Tom Morrow's LASIK Journal

The following is a journal of my LASIK experience, including an surprising complication with the epithelium:

Pre-op:

Before the operation my eyeglass prescription was:
OD (right eye) -8.75 +0.50 x150 equivalent sphere = -8.5
OS (left eye) -7.75 +1.00 x085 equivaletn sphere = -7.25
This prescription gave me 20/15 vision with glasses pre-op; without the glasses I was about 20/800.
My pupils measured 5mm wide under normal room lighting, and 6-7mm in extremely dim lighting. This seems to be at the wide end of the range treatable with minimal risk of night haloing.
Dr. Kawesch decided that he would correct the sphere in both eyes, and the astigmatism in the left eye only, since the .5 diopter astigmatism in the right eye is not significant, and it looked irregular on the corneal topos.

I realized that one way I could improve the outcome of the operation was by making sure that I don't move my eye during the laser ablation, so I got a red LED light (the kind used as a taillight on a bicycle), and practiced staring at that (one eye at a time) in a relaxed way without moving my eyes, every day for a week before the surgery.

I had researched the operation enough to know that experience and availability of followup care are very important, so I chose Dr. Kawesch, who had performed about 1500 LASIK eyes (plus 700 ALK eyes, and thousands of PRKs). I intentionally decided not to travel to Canada or elsewhere, because I wanted to get my followup care from the doctor who did the surgery.

Friday Jan 2, 1998: Day Zero


I went in for bilateral (both eyes) LASIK by Dr. Gary Kawesch. I arrived about an hour before the procedure. I gave them my credit card for the $4145 fee ($2100 per eye, minus the $55 exam fee I had already paid). They actually made two separate charges, a $1600 facility fee and a $2545 doctors fee. While they processed that, a technician measured my corneal thickness by applying numbing eyedrops and then using a little wandlike device attached to a computer, which measures with ultrasound. The technician touched it to my cornea, and the computer spoke the measurement. The process was repeated several times for each eye to make sure of a good measurement. It came out with:
OD (right) about 590 microns
OS (left) about 560 microns

They gave me my post-op kit with wrap-around sunglasses to wear during the day, eyeshields to wear at night, and eyedrops to use four times a day for a week post-op:
Occuflox to prevent infection, and Flourometholone (FML, a corticosteroid) to prevent inflamation. They also wrote me prescriptions for Vicodin pills for pain releif, Dalmane as a sleeping pill, and Acular as additional anti-inflammitory drops. I ended up not filling these prescriptions because they weren't absolutely necessary and I like to avoid taking anything I don't have to. They also gave me Refresh Plus Lubricating eyedrops in case I needed them for dry eye. We talked about how I would get home. I said that I was thinking of taking a bus, but they said that wasn't a good idea, so I said I would take a cab. One of the Doctors assistants asked me where I lived, and it turned out that my place was on her way home, and she offered to drive me home, without my asking. That really was beyond the call of duty; she said she doesn't usually give people rides home, but it happened to be on her way so she decided to do it.

They gave me 10mg of Valium sublingually to calm me down for the operation. This is the average dose; they vary the dose from 5mg to 15mg depending on the patient. Then they gave me a series of eyedrops to numb the eyes, and I waited about a half hour in a waiting room.

I entered the surgery room, and they gave me more numbing eyedrops, and I sat down in the operating chair. Dr. Kawesch confirmed with me that he was going to ablate the sphere in both eyes and the astigmatism in only one eye. At one time we had discussed intentionally undercorrecting for better reading vision, but we decided against that, and he verified that with me again just to make sure. He moved cushions around my head, and put me under the laser. We began with the right eye.

