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What I Learned Getting Lasers Shot into My Eyeballs

by Cecilia Aiello

"What letters do you see?"

"I... I don't see any letters."

"... Ok, how about now, can you read the letters there?"

"I... I can't."

This is how I learned, at the age of 9, that my eyes were broken. The optometrist kept increasing the letter size until we were on the big "A" that takes up the whole line. I could tell that she was concerned. I started crying. I was failing my eye test... and I had never failed a test before!

It turns out I had horrible vision and serious astigmatism. I was outfitted with my first pair of glasses and had that experience all of us glasses-newbies have, of discovering with wonder that it's possible to see leaves on trees and stars at night. And thus began my life as "that kid with glasses."

I asked about getting contact lenses in high school and was told my astigmatism was too severe. It turns out that for people with nice round eyeballs a contact lens can slowly turn in circles all day long. My eyes were shaped more like footballs, and so as a contact rotated it would distort and blur my vision. I also asked about the new laser surgery on the market called LASIK, and was told I needed to be over 21 and that it wouldn't work anyway because for that you also needed nice round eyeballs.

And so I resigned myself to a life of glasses. There are far worse things. Eventually, ten years later, I was able to use contacts, with the invention of Toric lenses that were weighted on the bottom to prevent rotation. But they were uncomfortable and expensive. So expensive that I would often stretch out the "2 week disposable" time on them into 3 or 4 weeks. This was not my brightest idea ever, and led to me getting a bacterial infection under my eyelid in my early 30s. I had to wear glasses for a year after that, and was nervous about using contacts at all once the eyelid healed.

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Me in my late 20s. Look at the amount of diffraction at the edge of those lenses!

There's no way to sugarcoat it, wearing glasses and contacts sucks. It commits you to a life of fiddling - constantly pushing your glasses up your nose, wiping your lenses with the corner of your shirt, or the tedious ritual of putting in and taking out contacts. It also means you need to live more cautiously. You're the one who doesn't jump off the dock into the lake. You're the one who goes home early because your contacts are dry and burning and you need to get them out.

Having a child gave me with a new sense of helplessness. After a few big earthquakes in Japan, I realized that if something happened in the middle of the night and I couldn't find my glasses, I'd be no help at all getting my family to safety. In fact I'd become a liability as I stumbled around tripping over things and getting in the way. But what can you do?

After moving back to the US, I was listening to the radio one night in the car when a commercial came on. It said "Have you been told you're not a candidate for laser eye surgery due to astigmatism!? New technology makes it possible!"

Well ok then!

A few weeks later I was at the laser vision office getting my eyes checked. Another week later I was walking out of that clinic with 20/10 vision.

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Rocking the recovery period. 3 days of rest in a dark room.

My eyes took about a month to fully heal, and I just got my one year post-laser checkup recently. I was grinning ear to ear as she kept decreasing the font size on the chart until the letters were laughably tiny. My vision was still 20/10, and the optometrist said that looking at my cornea she couldn’t even tell I’d had laser surgery. After 30 years, I had finally passed the one test that had always made me feel so vulnerable and small.\



 

 I've learned a few big life lessons from this miraculous year of perfect vision:

People are super adaptable. Your new normal is just a few weeks away.

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For three decades, I was the guy with glasses. The first thing I'd do in the morning is reach over to the nightstand and fumble around for them. For the first few weeks after laser surgery, I still did that, my hand pawing at empty air.

But now I'm the guy without glasses. I don't think about glasses or contacts. I don't even think about seeing. I just do it. I don't think of myself as a person who used to have bad vision. I don't have sympathy for people who do wear glasses. I act like I've had perfect vision my entire life, like it's my right and privilege.

The beauty and terror of the human mind is how quickly it folds new situations into the patter of everyday life. I've seen this in action with other contexts, like when I've moved to a foreign country and within a few weeks was acting like I'd been there forever, talking to the shopkeepers, eating exotic foods as if they were toast and butter, and complaining about the weather. I've seen the same effect with people who've lost a ton of body fat, and in a few weeks don't even register how dramatically different their lives are unless they take the time to think about it. Humans don't tend to spend much time standing around in awe. We reset our definition of what's normal and get on with things.

It's a good reminder that no matter how dramatically you change your life, in just a few weeks you'll be bopping around as usual. If you want to be a more content person, the work you need to do is 99% internal. Believe it.

However, on a more positive note, knowing that no matter what happens, in just a few weeks you'll accept it as your new normal means that you're free to get out of your ruts. Take that new job. Visit that new place. Take on that project. The scariest part is deciding to change, the adaptation phase is much quicker than you think.

Beware the power of negative anecdotes.

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When I was younger and curious about laser surgery, I asked a staff person at the local Lens Crafters about LASIK while she was fitting my glasses. She sucked the air in through her teeth and said "Oh no, I wouldn't do that. I know a woman that went in for that, and halfway through the laser slipped, and now she's blind in that eye." That one, non-sourced, non-sensical anecdote kept me away from asking about laser surgery for 15 years.

