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The Vision Thing

There's more to LASIK surgery than meets the eye

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My friend Jessica warned me about the smell of burning flesh. And the stinging sensation that lasted for hours. "It hurt like hell," she said blandly, the memory of her eye laser surgery still vivid after two years. Out of the eight people I know who have undergone "LASIK," Jessica was the only one who gave it to me straight. Or so it seemed. But why had everyone else been unanimously positive when I said I was considering it? My research had already assured me that no one has been blinded by LASIK; I just wanted to know how much I had to suffer.

I dialed up a few other friends who were still reveling in their triumph over myopia.

"No, I didn't have that much pain," said Franny, sounding puzzled. I believed her.

I called Tara. "No, it didn't really hurt," she agreed, though she confirmed the olfactory unpleasantness of fried eyeballs.

Satisfied with my scientific survey -- two to one! -- I decided the "no pain, no gain" credo did not have to apply to the miracle of restored vision. I called my eye doctor. "I'm ready to go for it," I said quickly, before I could chicken out. He set up a schedule for my pre-op tests and, eventually, an appointment at Laservue in Montreal. He sends patients to the Canadian crew because of their experience -- more than 35,000 operations. The expectation of perfect eyesight was thrilling, like meeting an extraterrestrial or something. Of course, that little matter of getting my eyeballs sliced and zapped was scary as hell. It would prove to be a lot more than I'd bargained for.

LASIK is short for laser-assisted in situ keratomileusis. Also called refractive surgery, it's a procedure that permanently changes the shape of the cornea, thus changing how light focuses on the retina. It can correct nearsightedness (myopia), farsightedness (hyperopia) and astigmatism, but can't help you if you're in over-40 reading glasses. While LASIK has been performed in other countries for more than a decade, this specific laser was only approved for use in the United States in 1998. That's why the Food and Drug Administration says "the long-term safety and effectiveness of LASIK surgery is not known" on its otherwise informative Web site (www.fda.gov/cdrh/LASIK). Some potential risks are known, however, including permanent eye dryness, glare or "halos" around lights at night and, worse, actually losing lines on the vision chart.

Everyone I know, however, has been delighted with the results. Still, in the weeks leading up to my eye surgery, a small, contrary part of me felt like LASIK was cheating somehow. Was it right to overrule the bad karma that had caused me to get glasses at age 7? How could it be so easy? My childhood had been punctuated by visits to the opthalmologist... and getting stronger prescriptions every year.

My mind spooled back in time, revisiting my "eye history." I still blamed getting glasses on Mrs. Cowger -- the second-grade teacher who inexplicably liked a darkened classroom, shades pulled down, the old bat. I scooted my desk closer and closer to the blackboard until she called to tell my mom I couldn't see. I remembered my first pair of glasses, with blue plastic frames, which I carefully removed before recess and, even so, managed to break on the first day.

I was finally allowed, at age 16, to get contact lenses. They were hard plastic in those days, and how I struggled to get used to them! I nearly failed chemistry because my eyes were so scratchy every morning, I couldn't pay attention to anything else. Things were better after I got new ones that fit, but it was too late for the periodic table.

I lost one pair of lenses underwater when some high school boys tossed me, screeching, into a swimming pool. Another pair disappeared when I threw up after too much vodka punch at a Polish wedding. More than once total strangers helped me search on hands and knees for a lens that had popped out. During late nights at college, I'd remove contacts that felt like Scotch tape on my eyeballs and suck them to "clean" off debris.

When I switched from hard to soft lenses in the mid-'80s, I suddenly developed astigmatism, as if my eyes had been released from a straightjacket and went crazy afterwards. After that, my "corrected" view of the world was still slightly impressionistic.

All my life, 20/20 vision seemed like an impossible dream. Except it wasn't anymore. I considered all the other technological advances I'd embraced -- microwave ovens, e-mail, cell phones -- and decided that my poor eyesight wasn't so much bad karma as a problem that science could finally solve. Au revoir, guilt. Bonjour, laser.

It was a gray day when Franny drove me to Montreal. I'd asked her to accompany me because she was an eye-surgery "vet." When the border guard asked what we'd be doing in Canada, Franny told her I was getting "Laservue'd." The woman smiled knowingly and waved us on.

We checked in early at the clinic on Rue Beaumont and had some lunch at a cafe downstairs. I was too nervous to finish mine. My 1 o'clock appointment arrived. I filled out paperwork, paid for the surgery -- $1600 American -- and had a battery of eye exams for the next hour. Everyone was good about telling me what would happen, and in excellent English.

What happened was this:

In an anteroom, I lay down while a technician streamed rivulets over my eyes; one of the drops was an anesthetic. Then she stood me up and netted my hair. I was otherwise normally dressed, including shoes. My surgeon, Dr. A. Gordon Balazsi, greeted me in the operating room and asked Franny if she wanted to watch. I took this to mean did she want to observe through the glass surrounding the surgery area? She said yes and disappeared. I would later find out that my brave friend had observed the surgery on the video the doctor watched as he performed it, my eyeball filling the entire screen.