I was staring up at a red LED with a bright white light circle around it, perhaps 3 inches in diameter. He inserted the speculum to hold my eyelids open, and pressed marking tools down on the cornea to make star-shaped registration marks for aligning the flap later on. It was weird watching the cornea get pressed on like that; it reminded me of the special effect you sometimes see in movies where they simulate a time warp by making the whole scene ripple, the way that water ripples when a stone is dropped in. Then he attached the microkeratome aparatus, and told me that I would feel a pinching sensation and that everything would go black for a little while. From my research I knew that the pressure stops the flow of blood to the optic nerve, and that is what causes the vision to blakc out. That is exactly what happenned. I heard the motor of the microkeratome whirring several times; I thought it was three times but it might have only been twice. It seemed like it took a minute or more, but I'm not sure how long it really took; it was probably closer to a half a minute. Then the microkeratome was lifted off, and I could see again, although not as clearly. Then he lifted the flap, and things got really blurry. I could still make out the red light, but it was much more faint and blurry. It was very helpful to have the white light ring, because I knew the red light was in the middle of that ring. He told me to stare at the red light and that if I lose it not to search for it but just to look where it was the last time. I did so, while the laser made its snapping noise. Dr. Kawesch was very encouraging through the process, repeatedly telling me that I was doing great. The laser stopped twice during the minute or so of the ablation, and I heard the optics moving around. I think this is because of the multizone program in the VisX. The doctor then closed the flap, and when he did I noticed that I was seeing the red light double, with one on top of the other. He made quite a few adjustments to the flap, smoothing it out. The double red lights that I was seeing got closer together and at one time merged, but then they separated again. He removed the speculum, and started patching the eye up. He told me that the epithelium was looser than expected on that eye, and asked if I had problems with contact lenses. He asked if I had worn Gas Permeable contacts. I said no, I only used disposable soft contacts. He asked if I wore them over night, and I told him that I would always take them out at night, and that they were too uncomfortable to wear a long time or often.

Then we went on to the left eye. This time for some reason they taped my head onto the pillows beside my head, whereas they had not done that for the right eye. Then the procedure went pretty much as before, except quicker. The microkeratome seemed to be on the eye for much less time, and I only heard two whirring noises (one as the flap was cut, and one as the microkeratome was backed out). During the laser firing, it only stopped once in the middle, rather than twice like before (probably because the left eye needed less spherical correction). Then when he laid the flap back, he didn't spend as much time repositioning it, and the red light didn't go double like it had on the right eye.

An assistant placed the wraparound sunglasses on my eye, and as I was leaving the room, Dr. Kawesch assured me that everything went fine. They gave me a videotape of the surgery. But he said that there was a problem with the epithelium in the right eye sliding off. He said that would cause that eye to feel scratchy for a while, but that shouldn't affect the final result. My vision was very poor, and my eyes were fairly painful, so I just closed them and rested while I waited a half hour or so for my ride home. On the way home, my vision was good enough in my left eye that I could barely make out the highway signs on the way home, but my right eye was very fuzzy and tearing continuously. It hurt enough that I kept both eyes closed most of the time. I got home, and basically just rested for a while. I had rented some books on tape, and I listenned to those after a nap, but I pretty much kept my eyes closed, especially the right one, whenever I could. By 10pm, the valium had worn off, and I was feeling restless, so I went for a walk around the block. I kept my right closed, and found that I could see okay (perhaps 20/100) out of the left eye. But out of the right eye I could only see blur, and it was very painful when I tried to open it. The right eye continued to tear, and I would wipe the tears away from below the eyeshields. I was given a videotape of my surgery, watched that. I found that it had only the left eye surgery, and that the right eye wasn't recorded on the tape. I remembered that the guy who had surgery after me hadn't gotten a videotape at all, and the technician said that they sometimes don't record the videotapes if they have other priorities, that the videotape is their last priority. I was, however, disappointed, because I had the idea that something went wrong with the flap on the right eye because it seemed to take longer than the left.

I took a 2.5mg melatonin pill to help me sleep, and put on the eyeshields. I was worried that the eyeshields wouldn't stay on with the elastic band that went around the back of my head, so I taped them to my forehead and and cheeks with First Aid tape. I awoke at about 4AM, and noticed that the eyeshields were not on my eyes. I must have involuntarily pulled them off while I was sleeping. This was rather scary; my right eye was still hurting, and I was worried that I might have rubbed it during the night. I decided that perhaps the constriction of the tape was what made me pull them off during my sleep, so I put them back on without the tape.