Our brain-architecture is wired around loss-avoidance. In an evolutionary context, it's usually better to assume danger, even if the actual threat is quite low. We jump at a sound in the bushes even though it's only a predator 1 out of 10,000 times. With a hidden, misunderstood threat, it's better for survival to be wrong 9,999 times and right once than be right 9,999 times and wrong once. This is the root of why that single horror-story laser surgery stuck with me so strongly.

Before laser surgery, I did my homework, checked the stats, asked a bunch of questions, and tried to drag my irrational fears out into the light. Yes, with laser eye surgery there's a small statistical chance of something going wrong. But just like the possibility of being in an airplane crash, you're in much more danger on your drive to the eye clinic than during surgery.

Despite all this, even as I sat in the pre-surgery waiting room I kept recalling the anecdote about the laser slipping. (It's probably one of the things that you'll remember about this article in a few weeks!) That's the power of negative anecdotes. There's nothing we can do to make these thoughts less sticky, it's how our brains are wired. What we can do is work hard to let the analytical sides of our brains make good decisions for us, and not be ruled by our fears and aversions.

In the context of modern life, our over-reaction to perceived threats isn't doing us any favors. The world has never been a safer place, and yet we're more frightened and neurotic than ever. The power of negative anecdotes is real. Every day people make bad decisions for their bodies and their communities out of fear from something they heard of TV or saw on Facebook. Once you understand that your mind is primed to glom onto negative anecdotes, you can take a deep breath and re-evaluate the situation with a cooler head.


Science is freakin' awesome!

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Let me tell you about laser eye surgery. On my first visit, I looked into a machine and my eyeballs were scanned down to the micron (a human hair is 75 microns thick). This produced a topographic map of my eyeballs, showing where the cornea was thick and thin. It looked something like this:

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Based on the results I was cleared for PRK laser surgery. The day of the procedure I did this scan again, and that information was fed to the computer that operated the laser. My right eye was numbed with some drops, then held open with a speculum tool (this was honestly the scariest part, and only vaguely uncomfortable). The doctor then took what looked like an electric toothbrush and proceeded to, as he put it, "polish the eye." What he was really doing was scrubbing away the top cells of the corneal epithelium to give the laser a clear shot at my cornea. This is the most "hardcore" moment of the surgery, but was absolutely painless.

An arm then swung over me, about a hand's span away from the eye. The doctor told me to look straight ahead at the small LED-type lights on the arm. The lights were the usual cotton-ball blur that I had gotten used to from a lifetime of poor vision.

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A rough approximation of how the lights looked at first.

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Then the machine started to hum. The lights pulsed gently, changing their pattern every few seconds. Each of these lights were lasers shaving off the uneven areas of my cornea, as dictated by the wavefront scan from a few minutes before. There was a faint smell just like burned hair, which was of course, the smell of burned eyeball cells.

This is when the magic started. With each pulse, the lights became less cottonbally and started to sharpen up. After about 10 seconds my eye was rinsed and I was looking up at a crystal clear view of the laser arm and the ceiling above it.

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How the lights looked 10 seconds later.

In 10 seconds a lifetime of poor vision had been erased. They quickly repeated the magic on my left eye, gave me a pair of goggles, some steroidal and antibacterial drops, and told me to take it easy for three days. Total time in the surgery room - 5 minutes.

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The amount of math and science behind those 5 minutes is awe-inspiring. You've got to have Fourier analysis to make sense of the wavescan data. You've got to have Plank's theory of radiation and Einstein coefficients to know the physics of a laser, and Bell Labs in the 1960s to make these ideas a reality. You've got to have Alexander Fleming discovering antibiotics in the 30s, and across the world Russian chemists figuring out steroids at the same time, both of which went into the drops that helped the epithelium grow back quickly and without infection. And this is just the tip of the iceberg. I can't imagine how many lifetimes of study, practice, and iteration went into those 5 minutes.

The world is full of people making outrageous claims. Only science delivers the goods. I'm constantly floored by how little interest or even basic respect is given to the pursuit of science. Science took a (mostly) blind man and made him see. I feel like banging garbage lids together in the streets and screaming about this, but most people are like, "Oh, that's cool... I guess," even as they tap away on their TOUCH ACTIVATED POCKET COMPUTERS INVISIBLY CONNECTED TO A GLOBAL NETWORK OF ALL HUMAN THOUGHT!!!

If anything changes with my eyes I'll be sure to update this post, but for now, the future is looking bright. I've found that I'm more active, more adventurous, and a more present person without a pair of lenses in front of my eyes. It's a pretty great way to live.

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If you're a fortunate person with great natural vision take a few moments now and appreciate how lucky you are, and be kind to those four-eyes among us that are struggling. If you wear glasses or contacts, take another look into laser surgery, I was really impressed by how far the technology has come in the last 5 years. It's a personal decision and your own journey to get there, but don't let your fear be the overriding factor.

If you have any questions about the procedure let me know in the comments, I'll do my best to answer them! Until then, I'll be seeing you. With LASER EYES!

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