I can see clearly now - eye laser surgery

Men's Fitness, Sept, 1998 by Robert M. Kahn

After 20 years of wearing thick glasses, laser surgery allowed Robert M. Kahn to see without them. Could it be the answer for you, too?

Life without glasses. That's the goal I keep repeating to myself as I sit at the Massachusetts Eye and Ear Infirmary in Boston, gripped by fear, waiting to have a laser burn into my eyeball.

I lean back in a reclining chair and try to enjoy the Valium coursing through my blood. A doctor, one of about five people in the room, pries open my numbed right eyelid with a speculum. I hear the squeak of ink on flesh as he draws with a surgical pen directly on my cornea. Those etchings will help him position the microkeratome - a small, hand-held slicing device that pulls back part of the eye's surface tissue.

What am I doing here, among these high-tech devices that look like they should be used to torture James Bond into revealing Her Majesty's state secrets? In a way, I'm a pioneer: I'm about to become one of the first people in Massachusetts to have LASIK surgery, a process that can dramatically enhance the eyesight of people with strong-to-severe nearsightedness.

I've been myopic since I was seven years old, and the strength of my prescription had gradually increased over time until I needed Coke-bottle-thick glasses to see. And I was fired of it. Despite the risks of the surgery (there's a small chance of scarring or brand-new vision problems), as my surgeon has repeatedly reminded me, having this operation was my own idea.

Those in the know refer to LASIK, or laser in-situ keratomileusis, as the "flap-and-zap" procedure: An instrument lifts up a flap of the epithelial layer of tissue covering your cornea, then a laser comes along and zaps the cornea, making it flatter. After all the research I've done on LASIK, the creation of the flap is the part that terrifies me most. And because the only anesthetic used during the operation is a few drops to numb the eye, I'm awake when it happens. Yet I simply hear fidgeting and feel some pressure on my face. "When are you doing the cut?" I ask. "We just did," responds Dimitri Azar, MD, director of the hospital's refractive-surgery services.

Now it's time for my encounter with the laser beam, which will determine how much my vision improves. I remember Azar's words during one of our pre-op meetings: "Because the laser is being applied so close to your nose, you may smell some burning flesh." The laser unit is pushed in front of my face. I see a tiny green light in the center, surrounded by a smaller circle of lights. "I think I saw this on The X-Files last week," I say hazily.

I stare into the machine and listen to a series of quick, loud snaps, like the sound an insect makes when it flies into a bug zapper. Each is a pulse of the laser as it shaves off a microscopically thin layer of tissue. "Stop moving your eye," Azar admonishes. I try to stare at the light in the center, but my eyes are watering so much that it's blurry, and I often lose sight of it entirely. Luckily, I manage to keep still.

Finally, the raised flap of tissue is put back in place. I feel Azar manipulating it, the way one might straighten a piece of cellophane over a freshly iced cake. Then he tapes my eyelid shut and puts a metal shield over it. The operation ends - all 10 minutes of it. It was painless.

I go home, fall into a deep sleep and don't wake up until 8 a.m. the next day. Then I hop out of bed and head straight back to Mass Eye & Ear, where another doctor slowly removes the shield and untapes my eye.

This is the moment of truth. Will I be able to see at all? Will I be sensitive to light? Will I be in excruciating pain?

I open my eye. The doctor tells me to look at the vision chart on the wall. I read one line. Then the next. And the next. Right down to the 20/30 line and a little below that, too.

I'm speechless for about 15 seconds, then just sit there mumbling holy cow, or something to that effect. The doctor schedules a follow-up visit for 48 hours later and tells me to go to work I leave the hospital, get on the train, and am back at my desk 20 hours after the operation.

Four weeks later, they perform the surgery on my other eye. The results this time are even better.

Today, my vision is about 20/35 in my right eye and 20/25 in the left, with a slight astigmatism that makes light a little blurry at night. My eyesight is not as clear or sharp as it was with thick glasses, but then I didn't expect it would be. As another LASIK patient recently summed up her own experience, it's as if I've gone from getting around in a wheelchair to walking with a slight limp.

Eyeballing surgery

If you aren't totally grossed out by now, maybe you're wondering whether laser eye surgery is for you. You're a candidate if, like more than a quarter of all Americans, you suffer from myopia - in other words, distant objects appear blurry. Nearsightedness is caused by excessive curvature of the cornea; laser surgery improves vision by flattening it.

To be considered a good candidate for LASIK surgery, your eyeglass or contact-lens prescription should have been stable for at least one year. And you'd better start saving: Costs typically range between $2,000 and $2,500 per eye, and most insurance policies won't cover it.