Thursday, May 25, 2006

What LASIK is really like

Actually I don't know since I had PRK done. Basically the three procedure they do perform at Jules Stein and most clinics is LASIK, PRK and LASEK. LASIK is the newest and is different from the other two because of the "flap". PRK is the original procedure and LASEK is a modification of PRK. Where in PRK, the surface cells over the cornea are removed, in LASEK the surface layer, if intact will be placed back over the eye and allowed to be heal back around the eye. If the surface layer did not survive the removal then the surgeon will proceed with the procedure as PRK. My doctor, Rex Hamilton, the director at Jules Stein Refractive Laser Center said he preferred PRK over LASEK since reintroducing the removed layer can sometimes lead to more complications anyway instead of promoting healing. As I found out, the reason that LASIK is much more popular now is probably because of comfort. Having the surface later of your eye scratched out is not exactly the most comfortable thing. After I had the procedure performed, it felt like I was chopping onions all day for the two days after. For me that sensation went away when I woke up Saturday and by Sunday the sensation to close my eyes had completely gone away. The cocktail of eye drops that I was given helps tremendously with the healing.

So on Thursday i did drive in on the vanpool and dropped myself off at the center. I signed in and the collected their fee. For being a UCLA employee I get a 20% discount on the procedure. So for me it came out to $2240 per eye. Which is a little above the average. I think if you look around TLC is about the same and another national chain LasikPlus is a few hundred dollars cheaper. The price include the procedure, for me it was Custom PRK, with Custom PRK the laser ablation is guided by measurements done on your eye. So where in PRK the ablation is done based basically on the refraction, the same way that they determine what your glasses prescription, in Custom the cornea is mapped with a LADAR and the the correction is applied to the corneas topography. So based on this glossy literature they gave me and what Dr. Hamilton told me, if you get PRK, working on your cornea is without Custom is like working on an ideal sphere. With Custom you are working with the actual 3-D topography of the cornea. So you can see then that if you were to get refractive surgery later on the claims would be that their new lasers have higher resolution or possesses a LADAR with an even higher sampling rate.

Besides the cost of the actual surgery, the cost of follow ups for a year and your dose of eye drops are included too. I also got a mug and a pen. Doctors visits are, the day of surgery, then you have a 1- day follow up the next day, for PRK you have a 4-day follow up to remove the bandage contact lens, then a 1 month check up, a 3 month checkup where they dilate your eyes and 6 months and 1 year if needed. You are also given a kit with 4 types of eye drops and a prescription for Vicodin. I also got another prescription for an oral steroid to reduce swelling around the eye lids on my 1-day follow up. The first eye drop is Vigamax, an antibiotic, Flarex, an anti inflammatory, i think, Systane lubricant eye drops and a fourth which is a local anesthetic eye drop that you're only suppose to use on the first day. All by the way are made by Alcon. The first three you are suppose to use 4 times a day for a month. The lubricant eye drops you can use until you wean yourself off of it.

Your counselor will also go over your finance options. Haha, its like buying a car. You can pay in cash, credit card, or open a loan. I was going to cash in on my credit card dividends but it turns out I have great credit so I took advantage of a 6 month interest free loan from CapitalOne Healthcare finance. This is especially cool since I can park my money in my ING Direct account for a couple more months at 4%. Of course you can probably have credit like a third world country and they will still give you a loan because if you don't pay everything off before the interest free period Capital One will be grinning a 19.99% APR grin. If you want to save even even more money you can also open a HCRA, a health care reimbursement account. UCLA offers one, but this probably depends on your employer. Basically you allot a certain amount to be deducted from your paycheck each months before taxes, so you can drop your taxable income by a bracket and save a couple hundred bucks that way. I missed our HCRA enrollment though since they only do it once a year here and its done in October. I might be able to claim the procedure as a tax deduction though, which you can't do if you opt for a HCRA.

So after Capital One approves the loan over the phone I'm admitted to a waiting room. I am given another eye test and it looks like both eyes are at -1.50 again. They also dilate my eyes and start giving me a local eye drop anesthetic. They also take pictures of my eyes first with a desktop machine where you look at little arrows pointing to a dot. They then take me into the laser room to take more pictures.

The laser room has a big warning sign. "Lasers" it says, also there's an icon of a big red laser streak. The air conditioning is cooler in the room, I guess the equipment generate more heat or so, so there is an optimal temperature and humidity setting for doing the procedure. There is a bed with a machine about the size of computer tower hanging over it that moves on at least two axis. The equipment takes up more space than I anticipated. I lie down flat and the overhead machine starts moving. They hold my eye open and tell me to stare at the red dot. So I do and they take pictures of both eyes. They move me back to the waiting room and I wait for about an hour until they are ready. I think they had a few other patients to do before me.