Saturday Jan 3: Day One Post-op

I awoke around 9:15AM, and this time the eyeshields were still in place. When I turned my head, a teaspoonful or so of tears leaked out of my right eye, and it continued to tear the whole morning. It was so painful that it was almost too painful to even open up either eye. I got a little panicky and wondered if I would even be able to see enough to dial the phone and call the cab. After waiting about 5 minutes, I had the left eye open, and it was seeing very well. I put in the eyedrops, and put on my wrap-around sunglasses to keep me from rubbing my eyes, and called the cab to take me to my 11:30 appointment with Dr. Kawesch. During the cab ride I kept my eyes closed because the right one was painful to open. When I got into Dr. Kawesch's examining room, I took off my sunglasses. I told him about my pain in the right eye, and he reminded me that it was probably from the epithelium sliding off that he had told me about the day before. I asked what the technical name for that was, and he said that one possibility is something called "anterior basement dystrophy". He put a drop into the right eye to let me open it, and all of a sudden it felt much better, although still painful. He had me look at the Snellen eye chart, and the right eye was so blurry that I couldn't even make out the big E at the top of the chart. But the left eye measured better than 20/20! That was good news. He examined me under the slit lamp, and said that some epithelium on the flap was missing on the Right eye. I asked him how much was missing, and he said about 4mm. That was scary. He drew me a picture, where the half of the flap opposite the hinge had its epithelium missing, and where that epithelium erosion was covering the pupil area, causing the poor vision I was seeing. The left looked fine. He said that over the next few days the epithelium would heal back in, and that this problem with the epithelium in the right eye should not affect the final result. He put on a bandage contact lense (a -.5D AcuVue) on the right eye to protect the epithelium from my blinking eyes, and to help it heal better. That made it even more comfortable, and I now felt like it was okay to leave that eye open. It still felt scratchy, like a dirty contact lense, but much, much better. I left the office, and felt good enough to take the bus home rather than taking a cab. From all the tearing the night before, I was rather dehydrated, and I found that Gatorade quenched my thirst well, probably because it replaced the electrolytes that I had teared out. The rest of the day I spent napping, calling people to report on my progress, listening to audiobooks, putting in my eyedrops, and watching a movie that I rented (Men In Black, actually not a bad movie). The left eye was painless, and the pain in the Right was very bearable, tearing only occaisionally.

Sunday Jan 4: Day Two Post-Op:

I was seeing well with my 20/20 left eye, so I drove to my appointment with Dr. Kawesch. I had to wear two pairs of wrap-around sunglasses, because my eyes were very light sensitive. I was impressed that Dr. Kawesch kept Sunday hours. He put in a numbing eyedrop into the right eye, examined me with the slit lamp with the contact in place, then took the contact out and examined again with the slit lamp. He also touched a red flourescein strip to the eye. My vision was better without the contact in place, but still very blurry. I could barely read the 20/40 line without the contact in place. He said that about 60% of the epithelium had healed. He noted that some of the epithelium had also been eroded from the area outside the flap circle, and that hadn't grown in yet. He said that when it grows back, there will be a chance that it will grow under the flap ("epithelial ingrowth"), but if that happens then he can probably remove it. He put a new bandage contact lense in place. It was somewhat more painful than before, and much more blurry with the contact in place than without it. As I left, I was very light sensitive, as well as very tired since I only got 6.5 hours of sleep last night. I slept for a couple of hours in the car before heading home, and the eye felt better. When I got home I put up a Snellen vision chart in my room, and I was indeed able read the 20/15 line with my left eye, but couldn't even read the 20/70 line (which was the top line on my chart) with the right eye. I have been wearing clear safety glasses around the house, just to be extra careful not to have anything get into the eyes. I went out for a walk at night, and I do see haloing, especially with the right eye. It occurs exclusively on bright lights; other things look fairly okay. If I cover the left eye and look at a streetlight, through the right eye I see it fuzzily four times. There is one image to the right, one to the left, and one diagonally up and to the left. When I tilt my head those images tilt along with it. But over the past few days, the multiple images seem to be getting closer together. With the left eye I only see one image. Although it has a bit of haloing, it is not too bad. I'm worried that these multiple images in the Right may be permanent. But then again I have heard of other people who had double or triple vision that had improved with time or enhancements so I am hopeful. At any rate, I am not going to be able to drive a car at night like this, so I hope that it gets better. The haloing is different from how I expected it would be; it is very speckled in nature. If you have ever done work with Lasers, you might know the "speckled" look that laser light has; this is what the haloes looked like, not smooth as I expected. So my guess is that either the VisX laser imparted that speckled texture onto my cornea (or heaven forbid, my retina), or that there is some light interference going on between the flap and the ablated stroma. Either way, it makes sense that this will heal over time and become less noticeable.

