Laser Eye Surgery – Experiences

I had a laser eye surgery and here are my experiences.

Introduction

In the childhood, I really liked books about algebra and computational logic. Slightly less, I liked Greek history and mythology, and I read hundreds of pages of it. Later, when everyone was blown away by Naruto lore, I was unimpressed.

In Greek mythology, there is Lynceus, who was said to have such an excellent vision that he could see miles away, and he was put on a lookout duty on legendary Argo ship. When I read about him, I assessed my vision to be comparable to his, but over time, I started to think that having this good vision must be a delusion.

Laser eye surgery risks and planning

I had made a decision to undergo surgery only once I’m over 25, and the brain is generally fully developed in humans. I knew that many people undergo surgery at 16-17, I find it exceptionally risky. In fact, in my case, my vision deteriorated by about 60% over the span of 7 years, from the age of 17 to 24.

“Surgery” mindset

Surgery is scary, I get it. I get it probably better than people think.

Yes, most likely your surgery will go just fine, just like for everyone else. However, you only need a single successful surgery. Try to think like this: a hyped, highly esteemed clinic may be able to perform 1000 completely successful surgeries, and something can go horribly wrong at surgery №1001. Furthermore, that surgery №1001 can be YOUR surgery.

Especially in the case of something as sensitive as eyes, ‘something gone wrong’ will likely mean losing eyesight.

That said, we can simplify the situation. Surgery is a risk, and a source of risk. Risks can be managed. Proper risk assessment and subsequent risk mitigation will minimize risk as a result of diligence and thus prudence.

Surgery priorities

My laser eye surgery priorities were in the following order:

• As few risks to health and harm to health as possible (and not only in terms of the type of surgery, but in everything)
• Being able to go back to work within a reasonable timeframe. 1 month can be OK, 1 year is maybe not!
• Budget considerations

As such, even before I go to a clinic, the following became mandatory requirements,

• A clinic must be time-proven and have been operating for at least 5-10 years.
  • One way to check this is by using Wayback Machine, while ensuring that the clinic years ago is the same clinic that there is in the present.
  • Another way is to check established social media (mainly Facebook, YouTube and LinkedIn) for historical posts and for changes through time.
• A clinic must have many branches in different cities, if not countries. (i.e. a clinic must not have potential to disappear without a trace over the first surgery gone wrong)

In contrast, the following were NOT important requirements,

• Having a cool domain name (website), i.e. something like e.ye or ey.es or eye.com. Purchasing a ‘cool’ domain name for business customers is, more or less, an expense that can be solved with a lump sum of money.
• Good, colorful website design. It’s OK for a website to be unattractive, especially a medical website. A business can solve a design problem can be solved by throwing money at it.
• Clinics do give material information, and the printed material design is not important.
• Having social media presence on Instagram, TikTok, Snapchat, and the like. With the potential exception of Instagram, I would in fact be extremely cautious about a clinic’s presence there. Yes, these platforms can be useful, but these social media generally target a different demographic.

General information

Preliminary evaluations, vision shortcomings and surgery types.

You will need at least 3 visits to the clinic,

1. Before surgery, to check if you are a good candidate
2. For the surgery
3. After surgery, at least once, for the results’ examination after some time

Clinics perform preliminary evaluations (inspections) to determine whether their client is a good candidate for an eye surgery. Age is a factor, but not an absolutely damnable factor: a person aged 50-70, potentially 100, can be a good candidate for a laser eye surgery. However, in the evaluation process, a candidate may be found to have eye diseases, significant abnormalities, significant eye damage, and so on.

The most important aspect considered empirically seems to be: cornea thickness, followed by the health of the back of the eye. Cornea thickness varies in population, and in some cases, it may be too low for LASIK or even for the entirety for the laser eye surgery, in which case, alternatives have to be considered.

In my case, I passed preliminary tests at every clinic, and was found to be suitable for all types of surgeries.

NOTE: In my case, at ALL clinics, preliminary evaluations were completely FREE. I was never asked for a government or private insurance, credit card information, ID information, or anything else!

Vision deficiency factors

To the best of my knowledge, there are 2 main vision deficiency (shortcomings) factors,

• Dioptric misalignment – where the light happens to be focused at an incorrect spot in the eye relative to the intended light receptor focus, leading to blurred vision at that focus.
• Astigmatism – very often natural, sometimes acquired, irregular shape of the cornea, where it’s not so much a circle and more of an ellipse (an oval). In this case, the eye incorrectly sees straight lines, additionally creates some double-vision, and lead to seeing non-existing rays of light that many people perceive to be normal (at any angle except from multiples of right (90°) or straight (180°) angles) . In mild cases, can be confused for dioptric misalignment above. On Twitter (X), it even became trendy to discover the difference between astigmatism vs no-astigmatism

Both factors are deemed to be marginal at the factors of 0.25, with astigmatism considered to be half as impacting as dioptric misalignment.

