Eyes Wide Cut
LASIK surgery promised to free me of the glasses I’d worn since childhood—but I’d have to have a tiny incision in each cornea. Was it worth it? Yes.
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IT’S THE AFTERNOON RUSH HOUR, and Austin’s MoPac expressway is clogged with traffic. My wife, Jessica, is behind the wheel, nudging us, inch by inch, toward the New Horizons Vision Correction Center at Seton Northwest Hospital, where I will undergo LASIK eye surgery, a.k.a. my “miracle.” That’s what everyone calls LASIK—a miracle.
But our slow progress has given me time to think, which is not good because what I’m thinking is this: Given that the operation involves slicing the eye open with what amounts to a tiny band saw, the real miracle is that anyone in his right mind would ever willingly undergo it. In fact, for weeks now I’ve had a movie scene stuck in my head: the opening of Luis Buñuel’s Un Chien Andalou, in which an eyeball is sliced in half by a straight razor. It is one of the most horrific scenes in the history of cinema, and I’m fixated on it, which puts me in a mood not appropriate to the miracle at hand.
“So,” I grouse, surveying the giant parking lot that MoPac has become. “This is why I’m getting eye surgery? To see this more clearly?” Actually, to see this more clearly is precisely why I’m getting LASIK (which stands for “laser in-situ keratomileusis”). Not this this, but the this that is my hometown.
I’ve been wearing glasses since the third grade, nearly four decades ago. I’ve always hated them. They gnawed into the back of my ears. They gouged into my nose and constantly slid down, causing me to spend half my life with an index finger in my face pushing them back up. And sometimes they broke, as they did the time I was playing basketball a couple of years ago and I turned around and got a face full of ball.
But the real problem was the vision itself. The frames created a border around the world. And even though I cleaned my glasses constantly, I could never get them quite clean enough; my view of life was usually dirty and smudged, as if I were looking out from behind a windshield that’s just come through a West Texas rainstorm. I wanted to see the world clearly, without smudges, without scratches, without an ever-present frame around it.
But the cost of LASIK was daunting. The procedure runs about $4,000 or more for both eyes. And because it is considered cosmetic, most insurance companies won’t pick up the tab. Then there was the little matter of safety. There is no recorded case in the United States of blindness resulting from LASIK. And complications occur in only 5 percent of LASIK surgeries; the vision of the vast majority of those patients is later corrected to, at worst, 20/40, which is legal driving vision. (A word of explanation about these numbers: The higher the second one, the worse your vision. If you have, say, 20/600 vision, you’d have to stand within twenty feet of an object to see it clearly, while a person with perfect, or 20/20, vision could see it from six hundred feet.) All things considered, a worst-case scenario of 20/40 was pretty great. Still, these were my eyes we were talking about. In the deep recesses of my mind the thought nagged, “What if something goes horribly wrong?”
I deliberated for months. Thinking about the procedure one afternoon, my mind wandered as I gazed out my living-room window. I’d heard of people who traveled to foreign lands to undergo LASIK so they’d wake up and see an exotic landscape. I would wake up at home. I’d see the live oak trees, the scraggly grass of my front lawn, and the Xeriscaped yard of a neighbor across the street. The prospect of seeing the place where I choose to live—and of being in some inexplicable way more involved with it because the shield of my glasses would no longer separate me from it—filled me with trembling anticipation. I decided that instant to have the LASIK surgery.
The procedure has emerged as the darling of ophthalmology since it became available to the general public in 1995. According to the technology and management consulting firm Arthur D. Little, the number of eye surgeries performed in the United States has soared from about 80,000 in 1996 to almost 900,000 this year, the growth due exclusively to LASIK.
One of the most prominent new LASIK fans is Troy Aikman. The Dallas Cowboys quarterback, who started wearing contacts when he was fourteen, had the procedure done last February. “I was 20/600,” he says. “I couldn’t even read the big E on the eye chart.” LASIK improved Aikman’s eyes from 20/600 to 20/20. “He sat up [after the operation] and read the clock on the wall,” says Dr. Harvey Carter, the Dallas ophthalmologist who performed the surgery. “His first word was ‘wow.’” Carter chuckles. “This procedure definitely has the wow factor.” Aikman says he had the surgery to be rid of the inconvenience of contacts: “The thing I like best is being able to watch TV at night and fall asleep on the couch and know that I won’t have contacts stuck to my eyes.”
Indeed, such pedestrian considerations seem to be the main reasons most people have LASIK. I had watched a video on the procedure that showed people skiing and mountain climbing and in-line skating, all activities they presumably couldn’t do before having eye surgery. Message: LASIK surgery will change your life. But I’d be satisfied if I could just go swimming and find the spot where I’d left my towel without wandering around like Mr. Magoo.
I discussed eye surgery with my optometrist, Dr. M. D. Jackman, who during an earlier visit had told me I needed trifocals for my aging nearsighted eyes. He ran some tests, including making a “map” of the shape and condition of my corneas on a computer. The cornea, the clear membrane at the front of the eye, provides about two thirds of the eye’s focusing power. Myopia, or nearsightedness, results from the cornea’s being too steeply curved, which causes all but the closest objects to appear blurry. To correct the condition, the surgery flattens the center part of the cornea. (For farsightedness, when the cornea is too flat, the laser steepens the cornea’s curvature by removing tissue from its sides.)