Monday Jan 5: Day Three Post-Op:

When I woke up this morning and took off the eyecups, I felt much better. The left eye is seeing great; it is almost as sharp as it was with glasses or contacts, albeit with slightly more haloing and less contrast sensitivity (dark blacks aren't as dark as they were with glasses). I didn't have much pain at all, and I could start to make out some details with the right eye; it wasn't completely useless like it was before. I went in to see Dr. Kawesch. He tested my vision as 20/50 in the right eye with the -.5D contact lense in place, which is a real improvement. Once again he removed the contact lense and checked the eye with flourescein and a slit lamp. He said that the epithelium wasn't quite all regrown, but almost. The epithelium had grown over the flap edge without growing under the flap edge, which means that the chance of epithelium ingrowth from here on out is very small. The part of the epithelium that hasn't healed is located in a crescent shape inside the edge of the flap opposite the hinge, between the pupil and the flap edge. He checked the left eye under the slit lamp as well, just to make sure that was doing well, and it was fine. I asked him about my observation that during the surgery the right eye seemed to take longer to cut the flap and lay it back down, and he said that no, they both took the same amount of time: 7 minutes for the whole procedure on each eye. I told him about how I saw two red lights while he was laying the flap down in the right, as opposed to only one with the left, and he said that is explainable by the epithelial depletion. I told him that I am worried that there was a problem in cutting the flap, and he again reassured me that it went fine. I thanked him, and drove home. I noticed that my eye was less light sensitive than before (although I still felt more comfortable with 2 pairs of sunglasses). Now that the right eye is 20/50, I am starting to see in a binocular, stereo way now, which makes depth perception much easier.

Tuesday Jan 6: Day Four Post-Op

Went in to see Dr. Kawesch, and he told me that the epithelium had completely healed in the right eye. I was at about 20/50 with the contact on, and he removed the contact lense because it was unnecessary now. Even though the epithelium had healed, it is still not completely unclouded. He said it would probably be 5-7 days before the epithelium smooths out it gets as clear as the other eye. I asked him if I could go on a cross country ski camping trip planned for next weekend (in three days) and he said yes. The next appointment to see him will be in two weeks. I was able to drive tonight. It was not great with all the haloes, and without the 20/20 eye it would have been horrible, but if I kept a relatively slow, alert pace, I felt safe. But then it started to rain, and I had a hard time getting home because the rain on the streets reflected the glaring streetlights and made the lane markers hard to see. Dark areas all seem to blend into black, whereas before the operation they would be more distinguishable. Hopefully that will not happen as the corneas become clearer.

Wednesday Jan 7: Day Five Post-Op

Today I woke up and was able to see about 20/40 out of the right eye, which was an improvement. The pain is mostly gone at this point. This was the first day that I woke up and said to myself "Hey, this operation was pretty cool", rather than "I hope my vision doesn't stay this bad". This evening I felt comfortable enough to drive an hour to Berkeley for my Unitarian young-adult group at night. I still see glare from headlights and streetlights. I notice that the streetlights that emit discrete spectrum light, like the orangish sodium vapor lights, have a very speckled appearance in the glare halo around them whereas continuous light sources like incandescent headlights have a smoother halo. But the glare is small enough that it doesn't prevent me from seeing anything that I need to see. I might be bothered with it over time if it stayed around, but as a temporary thing it is fine. I do still notice that blacks aren't as dark black as they were before the operation; they are kind of a greyish. But that is improving as well.