Surgery types

Apart from extremely personalized and specific surgeries, to the best of my knowledge (from going to different medical clinics), surgery types are as follows:

• LASIK – is the most popular type of laser surgery, however, LASIK is not the only type of laser eye surgery. That said, LASIK is the most practiced surgery due to popularity with well-known risks and complications, least painful, takes about 10 minutes per eye, recovery is 1 day, BUT the surgery itself is more complex and involves several steps (an eye has to be sucked with a ‘surgical vacuum cleaner’, then 2 lasers have to work in their turns), a bouncy flap remains on the cornea, which heals over time. With both surgery’s increased complexity and the flap that can potentially be torn, I chose not to undergo it.
• PRK – is an old, less complex, less invasive and cheaper procedure, however, subsequently very painful (after the anaesthetic ceases functioning). The clinics seem to recommend this surgery for people involved in active sports. The surgery itself takes no more than 5 minutes for 2 eyes, recovery up to 80% of vision the result in 1 week, full recovery in 2-3 months. PRK leaves a scar on the eye, which requires special care within these 2-3 months period of full recovery.
  • TransPRK is slightly improved PRK, where one of the early surgery stages (as far as I know, the removal of epithelial tissue, the tiny top outer layer of any tissue) is completely automated and done by a laser, as opposed to surgeon using surgical alcohol solution, but everything else is the same. Research shows no significant safety differences between PRK and TransPRK. That said, TransPRK removes one chore from the surgeon and puts one extra chore on the laser, so take from it what you think. In my opinion, because TransPRK is a newer development, in the field of something as sensitive as laser eye surgery, TransPRK must have initially demonstrated an equivalent safety to the well-established PRK procedure even ‘from the get-go’, at the early stages of deployment into production, and therefore, compared to PRK, TransPRK nowadays must be at least very marginally safer.
• SMILE - developed in 2007, approved by the American FDA in 2016, (quote) “combines the safety of PRK with the quick recovery time of LASIK”. The disadvantages are that it is only suitable for people with vision ranging from -2 (not 0!) to -6, and that SMILE is distinctly more expensive than PRK and LASIK. I didn’t choose SMILE, because I could not find a credible source online that convinced me that SMILE is as safe as PRK (but maybe I was just looking in the wrong place), and plus because I didn’t mind taking a longer vacation anyway.

Additional notable surgery types

• ICL, IOL, IC-8, and the like – not a laser surgery per se. The cornea of the eye is not touched by a laser, but a lens (like a vision correction lens) is permanently implanted either on top of the eye, or even into the eye. Depending on the exact type of Implant. This is the most expensive type of surgery of all, and it may correct vision and is very safe (according to different sources, the complete success rate is either 98% or 99.9%). However, part of the eye is not amended, but rather, a lens implant is implanted, and I would argue that it is the most invasive surgery type of them all. Implanting something into a human body is a option, but maintaining and preserving natural operation of an organ should be preferred, and is perhaps more… elegant! Therefore, I would argue that ICL, IOL, IC-8, etc – should only be used for complex eye cases, such as cataracts or other medical problems occurring due to age, medical blindness, or complex eye diseases.
• RK – Radial keratotomy, not to be confused with similarly-abbreviated PRK, which is “Photorefractive keratectomy”. RK is a non-laser eye vision correction surgery that can correct dioptric misalignment and astigmatism, performed with a diamond-edged scalpel, invented in the USSR in 1974. The surgeon must perform complex mathematic calculations to perform this surgery correctly, and a well-performed RK surgery should involve no than a limited (less than 15) incisions, and shouldn’t cause post-operational pain. However, RK and its shortcomings are fortunately well-known in the West. Due to decreased safety, increased invasiveness by design, human factor, and other reasons – nowadays, RK is almost entirely superseded by LASIK and PRK.

Costs

Below are approximate market prices in USD as of December 2023,

• PRK - $4000
• LASIK - $4750
• SMILE - $5000
• ICL.. - $8000

My choice and reasoning

• LASIK - Too much risk, not happy about invasiveness, post-operation recovery risks.
• SMILE - Approved by FDA in 2016, not yet convinced that it’s as safe as PRK.
• ICL.. - In my opinion, most invasive, I don’t want an implant.

Therefore, I opted for the safest PRK/TransPRK, with very slight preference toward TransPRK. Yes, PRK/TransPRK is painful, but I’m no stranger to pain.

Clinics’ experience

Recalling “Surgery priorities”

Briefly recall my clinics’ must-haves,

• A clinic must be time-proven and have been operating for at least 5-10 years.
• A clinic must have many branches in different cities, if not countries.

Briefly recall my clinics’ not important,

• Cool website
• Website design
• Printed material design
• Social media presence on questionable platforms

I did my research, and I found only 3 clinics in my region that match my criteria. To make this information more versatile and independent of age, quality changes, and location, the clinic brand names are not mentioned, and the clinics are simply referred to as “Clinic №1”, “Clinic №2” and “Clinic №3”.

How to assess clinics – Actively

Just like romantic relationships, your relationship with a clinic is a 2-way street. They assess you, you assess them.

Additionally to the above, I’d like to list factors I used to actively assess clinics.

