This article is intended to supplement existing descriptions of laser eye surgery by being specific to an area, and by being new. It provides an example experience of laser surgery in Southern California, occurring from May to June of 2009.
On May 7th at 4:30 in the afternoon, I called the TLC Center in Ontario, California. I asked what the cost of LASIK for my eyes would be. Dawn, a counselor, took my call and said $2,300 to $2,600 per eye. I asked how many surgeries the TLC Center did per year, and of those, how many had complications. Dawn told me that in 2008, they did 5,000 surgeries. The highest complication rate was 2-3%, which denoted those who experienced dryness in the eye (I don't know if the dryness was chronic).By the end of the call, Dawn and I had scheduled appointments for the counseling, preoperative exam, and operation. The preoperative exam and counseling session was scheduled for May 14th, and the a tentative surgery was scheduled for May 21st. At this time, I had myopia and minor asitigmatism, yielding vision quality of roughly 20/200.
On May 14th, I looked up the route via Omnitrans bus, and walked twenty minutes to the nearby bustop with $3.50 for a day pass. Two buses and three hours later, I walked into the lobby and was greeted by Virginia, one of the center's many friendly nurses who worked at the reception desk. Within ten minutes, Dawn opened the door to the waiting room, called my name, and we met face to face for the first time. We began the preoperative exam.
Dawn, Dr. Jenson, and Dr. Pirnazar took turns evaluating my eyes. They took my prescription, examined the shape of my cornea, and did some other tests that I didn't recognize. In Dr. Jenson's words, I was a "textbook case" for the surgery. It was Dr. Pirnazar who would perform the actual surgery. He was a large, strong man with a radiant, friendly voice and engaging demeanor.
A week later, I took the same system of buses to the center. This was the day of the surgery. By this point in time, I had spent $90 on three prescriptions: Lotemax, Zymar, and Restasis. My Blue Shield PPO plan had paid for the costs beyond $90. Dawn told me that these prescriptions are valued in the hundreds of dollars. Lotemax and Zymar are intended to help keep the eye healthy in the window of time surrounding the surgery date. Restasis is a tear stimulant that, over time, trains the eye to produce more tears than normal. It is taken for about a month and a half of time surrounding the surgery.
Over the next month, I would spend about $30 on over-the-counter artificial tears - these had to be preservative free, which I think requires that they come in small, single-use containers. At the two drug stores, the only artificial tears explicitly labelled as preservative-free were also also single-use. I tried two brands: Bausch & Lomb and Optive. I preferred Baush & Lomb, because their single-use containers would yield several drops instead of just a few, and I could re-use the same container throughout a couple of days. Anyway, these artificial tears were taken every 1-2 hours for one month after the surgery, and they serve as general-purpose lubricants to immediately relieve dry eyes.
But back to the trip on the day of the surgery. On this trip, I brought along my checkbook and driver's license, which would be used to pay $4,500 as soon as I greeted Virginia in the lobby. Through some technological means, they processed the check as soon as I handed it over, although the balance wasn't deducted from my bank account for another few days. This covered the total cost of the surgery. Dr. Pirnazar was giving a discount (supposedly due to the economy), and thus this cost was cheaper than what Dawn had quoted me over the phone.
The procedure was largely automated. First, I went through an "intralase" procedure, which roughly 40% of patients go through. It is the most modern of the available methods for creating an outer corneal flap, because it uses a laser instead of a physical blade, or microkeratome, to open the flap. The laser creates some gas bubbles under the eye's surface, which in turn force the flap open. As I sat in a chair for this, it was easy to hold still as the laser created the flap. After doing one eye, the other was done. The laser spent about 15 seconds per eye, and I remained laying down for several minutes. I felt nothing, but at one point my eyesight went grey, which is normal at this step.
After this, I could barely see. It was a little like sudden bright light after being in the dark for a long time. Now it was time for the vision correction, which would be done by a separate laser.
The doctor let me stand and his assisting nurse guided me to another chair about 10 feet away.