Thursday Jan 8: Day Six Post-Op

I woke up and my vision was about 20/35 in the right eye. Left is still 20/20 or better. A funny thing is happenning now that my right eye is getting good enough to start giving useful information: Things are all of a sudden slightly blurrier overall. I think that before my brain was pretty much ignoring the right eye, but now it is starting to integrate the blurry information from it into the picture.

Friday Jan 9: Day Seven Post-Op

I am about 20/30 this morning in the right eye. It definitely is more useful. I did some driving this evening, and at this point the glare/haloes are not much worse that what I would get with a dirty pair of contact lenses.

Saturday Jan 10: Day Eight Post-Op

Today I almost read the 20/20 line of my eye chart with my right eye! I would say I am about 20/25 or so, and a very blurry 20/25. I really understand how people say that Snellen acuity (20/whatever, determined by reading lines on an eye chart) isn't a very good indication of how well you can actually see. Even though I can almost read the 20/20 line, it is very difficult and it is very blurry. There are two different things that can make vision less than perfect: lack of clarity of the cornea, or incorrect curvature of the cornea. I think that the lack of clarity is the problem that I am still having; the curvature seems to be roughly right, but it is like there is a slight haze over my right eye still. But I remember that when I first had the operation about a week ago, my left eye was 20/20 but with haze, and that haze mostly went away. In the left eye I can still notice just a little haze during the day, but it isn't a major issue; most of the haze has cleared up. This reinforces for me the fact that people should realize that 20/20 vision after LASIK or PRK isn't necessarily "perfect" vision; it may still be very blurry.

Sunday Jan 11: Day Nine Post-Op

I went for a hike in the rain today, and really felt the joy of not having to keep drying the rain off my old eyeglasses. The wind was very strong on San Bruno Mountain, and it would blow my hood in such a way that it covered my good left eye. I noticed that I didn't have much of a problem seeing out of just the right eye when I covered my left eye, which was very encouraging. I drove home at night in heavy rain, and didn't have any problems with my vision at all; it was as if I was wearing glasses. That is not to say that I don't still have somewhat foggy vision, but the fog from the rainstorm was much greater than the fog from my healing response, so I didn't notice it at all. I can just barely read the 20/20 line with my right eye on the eye chart I have at home, although it is still noticeably blurry. Thinking back on my decision to have bilateral surgery (both eyes at the same time), I think that was probably a bad decision. If both of my eyes had the same bad experience that my right one did, I wouldn't be able to drive at all until about now, nine days after the operation. With PRK where the healing response is expected to be slow, I absolutely positively would not recommend bilateral surgery to anyone. With LASIK my left eye recovered to the point where I could drive in just a bit more than a day (which is normal), but it could have taken the nine days that my right eye took.

Monday Jan 12: Day Ten Post-Op

I often have the feeling that I am wearing dirty contact lenses and that I should take them out, but then I realize that I don't have contacts in, and that is a relief. I have been using Allergen Refresh Plus eyedrops several times a day, and I notice that they are helpful; if I don't use them I get a dry feeling and my eyes get a bit more foggy.

Tuesday Jan 13: Day 11 Post-Op

I have noticed that my eyes are blurrier when I wake up in the morning the past few days. This is different from the week post-op, when they would be most clear when I wake up in the morning. My Right eye is still bloodshot in a few small places. I discovered that if I pull my left eyelid up, my left eye is bloodshot above the iris; maybe it was like that all the time since the operation and I just never noticed it because I didn't pull the eyelid up to look. I decided that the morning blurriness and the bloodshotness are a cause for concern, so I made an appointment to see the Doctor tomorrow just to make sure everything is proceeding smoothly. Overall, I am seeing great now, even at night. There are still haloes and fuzziness, but they are becoming less noticeable. Whereas post-op it seemed like darker areas faded into black, I can now see about as much detail in the darkest places as I could before the operation. Even though my right eye is almost 20/20 looking at the eye chart 10 feet away, I can just barely read 12 point type held at a normal reading distance of 1-2 feet under bright light with that eye. Perhaps I am overcorrected, or perhaps there is some significant astigmatism in that eye. I went out riding my bicycle in the rain at night in San Francisco, and thoroughly enjoyed the experience of not needing to wipe my glasses (because I wasn't wearing glasses!) After going for 6 or so hours without the lubricating Refresh Plus drops, my eye was getting a bit foggy and dry; it was uncomfortable to read a book even with the left eye. But putting the drops in fixed that.

