I intended to do this last year. I did some major information gathering at my last eye appointment, got glasses that I actually like, and got a recommendation to a good, competent surgery place. But I didn't follow through. At the time, it was money, and once the new year started, it was mostly just procrastination from nervousness and fear. But recent times of getting dust under my contacts, not being able to see in a nightclub because of light glares, the annoyance of glasses, and the realization that we set aside pre-tax money for the operation this year and this year is approaching its end have finally kicked my ass into a more active pursuit.

The steps that are next on my list: I need to take my contacts out for 3 weeks, and go get a current pre-op exam with my eye doctor. The contacts need to come out because they are hard lenses, which work to effectively correct astigmatism by literally reshaping the eye, and the exam needs to accurately determine natural eye status. That appointment is scheduled for Oct 17th. After that, I will be going to the The Refractive Institute to get a consultation with the doctor. [set for Oct 21] I am waiting a callback from the secretary for that appointment. Then we'll see about the actual surgery. Maybe I can get new eyes as a Christmas present from myself.

So, starting this Friday, no contacts. Sigh. I hope I'll survive.

I had another eye appointment today with Dr Edward Ross. This one was the pre-operation eye exam, which meant he was doing everything with an expectation of planning for LASIK in mind. I did my very best to make sure everything went well.

It went mostly like any other exam. He did the basic metrics of how well I could see without glasses ("E? What E?"), with glasses, if I did colors well, glaucoma, etc. He seemed to be taking a few measurements that I'm pretty sure don't get done at my normal exam, but I neglected at the time to ask what they were for. Then he put eyedrops in. Ugh. One the bright side, I've gotten much better(1) since my pre-contact years. I don't know if I simply have better muscle control or have trained myself from years of contact usage, but I kept my eyes open a little, and he was able to get the drops in on the first try.

The first drops were (I think) numbing drops. If they were, I don't think they did any good. The second "drops" were actually little pieces of paper that he stuck to my lower eyelid (I found out later this is called Schirmer's test). He told me to relax (yeah right) and try not to blink (it scratched every time I did), and waited for approx 2 minutes (seemed like an hour). I was on edge the entire time, trying not to freak out with these things sticking into my eyes. Finally, he took them out and told me that from a purely objective clinical standpoint, I had "normal" tear production in my eyes. Which means I'll probably suffer slightly from dry eyes after LASIK. Then he put more drops in, which I think were dilation drops. Ouch.

I sat out in the waiting room for 15-20 minutes, and filled out an info form and read some surgery info sheets. I found that I could read without my glasses pretty easily with dilated eyes, as long as the words were about 6 inches from my face. I probably looked pretty funny. Finished up the exam, got as accurate eye reading as we could, and talked a bit about the surgery, and left. I discovered I could see with my glasses on just fine, as long as I didn't need to focus on anything less than 5 feet away, so I drove back to work, proceeded to turn up the font on my work by 3x, and sit far away from my laptop. Fortunately, I didn't have to work long before I could leave.

I'll be going in Tuesday for a consultation (not operation!) with the LASIK doctor. I'm making up a list of things I want to ask him or talk about with him. Here is the list so far:

I already feel like I know the risks and possible problems. I know there's a pretty high chance I won't get 20/20 vision back, which is fine. If I can see better, great, and I'm willing to go back to contacts part-time. I will almost certainly suffer from dry eyes, which is relievable with drops, and should (hopefully) decrease within 6 mo - 1 yr.

Other risks including: Glares or halos which affect nighttime vision. I have already experienced fairly severe nighttime problems while wearing contacts. Hopefully it won't be so bad that I am unable to drive, but mild affections I can live with.

Laser malfunction, doctor error, and infection. By choosing a reputable institute (despite the price, ugh), with an experienced doctor (Dr Zimmer), and doing appropriate care, I don't think I can minimize these any more.

Contrast desensitivity, double vision, hazing, blurring. Would suck, but in some cases is correctable by enhancements.

