Several friends and aquaintances have asked about my experience with radial keratotomy, surgery to correct near-sightedness. I had a very good experience with RK toward the end of 1994. My previous contact lense prescriptions were -4.50 and -1.75. My eyes improved so much, I don't bother with contacts or glasses anymore. I've had the corrective lense restrictions removed from my drivers license and pilot medical certificate.
The process took some time, money and patience. I had three people tell me their experiences with it before taking action. The best advice I got was to defer judgement until at least six months after completion. There are side-effects during the recovery period that make things imperfect, but tolerable as a cost of the effort.
My doctor and I agreed to do both eyes at the same time. This is controversial, and I'm quite happy we did it that way. It meant one less round of the surgery/recovery process.
I had a friend drive me to the doctor's office. I chose a doctor in Holyoke, so this was a non-trivial favor, costing half a day of work for each of us.
They gave me a thorough eye exam to confirm my suitability for the procedure and to map out the surgical strategy. There are three variables to be planned, the number of incisions, their length, and depth. They gave me anesthetizing eyedrops as well as drops to undilate the pupils. They gave me some valium, at my option. When the drugs were all in effect, they walked me into a room similar to the examining room, though they were all in surgical garb at that point. I sat in a reclining chair, just like from a dental office.
The surgeon moved a circular light about twelve inches from my face and told me to keep looking into the light. This was quite comfortable, since my eyes were undilated to minimum light sensitivity. The only discomfort was when he put a clamp on me to hold my eyelid open--it pinched a bit, and nothing makes you want to blink as much as not being able to blink!
The contact with the eye itself turned out to be a surprisingly comfortable experience. As I had learned from years of contact lenses, the surface of the eye is texturally similar to that of a hard-boiled egg, so I could sense the pressure, but it was not painful. There was no psychological discomfort in seeing the instruments approach the eyes because he was working so close to them as to be beyond the nearest focal point of the eye. As there was pressure from an instument, my view of the circular light would be slightly deformed correspondingly.
The sequence went like this. He started with an instrument taking some sort of depth/pressure measurements. A nurse read him a series of numbers from the instrument. He then took a die and stamped an impression on the cornea of lines where the incisions would be made. He then took the special-purpose RK scalpel and made one of the incisions. All I sensed was a ripple in my image of the light. He then did two more. He shifted position and did three more. He shifted once more and did numbers seven and eight. He did a few more measurements and then took off the clamp. The clamp was in place for less than five minutes. Then he did the other eye.
About fifteen minutes after I walked into that room, I was done and walking out. They had my friend come into the room so he could hear my instructions, and then we walked out. My eyes were teary and scratchy--in fact I had scratched corneas, very carefully scratched! But through my tears, I could see things were different. Once we got to the car, I closed my eyes and let them rest during the trip home.
There were four prescriptions which I had gotten filled in preparation for the surgery. There was a sleeping pill for immediately after I got home from surgery. There were pain pills for the next couple of days, and there were two eyedrops, one an antibiotic and the other, steroids. It did sort of seem like my eyes were on steroids, since they've gotten so much more efficient, but the point was to help the healing process.
When I got home, I took one dose of each, had my friend start a log of the medicines, and put myself to bed. This was on Friday. I woke up the next morning and did not want to open my eyes. I made my way to the bathroom like a blind man, and forced my eyes open for the eyedrops. I took the pain pill and went back to bed. By Saturday night, I was up eating dinner served by another friend by candlelight. The chief problem I faced was light sensitivity. Sunday morning, another friend brought breakfast, and the scratchy pain was mostly gone, but I still didn't want to keep my eyes open to the light. By Sunday afternoon, I was up walking around the apartment, which motivated me to open my eyes more often. By Sunday night, I was able to watch television, literally looking at a light source. Monday morning, I used public transportation to go to work.
At lunch time, I was informed I had a business trip the next day. By the way, I had left my car in the shop Thursday, and it was now ready for pickup. One problem--I no longer had suitable eyeglasses, but my license required corrective lenses. So I got a lift from work to the Registry of Motor Vehicles, passed the eye test and got a new license. I got the car out of the shop, went back to work, picked up tickets for the trip, and left. The next day found me driving an unfamiliar car on unfamiliar streets with no glasses.