I laid into position, and Dr. Pirnazar prepared one of my eyes for the LASIK laser. As I stared up into the machine, I saw what looked like a complex grid of dozens of red LEDs. A thick green light was in the center, and I was told to focus on the green light, even as my eyesight went blurry. An eyeball tracker checked my eye position about 4,000 times per second. If my eyeball had stopped looking at the green light, the machine would've shut down. I was able to hold still, however. I felt no reflex to blink, and even if I'd wanted to, my eyelids were held open. As the laser reshaped my cornea, the machine emitted a very mild burning scent. The smell is normal, and vaguely resembles a burning PCB board. No actual burning takes place in my eye, though - the laser itself is cool. It was active on my eye for about 30 seconds. On some patients, this takes up to 45 seconds. Upon completion, Dr. Pirnazar returned the corneal flap into its place. Then he did the other eye.
As I stood up from the surgery, my vision was washed out, as if I'd just opened my eyes in a swimming pool. Light was mildly irritating. Before leaving the surgery room, Dr. Pirnazar and I posed for a picture. Then, I was given protective plastic eyeware (like cheap Racketball goggles).
As my roommate drove me home, I was producing so many tears that they temporarily spilled into my nose. This is normal following surgery. I took a Xanax that they give everyone for free on the day of surgery (for sleeping), and slept with the eyeware. It is strongly recommended that all patients go to sleep after the surgery.
30 hours and another $3.50 later, I sat in the examination chair and passed a 20/20 eye exam. My left eye was 20/20, and my right eye was 20/15. My present side effects included severe halos (glowing lights) at nighttime, mildly overpowered brightness at daytime, marked dryness upon waking, and occasional irritation, as if an object was in my eye. The glows/halos are understood to persist for 1-3 months, as the eye continues to heal.
During the one-day-after examination, Dr. Pirnazar observed a small "fiber" lodged in my left eye, which was a little unusual. This would make my left eye more uncomfortable than my right eye during the first week of healing. To monitor progress, he asked to see me on a weekly basis for the next couple weeks. On these visits, he told me that my left eye was gradually "melting" this debris, and it was being absorbed back into my body by my eye's natural healing process.
One of the primary concerns here was that my body would aggressively react to the foreign body, concentrate white blood cells into the area, and inflame the eye. Inflammation is the main scenario that Lotemax is designed to fight, so I continued this prescription for three weeks, compared to the ordinary one week recommendation.
During the first week after surgery, my eyes were particularly vulnerable, and I needed to avoid any heavy physical exercise. The purpose of this was to avoid cringing due to physical stress, and of course to avoid being physically struck in the eye. I needed to avoid swimming, and to avoid getting water in my eyes during showers. I couldn't stare at a computer screen without frequently taking breaks and lubricating my eyes with artificial tear drops.
The second week after surgery was much more enjoyable than the first. I felt very little irritation during the day. With this new comfort, seeing things at all times became a newfound pleasure. I wasn't wearing glasses anymore, and this fact seeped into my daily self-awareness. My confidence and freedom probably increased by about 5%.
Six weeks after the surgery, my symptoms were almost entirely gone. I was able to be awake at all hours of the day without needing artificial tears - the dryness in my eyes was gone. The glowing halos around light sources at night was also generally gone. Only certain lights at very far distances exhibited a small glowing halo effect. Irritation only occurred at the end of my day.
I am very satisfied with my experience. The advantages are more or less the exact same freedoms that most people enjoy with contacts, only my vision is even slightly better than 20/20, and I don't need the contacts.
One ideal of my philosphy has been to live as simply and as mobile as possible, and this helps. Now, there is one less physical item that I need to own and worry about. I can physically move with more ease.
Cost Summary of the Surgery:
| Surgery | $4,500 |
| Prescription Drugs (after Health Insurance) | $90 |
| Artificial Tears | $40 |
| Bus Fair for Routine Checkups | $17 |
| Total: | $4,647 |