The estimated risk for most individual problems is considered to be around 1% or less.

Partial or complete loss of sight. Would suck majorly. Please, God, no.

More updates next week when I meet the actual doctor for a consultation.

(1) - Most of what I remember from childhood eye appointments is the doctor struggling for 10 minutes with additional help in order to pry my steel door eyelids open so he could put drops in. I didn't consciously try to resist, I was just unable to do it.

I had my consultation with Dr Zimmer of the Refractive Institute today. Short story: I have an appointment for a LASIK operation on both eyes on Thu, Nov 6. Wish me luck.

And here's the long story:

I got to the office after a harrowing trip of wrong turns and too many traffic lights, and was rather late, but there was nobody else there at the time, so it wasn't a problem at all. The receptionist/nurses were both very friendly and helpful. After signing a couple confidentiality forms, I was taken to a room to check corneal characteristics.

corneal analysis
The first machine I sat down at looked like a tunnel with circles of blacklight around it. I put my chin on the mark and tried to hold my eye open as it centered on me and took a picture. Nothing touched or even came close to my eye, but I still couldn't help but cringe. She did each eye individually, and managed to get unblinking sessions of each.

The machine was a corneal topographer, which created a topographical map of my eyes.

The corneal map helps to indicate possible obstacles for surgery, such as pre-existing medical conditions, corneal scarring, or extreme, irregular astigmatism. If there was any red in the center area, any surgery would have to be modified or cancelled. In the actual surgery, the cornea is cut, reshaped, and flattened some, and too much curvature variation creates higher risk for refractive error.

After that, I sat back in a chair, and managed (barely) to let her get numbing drops in my eyes. After a minute for the anesthetic to take effect, she had me look straight ahead while she pressed a small pen-like measuring instrument against my eye. It was small and unobtrusive, and my eyeballs were completely numb, so it actually didn't bother me at all.

This test was to measure corneal thickness. She took about 8 measurements in different parts of both eyes. Mine came out to about 570 microns. The average is about 550, and the minimum that they will do surgery with is 410. The number is determined by the minimum thickness for a corneal tissue bed to maintain corneal stability (250) plus the thickness of a the flap cut (~170) plus the amount of tissue removed during surgery (related to diopter).

discussing results
After doing those steps, we moved into the office where I learned what the results meant. I asked her about her surgery, and we discussed general safety precautions. After a while, Dr Zimmer came in, looked at my test results, and offered to answer all my questions. He claims to have been doing refractive surgery for over 14 years, and has done approximately 14,000 surgeries. His minor complication rate is around 0.4%, and all of those were correctable with more operations. He claims to have a major complication rate (negative prescription change, loss of vision, severe blur/double vision/halo) of 0.0, as well as an infection rate of 0.0 (she claimed this was thanks to very strict sterility procedures, as well as instructions for eye protectors and antibiotic drop treatment for 4 days). His enhancement rate is around 4%, done strictly on a patient-desired basis, and all surgery related care for the next 2 years is completely covered.

That all sounded good to me. Better than I expected. I was unable to think of any more reasons to be scared off (except for the price, but we've already planned for it). Convinced that I was hearing the truth and that there was a reason he was so highly recommended, I went ahead and made the appointment. So, two more weeks of glasses, and then, for better or for worse, something changes.

Here's hoping for success.

The other big thing that has led me to feeling good about this is that I don't feel like I've been pushed or prodded or lied to into making a decision. I have been warned many times that I might not get perfect vision, and signed papers acknowledging risks and probably side effects. Dr Zimmer did say the evil PC words*, but not until after all the vision, cornea, and tear tests had been done and looked at. He was upfront with me about some of the errors which cause problems like glare and blurring. I didn't pay for the consultation or give them a downpayment; in fact, the first money the Institute will receive from me will be on the day of my surgery. I was told in detail about the tests both the institute and my doctor did to ensure I was low-risk for complication. And most of all, I was the one who approached my doctor about the surgery, not the other way around.

* "perfect candidate"