Balazsi instructed me to lie down on the table and align myself under the equipment. He said to keep looking at the red light overhead. Then something was placed over my right eyeball, I assumed to hold it steady. I felt a teensy bit of pressure, then nothing at all. Balazsi covered my left eye and got to work.

When I tell this next part, most people wince. A machine with a very tiny, very sharp blade came from somewhere and made a microscopic cut, then Balazsi manually lifted the cornea over, like a little lid. My red light became a red amorphous blob.

Then came the lasering -- eight "applications" per eye, each accompanied by a little whirring noise. This is where it got very trippy. And speaking of drugs, I'd been given a Valium about 20 minutes earlier, so I was totally relaxed. When the laser hit my eye, evaporating microns of my cornea, I saw hundreds of little tiny black squiggly lines. Wow, I thought, this is what burning flesh looks like from the "inside." Cool. When the laser stopped, the squiggles disappeared.

Then Balazsi replaced the corneal flap, and I sensed him gently "tapping" it in place. He re-moved the thing holding my eye, covered it and repeated the process on the other side. The whole thing was done in minutes.

I'm a little fuzzy on the post-op. Somehow I was outfitted with plastic shields over my eyes -- taped to my face so I couldn't remove them. They had little holes for air, and were transparent so I could see to walk. But other than that I was to keep my eyes shut for the next six hours.

I popped four ibuprofen in the car. At the hotel I went to sleep, noting that my eyes were burning a little but did not "hurt like hell." I woke up nearly three hours later and squinted my way to the bathroom. The burning was gone, replaced by a mild scratchiness. I napped a little more, and eventually I could open my eyes -- though the shields stayed on until the next morning. We went to dinner at a bistro two blocks away, where everyone stared at me except the waiter; he kindly pretended not to notice I looked like the victim of some terrible accident.

Dr. Balazsi approved my eyes the next morning and gave me a pair of reading glasses that I would now need, along with some artificial tears I'd be needing a lot. The surgery severs tiny nerves in the eyes that are involved in tear production, and it would take them a while to grow back.

Elated, I got in the car with Franny to return to Vermont, reading license plates and billboards like a first-grader along the way.

When I woke up on the fourth day after surgery, something was wrong. My left eye seemed to be coated in Vaseline, the visual acuity decreased. Panicked, I called my eye doctor, and though it was a Sunday he came in to examine me at his office. "It looks like you've developed a little keratitis," he told me calmly, referring to an inflammation behind the corneal flap. He set me up with an opthalmologist that afternoon who would prescribe a treatment.

Keratitis -- diffuse lamellar keratitis, to be exact -- is not typical after LASIK, but it's not unheard of. In one study I read, 36 out of 2711 eyes developed it. The cause is not well understood; could be a speck of dust under the flap, or just the body's immune response. The condition also has the more exotic name of "sands of Sahara syndrome" because that's what it looks like under a microscope. My own sand dune was near the center of my cornea, dulling my vision. The condition is not serious if treated immediately. Long story short, I used steroid eyedrops for a month and it went away.

Nearly two months after the surgery, my eyes are still dry but improving. It is surely more challenging to have LASIK in the winter. And a recent flight taught me that only the actual desert is more arid than the inside of an airplane. I drink tons of water, generally treating myself like a wilted plant.

Others note me plying the artificial tears, but the most profound changes for me are invisible. The first, of course, is being able to see without aid. Though I wear glasses for the mounds of reading I do, on the highway I'm an eagle. Well, almost.

It's really strange seeing clearly in the places I never could before -- namely, in the shower and bed. I've had blurry baths since elementary school; what I can see now motivates me to clean the bathroom more often. From my bed, I'm still amazed to see perfectly the walls, curtains, floor. The first few days, it was shocking to see myself in the mirror. That's what I look like in the morning? Yikes. But an experience one night several weeks ago really stunned me. I had put down my book and reading glasses and, as I reached to turn out the light, I felt a sudden stab of alarm. I had to see -- I had no choice!

The utter clarity momentarily unnerved me, and I realized how accustomed I had been to the soft focus at either end of my day. Now it was gone. When I mentioned this to a bespectacled friend later, he replied that he liked "having the option of a relaxing, blurry view." Exactly, I thought. I have lost one of my options. I don't want myopia back, but I did mourn its loss just a little.

I noticed, too, that seeing well has made me feel more visible to others. Being in the blur was rather like when a baby thinks no one can see him if he puts his hands over his eyes; if everyone is hazy to me, perhaps I am hazy to them. Illogical, but there it is. I had always treasured my ability to withdraw, to be "not seen," and now I realize what a trick of the mind that was.

Probably this will pass as I adapt to sightedness. The really incredible thing, though? I feel like my vision is better in the larger sense of the word. I'm not claiming that LASIK made me wiser or anything; maybe it's just that my post-surgical affirmation worked. When I came home from Montreal, I took Franny's advice and performed a little ritual with my contact lenses and all the accompanying products. Nothing too esoteric; I just gathered them up and said out loud to the air: "Thank you for this incredible opportunity to have the gift of sight. I will use it as a metaphor and an inspiration to see everything in my life more clearly." Then I dumped the products in the trash.

I had expected that LASIK would allow me to see the world with new eyes. But I never imagined so much of the looking would be inward.

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