After running the tests, Jackman told me that I was 20/400 with an astigmatism (meaning the cornea is oblong instead of round), and concluded that I was a good candidate for eye surgery. There are three types of surgery available. Radial keratotomy (RK) is the oldest, dating back to the early eighties. (“Kerato” means “pertaining to the cornea.”) It involves cutting the cornea in a radial pattern around the pupil and is rarely used anymore. Photorefractive keratectomy (PRK), the first laser vision surgery, was invented in 1987. It uses an excimer laser, which produces a powerful beam of ultraviolet light, to reshape the cornea. The excimer is known as a “cool” laser because it does not burn tissue but rather ablates it, like wind taking soil off a lawn.
LASIK goes PRK one better. It combines the excimer laser with a surgical instrument called a microkeratome, which cuts a tiny flap across the outer layer of the cornea. The flap is lifted up and the laser’s ultraviolet light is then applied to the inside of the cornea, flattening it by removing a superficial layer of tissue. (In ophthalmology circles, the procedure is known somewhat indelicately as “flap and zap.”) Only a slight incision requires healing, rather than the entire surface of the cornea, as is the case with PRK. LASIK is painless and takes about ten minutes per eye, and the recovery time is normally only a day or two, compared with several days to a week for PRK.
Jackman recommended the procedure for me but warned that its immediate results can vary quite a bit. In most cases, people experience little more than a slight headache, if that, and are able to see clearly the next day. However, he said, full correction can take up to several months, and in rare cases a second procedure, called an “enhancement,” is required. He said the condition of my eyes would likely prevent me from achieving 20/20 vision, but he was confident that I’d attain at least 20/40, and probably 20/25. And even if I did make it to 20/20, he added, I would have to wear reading glasses. The inability to read small print is unrelated to the causes of nearsightedness or farsightedness. It results from a condition called presbyopia, which people in their forties develop, and because it has nothing to do with the cornea’s shape, no surgery, not even LASIK, can do anything about it.
Most people just go in and have the procedure, but a few, like me, are given a Valium beforehand. (Maybe they’ve also seen the Buñuel film.) Jessica and I arrive at the New Horizons Vision Correction Center, and Jackman escorts us into the room where Dr. Tom Walters will perform the surgery. I lie back in a reclining chair, and a technician puts a few numbing drops in my eyes, the only anesthetic necessary. I’m told to stay as still as possible. After a few minutes, a speculum is inserted to keep my right eye open. The speculum feels a little weird in my eye—not painful, but like something I might want to scratch. Perhaps because my mind is concentrated on the surgery about to take place, the inability to blink doesn’t register as a sensation, only as a fleeting thought.
The laser looms above me, and I stare into it, at a blinking red dot. The microkeratome is fitted over my eye. I’m told that everything will go black for a few seconds. A technician steps on a foot pedal, and the microkeratome’s tiny blade cuts across my eye, making the flap in my cornea. Despite the Valium, I feel myself tighten with a slight panic, caused not by pain—there is none, only a slight pressure on the eye—but by having been plunged into pitch darkness and by my Un Chien Andalou imaginings.
The top of the cornea is peeled back. Then Walters fires up the laser, which makes a clicking sound, and alters the curvature of my eye. He then puts the flap back down and smooths it into place. The speculum is removed, and a few drops of solution are put into my eye to prevent infection, swelling, and pain. The procedure is then repeated in my left eye. Again, there is a little discomfort but no pain.
When the procedure is over, half an hour later, I sit up and look at the clock on the wall. “Six-o-three,” I exclaim. I’m beaming with wonder at my ability to see without glasses. It seems like, well, a miracle. The exultation, however, is short-lived. As I walk through the hospital corridors with Jessica and Jackman, everything is hazy. “I know that’s an exit sign,” I say, “but I can’t read the letters.”
“That’s fine,” Jackman says, reassuringly. “You shouldn’t be able to yet.” Jessica drives us home. There’s little traffic on MoPac, which is itself something of a miracle. I test my eyes on the road signs. I am able to read them only a split second after Jessica can, though they are fringed with haze.
We get home and have a light dinner. Afterward I put drops in my eyes, as instructed, tape clear lenses over them to keep me from rubbing them during the night, and go to bed. The next morning, as excited as a little kid on Christmas morning, I wake up and look at the digital clock. I can make out the numbers: 5:47. But, still, there is haze. I race downstairs and look out the window. Somehow, even through the visual fuzz, I see the world, my world—the live oaks, the scraggly grass, the Xeriscaped yard across the street—with amazing sharpness. I’m simultaneously amazed and disappointed. Jackman had told me that it might take a while, but the thick haziness makes me wonder if the operation didn’t work.
Later in the morning, I have a post-operative appointment with Jackman. He runs some tests and says everything is good. “You’re at 20/40,” he says. “You’ll notice your eyes improving through the day.” In the afternoon I go to my son’s basketball game. The hardwood floors gleam with an almost surreal shininess in the natural light that streams through the open windows. Outside, the trees seem almost to pulsate with visual articulation. I’m uncertain whether I have my new eyes, a particularly beautiful day, or my imagination to thank for the clarity, but I love what I see.
In the evening I drive to a book-signing party for a friend. Let me say that again: I drive—without glasses. There are starbursts from the oncoming headlights, but no worse than when I wore glasses. People can’t believe that I had surgery 24 hours before. I shrug. I’m already getting used to this miracle.
But it turns out to be an imperfect miracle. My vision is now 20/25. Even though I was told beforehand that I probably wouldn’t attain 20/20, I am nonetheless slightly disappointed that I didn’t. But I can live quite happily with 20/25, which more or less means that I read road signs a split second after someone with 20/20 does. My vision is quite sharp, at least as sharp as it was when my glasses were dirty, which was almost all the time. And knowing that I will never have to rely on glasses again is wonderful, even if it does mean seeing MoPac at rush hour all too clearly.