Wednesday Jan 14: Day 12 Post-Op

I went in to see Dr. Kawesch today. He said that the blurring I have in the morning is normal due edema of the cornea. I will probably want to keep using the lubricating eyedrops for a month or so. He said that the bloody "bruises" in my eye which are now disappearing normally are gone in 2-3 weeks post-op. His assistant did a refraction with the autorefractometer, and manually for the right eye and found:

OD (right) -1.25 +2.0 x 61
OS (left) -0.75 +0.5

I see better than 20/20 with the left, and "a blurry 20/25" with the right. With both eyes I am 20/20. Even though the numbers 20/20 versus 20/25 would make it sound as if the eyes are very close in their abilities, the difference I see is immense; the left is almost perfect, while the right is pretty bad, very difficult to read normal type with. The prescriptions above indicate that the spherical correction is about as good as it could be, neither nearsighted nor farsighted. But there is a significant 2 diopters of regular astigmatism in the right eye. Before the operation there was virtually none (.5D) in the right eye. And since the refraction doesn't measure irregular astigmatism there may be some of that as well in the right. I asked him about the astigmatism, and he said that it might partly be caused by edema during the healing, but it is also likely that it will not completely disappear. He said (as I already knew) that cutting the flap will cause astigmatism in some percentage of the population, and it looks like I statistically am one of those people. Looking at bright lights like streetlights with the right eye, I see only one light, which is good. But the light appears very distorted and diffuse. But to balance the bad news, I must note that the left was and is my dominant eye, so the right isn't that important anyway, and I really can see great with both eyes combined most of the time. Even though the right eye is worse than I expected, the overall result is better than I expected.
 
 

Sunday Jan 18: Day 16 Post-Op

I went on a ski trip to Tahoe this weekend, driving a total of about nine hours, mostly in the dark. The right eye is still pretty much useless at night due to the astigmatism, but my brain seems to be successful in discarding the blurry information from that eye and using the sharp information that my left eye provides. I still have good depth perception; I guess the brain can still get some stereo information from that right eye.

Driving at night is the time when my vision is most noticeably degraded, but it still isn't too bad. The main effect that I notice is that when it is very dark I see starbursts around point light sources: headlights, streetlights, taillights. The "speckle" glare that I had noticed at night is gone, however. The starbursts that I see are like spokes emanating from the point source. The size of the starbursts is very variable, and I figured out that it is related to the size of my pupil. They only occur when I am driving in areas with few or no streetlights, like unlit highways. If I look at something bright, like the headlights in my rear view mirror, then the starbursts shrink down and disappear for a few seconds. It is kind of wild seeing the starbursts change size depending on how light it is; they may shrink down as I pass an oncoming car, and then grow again in a few seconds. The size of the starbursts is roughly the distance between the two taillights of the car ahead of me in the dimmest light. As you read this, it might sound really horrible, but actually it isn't bad at all. I can see fine through the starbursts, and they only occur on point sources; highway signs and lane lines still look sharp and very visible. Since most of the driving I do is on city streets or well-lit highways, I hadn't really even noticed them until this trip; on well-lit city streets I don't see the starbursts at all.

I am somewhat curious about the spokelike shape of the starbursts; From my knowledge of optics, I would have thought that the pupil opening up past the ablation would have caused a fog around the lights, not a spoke shape. My guess is that the spoke shape comes from the edges of the flap healing at different rates; perhaps as the flap heals a bit more the starbursts will diminish or go away. Surgeons often say that it can take up to 6 months or so before post-LASIK night vision gets as good as it will get.

