement on the big screen that read: "Text this number to win a free Lasik surgery."

I scanned the crowd and guessed that they were approximately 30,000 people in the stands. Then I figured that maybe only half were wearing glasses or contacts. That left around 15,000 people who were potential candidates for Lasik surgery. So I thought, "How many of those people are going to enter the contest?"

So I whipped out my Smart Phone and typed away, nonchalantly so no one else would get the same idea :-)

But that's not how the story ends. More on that later.

My Journey to Lasik Surgery

Over the past ten or fifteen years, I've known several people who have had various forms of laser eye surgeries. They've ranged from PRK to LK to other acronyms which currently escape me. It's always been something I've thought about doing but never did. One reason was the cost of such surgeries and the fact that most insurance companies didn't cover it. Another reason is that I'm basically a weenie when it comes to meddling with my eyes. I also heard that only a small percentage of people experienced worse vision after their surgery than they had before. And then I would think ... "Well, somebody has to make up that small percentage of people and I wouldn't want it to be me."

So for those reasons, and others that must remain top secret for now, I put off seriously considering Lasik surgery all through my twenties and almost to the end of my thirties. But that all changed in the summer of 2007 and by February 8, 2008 my new life with a new set of eyes began.

The Tinted Glasses Era

Long before they invented "transition" lenses, they had tinted glasses. You could pick your shade of brown (or maybe even blue) and enjoy a break from the bright sunlight. The only catch was this: they were ALWAYS tinted. Inside or out, light or dark, always tinted.

Oh the good old days of wearing glasses ...

Sexy Epoxy

My dad was one of the original DIY'ers (Do It Yourselfers). Our house, especially the basement, had a conglomeration of tools, tubes, and other interesting items. Once when I was in grade school, I broke my glasses doing something and rather than get a new pair, my dad whipped out a tube of epoxy and glued the frame back together. Unfortunately, the epoxy turned a dull gray when it dried. Even more unfortunatetly, I had broken the frames right down the middle between my two eye. At least it was a conversation starter ...

A Little Background

I began wearing glasses when I was in Mrs. Townsley's third grade class at Woodrow Wilson elementary school in East Peoria. Those were the days of big plastic frames and I even sported tinted lenses later in junior high. I can remember going in for my regular eye exams and getting a new pair of glasses. Each time I got a new prescription, I felt like I was walking up hill for about two or three days. As a kid, I got used to wearing an eyeglass band whenever I played sports and wearing glasses probably saved me from being a catcher!

My Lasik Experience

In the spirit of the Internet, where everyone shares something about everything, I've decided to open up a late-night blog to document my personal lasik experience. I'll have to update my profile picture -- it's so prescription challenged.

I'm now almost two months removed from when I had my lasik surgery done by Dr. Motwani at the Alpha Laser Center here in San Diego. It's been nothing short of a miracle!