Now at this point, I should explain that I was realizing that my vision was not perfect. The left eye came out really well, but the right still needed some correction. Since it is much easier to correct for undershooting than overshooting in this surgery, the goal is to undershoot. The right eye was about 20/70, and the left was 20/30. It was a challenge to read the street signs. My eyes also had a disarming propensity to water like crazy an hour after I woke up, making the drive from the hotel to the customer into an adventure. As the trip progressed, the morning drive became easier because I got to know the route and my eyes were settling down.
When I got home, I shuffled through my old eyeglasses and found a pair from my teenage years. Guess what my prescription was back around the time of my Bar Mitzvah! I was finally rewarded for being a packrat. I used the glasses for driving for about a month, and scheduled enhancement surgery for the right eye. The doctor and I agreed to leave the left eye alone since it was already good enough. In fact that turned out to be an excellent decision, since it has subsequently drifted to 20/20 in the healing process, which would have otherwise turned into an overshoot causing me to need reading glasses. Someday, I will need reading glasses.
When I went for the enhancement, I braced myself for the entire process all over again. I got all the prescriptions again. No one pharmacy had all of them--I had to call around. I lined up another friend for the half-day off Friday. I cancelled all plans for the weekend and planned to have friends look after me in shifts again.
It turned out a bit different. They gave me only half the dose of valium. Instead of undilating my pupils, they dilated them. This made the light seem pretty bright. He did the clamp thing, tooks some measurements, and made tiny extensions to the incisions. Three minutes, perhaps. I went home with a teary eye and a good eye. I took my medicines and went to sleep. I woke up Saturday morning and everything was fine. I was not in pain, I was not especially light-sensitive, and my vision was much better. I no longer needed my ancient glasses. I was almost done. Instead of my friends taking care of me, the weekend turned into a party where I got to host them. I actually went out to a concert on Saturday night.
Over the next couple of months I went back for checkups. My eyes got better. They seem to have stabilized at 20/20 and 20/25, which is just fine with me. The 20/25 eye will turn into my reading eye during the transition to needing reading glasses--its near vision will remain longer than that of the 20/20 eye.
I'm reluctant to discuss price because the prices I found at different clinics varied so much. I ended up going to a friend of a friend, and I don't know if the price I paid is available to just anybody. I do know that it was on the condition that I do both eyes at once, saving the doctor the time of dealing with me for twice as many visits. If you ask me, I will tell you. Other than that, I will tell you that I was generally quoted between $1500 and $2500 per eye. I paid less than that.
It's been a year since I had the initial surgery, and I agree with the friend who told me it was the best gift he ever got himself. It's hard not to gloat when friends complain about their contacts bothering them. I no longer have to stock solutions or worry about having a case and saline for when my eyes get tired. When I wake up, my eyes are all ready to go. I can read the display on my stereo across the room from my bed. I no longer have to bring an emergency pair of glasses when I fly a plane. My toiletry kit is now much simpler for travel.
I now view glasses and contacts like prosthetics. They are
important fall-backs for when surgery cannot correct the problem. But
when the problem can be fixed with surgery, why just live with
prosthetics?
As of my annual eye exam in 1998, my eyes are both 20/20
uncorrected and doing fine. As I experienced with glasses and contact
lenses, my eyes are not 20/20 by the end of the day due to fatigue.
They also vary with my general physical condition, and the right eye
is more susceptable to glare than the left; I don't know if that's
related to RK. I continue to be somewhat light sensitive, but have
required sunglasses since childhood, so I don't attribute that to RK.
The surgeon left his practice to open some other businesses; I have
no idea what to make of that career transition, but he's still listed
as an opthomology provider in one of my health insurance guides.
An aquaintence recently reported to me that improvements in laser
techniques have made the process much quicker and less painful.
Apparently the epithelium no longer needs to be peeled away to the
same extent as with earlier laser techniques. His lover (hi Keith!)
was a very happy customer.
Back to Doug's
writings page
Post-script