In the waiting room, Kelly one of the techs gives me my kit which has the eye drops and the funny goggles. The shaded ones are just regular sun googles. The white ones are ventilated goggles that I'm suppose to wear at night when I sleep so that I don't scratch out my eyes while sleeping. The white ones unfortunately make it look like I've been awake for months since they leave little rings around the eye sockets from wearing them for hours. They fade eventually during the day. Everything you need is pretty much in the kit, you'll only need to refill a prescription for the Flarex eye drops and buy more lubricating eye drops later when the initial samples run out. Whey are ready for the procedure they give me paper gown to wear and smear iodine around my eyes.

We go back to the laser room. Besides me and Dr. Hamilton, his three techs are also in the room as well as another Doctor who is there to observe, its a learning hospital after all. So I am lying down on the bed again and my feet are propped up on a little wedge. They also give me a football to keep me preoccupied while they shoot laser. You get a teddy bear if you're a girl. They put more numbing drops in my eyes and Dr. Hamilton proceeds with removing the surface later of cells. I feel a little bit of pressure on the eye when he does this. The while time you're suppose to stare at the red dot. So after the right eye is prepped the laser does its first pass and collects the surface map of the cornea. After a couple of minutes the laser is ready to do the ablation. You stare at the dot and a buzzing sound starts, it sounds like an electric fly trap. You can also smell an acrid smoke smell. basically the part of your cornea that the laser is vaporizing. After about 20 seconds its done. The machine overhead moves over to your left eye and the exact same thing is repeated. When its all done I actually started seeing well, but very soon it gets hard to keep your eyes open. We go back in the waiting room and Dr. Hamilton and his observer check the work. They okay it and I'm done, but I have to return the next day for my 1-day follow up. Kelly gives me a peach colored Vicodin pill and a Tylenol with Codeine.

I left the Laser Refractive Center and took the campus shuttle back up to the Powell Library. I figured I should probably get on the couch before the codeine knocks me out. Since I won't be able to see all that well until about Saturday night I start on my audiobooks. For the post op I got "Crime and Punishment" by Fyodor Dostoyevsky since I've been trying to read it for like two years but am still stuck on page 100 or so. I also got "How to Make People Like you in 90 Seconds or Less," Boothman and "Zen and the Art of Motorcycle Maintenance" by Persig. Crime and Punishment still confuses, probably not the best idea to try to follow it loaded up on painkillers. "How to Make People Like You" is a complete waste of money but "Motorcycle Maintenance" was pretty interesting, except its not so much about motorcycles or buddhism as it is about mental illness and philosophy. By about 3:45 my van picked me up, I got a ride home from Alina, one of my riders, I took my 1000 mg of Vitamin C which they recommended I take everyday for 3 months and I went straight to sleep.

The next day I woke up and my eyes were incredibly irritated. I guess I really should have filled that Vicodin prescription. Those onions that I felt like I was chopping now felt like they were being forced into my eye sockets. I used a couple drops of the numbing drops that was in my kit for the first time. That was pretty incredible. Almost instantly where it was painful was just numb. Unfortunately they only last for about an hour. My mom dropped be off at the van pick up again and I got back to campus for my 1 day follow up.

Back at the center Dr. Hamilton checked my eyes again, I was seeing about 20/40 with both eyes. He also prescribed me an oral steroid that I'm suppose to take for 6 days to help reduce the swelling around the eyes. After the checkup I went back to the library to sleep and continue my audiobooks. If I kept my eyes close its actually not too painful. But I used the drops one more time for the ride back home. On Friday before going to sleep I took two tylenol and they actually took effect pretty fast within about 10 minutes. Tylenol usually has almost no effect on me unless I take a huge dose.

On Saturday I was feeling much better, the only thing that was bothering me was the fluctuations in vision. My vision is suppose to fluctuate for a couple of weeks, but would be very pronounced the first week. It wouldn't be too bad but it seemed like one eye was fluctuating more than the other so I was seeing better with one eye than the other and it made me a little dizzy.

On Sunday it wasn't very bothersome anymore and on Monday I returned to work. I also started driving my car but not the van. The eye are tolerating driving pretty well, I think actually see the best on the road right now. At work tough I have to use eye drops a lot, at least every 30 minutes. I didn't realize how dry the eyes get from staring at a computer screen for 10 hours. So until the surface layer of cells fully heal, eye drops are my best friends.

On Tuesday I had another follow up appointment, this time the bandage contact lenses were removed and he made more drawings of how things were growing back. My next check up will be in a month and hopefully there will be no complications cause getting zapped again would not be cool. Dr. Hamilton also told me that the dry eyes are what usually causes the fluctuations. Until the cells are restored the unevenness of the layers over the cornea distorts the vision.

So if you guys are interested in the surgery or the laser center here you can learn about laser refractive procedures from

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