Another thing that I notice if I look carefully at night is that I see a faint second image of strong light sources right below the main image. For example I will see a faint second pair of taillights right below the actual taillights of the car in front of me. This used to occur before the operation as well, though, so it wasn't caused by the operation. I think it is some minor irregular astigmatism in that left eye.

During the day my vision overall was great. It is as if I were wearing contact lenses, but without the uncomfortable feeling that I had with contacts. Normally when I ski I would wear prescription glacier glasses with side shields, but they were always getting fogged up; I think the reason was the thick prescription lenses wouldn't change temperature with the surroundings. But now I can wear regular ski goggles, and they didn't fog up at all.
 

October 1998

Sorry about the large gap in my journal entries. My LASIK turned out great, and I didn't feel like it was that important to record all the details. Over 4 to 6 weeks after the operation the fog in the right eye went away, and now the right eye sees slightly better than the left. My eyes both measure 20/20 individually, and using both eyes together I can see 20/15 (slightly better than average). The recovery was slow, and for a few months after the operation my eyes were very dry and I had to use lubricating eyedrops twice a day or more for comfort. But the dryness is now gone. The light sensitivity went away after a few weeks. For the first few months my eyes would be gunky and cloudy when I woke up in the morning (especially when I slept at altitude), but that ended too, and now they are fine in the morning. I do notice that approximately once a week, usually when I am tired, I will feel a discomfort in one eye or the other, where it feels like a small particle got stuck in there. I don't remember this feeling before the operation, but it might have been there before. Overall, the comfort of my eyes is better than they felt when I wore glasses; I don't feel the eyestrain and soreness that I used to feel when I was tired. I still have the problem where when I am extremely tired, I get a little bit of double vision, but that is a result of the vertical phoria in my eyes, and that happenned with non-prism glasses too, so that is unrelated to the operation.

The only significant side-effect that I am left with from the operation is that I do still have the night vision glare (starbursts and fogging). It is much less of a problem than I thought it would be, and it doesn't affect my ability to see or drive. I just see these starbursts and a little fog superimposed on top of a sharp image. It is no worse than wearing a pair of glasses that haven't been cleaned recently, or driving with a dirty windshield. After having the starbursts there for so long, I don't really notice them anymore; it was kind of a novelty at first but now it is just a part of my vision. And it is only at night or in low light; during the day I see great. Knowing as I do now that the 7mm ablation was not quite large enough to prevent the starbursts for my pupils, I might have waited until the lasers that my doctor had could do a wider ablation like 8mm (But perhaps not, since wider ablations can weaken the cornea more and can be less likely to give the exact correction needed).

So now I am getting ready for my 9-month followup visit with Dr. Kawesch, and I am really happy with the results. Not everyone has results as good as mine, and I would have been happy with less perfect results, but this really worked out well for me. I am giving away my glasses frames, and shopping for non-prescription sunglasses.

August 1999: more than 1.5 years postop

I went to my optometrist for my yearly checkup, and everything looked great.  I was just under 20/15 (better than normal) in the left eye, and almost 20/15 in the right eye.  With both eyes together I see a solid 20/15.  Refraction was normal, with no measured astigmatism along the old meridians.  While examining my eyes with the slit lamp, she said the left eye was basically indistinguishable from an unoperated eye, while there were still some very minor edges to be seen in the right eye around where the flap's edges were.  My vision seems to have gotten slightly better over time, and now I hardly ever notice the starbursting.  I'm not really sure whether I have just gotten used to it or whether it really occurs less.  Note that even though I have 20/15 vision, I don't think it is quite as sharp as it was when I wore glasses, but it is very close (the 20/whatever number only measures your ability to read text, not the overall sharpness of vision).   I do still notice that when I look at stars at night, they are not as clear as they were with glasses, but frankly, it's worth it for great vision most of the time and not having to futz with glasses on overnight camping trips.

April 2005: more than 7 years postop

I have continued getting regular checkups every year, and my vision has stayed great. Measurementwise, I'm not quite as perfect as before; my right eye is 20/20 while my left is 20/25(slightly worse than normal), but it's hard to complain. The starbursting at night really feels like a nonissue. It's noticeable if I look for it, but doesn't hinder me at all.