See Change, Part 1

I remember when I started wearing glasses, in third grade (1970). These days I think they test kids a lot younger, but back in the day that was the first test I took and I needed glasses pretty badly. I used to always sit in the last row of class, and on that first day with glasses I went to my normal seat and was amazed when the teacher started on her material.
I couldn’t believe it – she was writing stuff on the wall up there!! All this time I thought she was just telling us stuff, I had no idea she was writing things on a “blackboard” and pulling maps down from rollers. Wow.
I told her this at morning break, and she looked at me funny, in a way I ow recognize as disbelief, and moved my seat to the second row, permanently. I forget if it was her or my Dad who said, “No wonder your handwriting is so bad.” [And people ask, “How did you decide to study psychoacoustics in college?”]
Today, 37 years later, my prescription was nearly -10 in the right eye and nearly-11 in the left, including some astigmatism in the left eye. If 20/20 is normal” vision, this corresponds to approximately 20/2,000. What other people could see at 2,000 feet, I could only see at 20 feet. The problem with lenses this strong is that the light is distorted by the lens except at the very center. With a strong lens, that center area is very small. So as my eyes scanned across a page of text, the eye would see distorted, then focused, then distorted text. The brain can process it, but it takes more cycles, and it’s fatiguing. I used to be the fastest reader I know, these days, not so much.
Of course, there’s all the usual reasons why wearing glasses sucks: Raindrops in the rain, fogging up when you walk inside during the winter (six months, here in New Hampshire), and getting smudged with every kiss, etcetera.
So, after five years of occasional research and consideration, last Thursday I had Lasik surgery at Laservue in Montreal. Technically, in their marketing-speak, thin-flap, high-definition, custom-wavefront Lasik. Here’s the story.
It’s a very modern clinic, on the second floor of a medical office building. The area I saw was about half the floor. It appears they have most of the whole floor, but we weren’t in the other half.
I checked in at 1 PM. I gave them the patient consent form, checked my basic information, and gave them my hotel information. After a short wait, a technician took me to what would be the first of six testing and treatment rooms. She started with the CRS-Master wavefront measurement and a standard refractive test. This created a computer map of the topology of each eye, and programs the laser how to do its work. We moved to a second room and she measured the thickness of my cornea (and the curvature too, I think). Then we went to a third room, much like a standard optometrist office, where, in fact, an optometrist conducted the standard subjective eye exam.
After confirming that indeed I was a candidate for surgery (verifying the pre-testing dne by my local eye doctor), and confirming that indeed I would like to have the surgery done, they sent me to billing where I signed the billing release and ran the Visa card. $2,400 Canadian, currently with a ~10% discount rate to the US dollar.
She directed me to a second waiting room, and soon the two doctors came out to have a discussion about my supposed allergy to Proparicaine HCL, a common eye numbing solution. Long story short, they were pretty darn sure I wasn’t allergic, but had a vasovagal syncope, common among young men, which is when I was originally diagnosed. They asked a few other questions, nodding and looking at each other knowingly, until one finally said, “Classic.” They would put a single drop into each eye and look for a reaction, but didn’t expect one.
They took me to another room where a paramedic asked me to lay on the table. I said, “This is it, right? This is probably the last chance to use the bathroom before surgery?” It was happening kind of fast at this point, and it suddenly occurred to me that, you know, there was a certain amount of fear, and, well, peeing my pants would be unfortunate. So I ran off to the restroom, whilst Kathryn, the nurse, and the doctors had a brief laugh. “That’s certainly a nervous pee,” he said. As it turned out, I’m glad I went.
So then I’m back in pre-op, laying on the table, being told, “Okay, look straight up (drop into each eye), look up toward me [she was standing behind me, at the head of the table] (another drop), look down at your shoes (drop, drop).” This went on for several rounds, and if you go read anything about the Lasik surgery procedure, you will know why they want the eyes good and numb. At one point I was unable to look down at my shoes. I tried, but couldn’t seem to do it, and I think at that point they know they’ve got enough in there.
Next, stand up, a little weirded out by the heavy eye numbing, and the next thing you know I’m laying on the table of the Zeiss MEL-80, an excimer laser.

At this point you can see my sleeve rolled up – they had given me a shot of Atropine, to control that vasovagal syncope, and on the television screen you can just barely make out a close up of one of my eyes under the laser. And how does the laser work, exactly?

Rather than burning or cutting material, the excimer laser adds enough energy to disrupt the molecular bonds of the surface tissue, which effectively disintegrates into the air in a tightly controlled manner through ablation rather than burning. Thus excimer lasers have the useful property that they can remove exceptionally fine layers of surface material with almost no heating or change to the remainder of the material which is left intact.

Here is what I remember of the surgery itself. All of this happened in less than ten minutes, maybe five or six. I lay on the table, and they put the bolster under my knees. The table is motorized and it rotates me under the laser. I get the shot. I am positioned to work on the right eye first. They put a clamp on my eyelid to hold it open. They tell me to look at the green spot – which is actually a wide green pattern, kind of like a snowy TV screen, or a 2D barcode. The nurse says, “Now we will let you hear the sounds of the surgery, so they will be familiar. First, the [name I forgot] will position your eye, then the microkeratome will make a sound [buzzing sound], then, finally, the laser will make a high-pitched sound.” The doctor held my head. The second doctor took my pulse. The microkeratome was lowered toward my eye. The nurse called out two numbers, something like, “436, 528.” The doctor said, “Lower,” which I took to be a confirmation, or a “Go” statement, rather than a directive.The buzzing started. My sight went very blurry. “Keep staring at the center of the green dot.” I thought, “No turning back now.” Funny time to think that, but whatever. The buzzing stopped. Through blurry vision I saw a clear sheet with a hole in it placed over my eye, probably a sort of bib to protect the eye from debris. The high-pitched sound began.
I did a lot of reading about all this, over five years, but no one, nowhere, told me there would be a smell, like burning hair. So I stopped breathing through my nose.
A few seconds later, at most a minute or two of ablation, the doctor said, “Perfect.” The laser stopped, he removed the protective sheet, the flap went back onto my cornea, and he started putting drops in my eye while it sealed in place, which took maybe 10 – 30 seconds. The table repositioned me for left eye treatment, and we began again. The left eye took a bit longer because it was a stronger correction. I was twitchier, and tried to focus on my breathing.
And then, the table moved me out from under the laser, and the doctor said, “Aren’t you glad you don’t have four eyes?” which is a very funny double entendre, if you think about it. Even at this moment, through blurry, wet eyes, I could tell the light was entering my eyes totally differently.
They walked me across the hall to a typical optometrist setup, and did a close inspection of each eye. My left eye had a ‘piece of mucus’ he carefully brushed away – this could have been a euphemism for making sure the edge of the flap was not curling up. In any case, he did that, said, “Perfect,” and they taped plastic shields over my eyes, which I wore until the next morning. I got some basic instructions, and we walked down the hall, got our coats, and some water, and drove out of the parking lot at about 2 PM, one hour after checking in.