• Common folk’s reviews – especially the negative ones. I used Google reviews. Of course, some surgeries went wrong, but common trends is where it matters.
• How do clerks feel – did the clinic take steps to make clerk lives easier? This is important. For example, if clinic’s clerks work on old and slow computers, then the clinic is probably cutting expenses money for far, far more important aspects.
• What do the doctors tell me (are they trying to cheat me in any way?)
  • I deliberately prepared and asked stupid questions to test them.
  • I also tried to pay attention to what doctors choose to say and not say.
• Ask about equipment, what laser is used and how long ago was it purchased. Yes, lasers do last for 10 years, and they must undergo maintenance, but I need a single successful surgery, and therefore I made it a priority that the laser be new and modern.

How to assess clinics – After an active visit

After you went to the clinic

• Research the laser they use. Is it a good laser for your type of surgery?
• If no red flags emerged so far – Research the surgeon, specifically avoiding the materials on the clinic’s website. What their hobbies are, what they are busy with on weekends. Additionally, I checked how long they have been active in the scholarly field (e.g., Google Scholar). If it’s been a long time, it may mean, perhaps, that the surgeon’s current passion is “collecting money” and not “profession”. Researching surgeon is important for at least 2 reasons,
  1. Making sure that they are literate enough to perform changes to your body, but most importantly,
  2. Making sure that you feel comfortable around them and with them.

The harsh reality for surgeons is that, yes, surgeries, like anything else, can become second nature, something they can do asleep, but because damage potential is so great, the surgeon requirements are (rightly or wrongly) inflated. I was anecdotally told that 99% of potential human factor risk with PRK/TransPRK is that the surgeon may enter numbers incorrectly, however, to prevent this, we as patients, demand Master’s degrees! Unfortunately, this is the best bad method to minimize risk.

With regards to feeling comfortable – the success of any surgery partially depends on patient’s conscious or subconscious cooperation. Liking someone at a personal level (achievable only through subjective means) can help alleviate this boundary to success.

Clinics

• Clinic №1: Rated 4.5 stars on Google. I liked everything, I liked the professionalism and the fact that they have clearly been working for many years. I later found staff photos from 20 years with many of the same staff. Reception staff and patients have a coffee machine with all consumables. Three ladies at the reception were sitting and calmly enjoying their tea and coffee. The clinic initially recommended me LASIK, but once that I wanted PRK, they did not attempt to dissuade me, and this is a huge plus. A new modern German-made laser was purchased 7 months ago. The negatives: transportation options were really bad, relatively inexperienced surgeon (no Master’s degree, scholarly activity 5 years ago) who replaced the virtuoso, extremely talented founder of the clinic (who retired in Portugal, so what factors can substantially guarantee that the new surgeon is good?), and finally, the price is quite steep.
• Clinic №2: Rated 4.8 stars on Google. At the reception, there is one woman is her 40-50s, who basically does all the administrative work there (they save on employees!) After my stupid questions and mentioning several times that PRK is my preferred option at that point, they started actively trying to persuade me into expensive surgery types, especially ICL/IOL! I have a suspicion that they have a high rating because they target young and stupid people from Instagram (with rich parents), and they are scamming everyone into LASIK or the like, where the risks for the youth are low, the results are fast, and accordingly, positive reviews come quickly. Not much information about the surgeon online.
• Clinic №3: Rated 4.3 stars on Google. They have been working for more than 20 years, but I was invited to a small branch for an initial examination. I arrived on a weekend, and therefore no one except the examining doctor was in the branch. I really liked the doctor’s honesty. He said that they bought a new laser 14 months ago, Schwind 1050RS, and plus they are doing (literal quote) a beta-test of a new laser that is not yet in use. But the main things I liked were in the end of our session: yes, each clinic gave me a promotional booklet with information, Clinic №3 gave me a printed in black-and-white on regular A4 paper, bound Word document of about ~20 pages with very detailed information about surgery: what happens, how and when. This totally made me lose my heart because Clinic №3’s focus is not on sales, but on patients literacy! (regards, o’, Clinic №2) This means that they target diligent and judicious patients, and they don’t mind going an extra mile educating patients!

It happened this way, in this order, but needless to say, I chose clinic №3. Clinic №1 was a notable close second.

I then performed research on clinic №3 surgeons, and I chose a surgeon whom many people praised, and no one complained yet. They have 2 Master’s degrees, and overall they are a cool surgeon: smiling and affectionate. They post funny and life-loving videos on Facebook about nature and gardening.

The surgeon had a slot for a suitable to me day, and I made an appointment.

On the day of surgery

We arrived with a family member (you must not go back on your own, you’ll be on strong painkillers that may affect your judgment).

They asked me to sign a disclaimer stating that I understood the risks. I liked that they did not get me to sign away all my rights, i.e. a right to sue.

Once signed, they gave me a bunch of prescriptions for medications required, I bought them at a nearby pharmacy, at about $60. Then the clinic nurse took meds from me, laid them out in a prepared first aid kit case and verbally explained in detail what and how to take for about 5-10 minutes, plus gave me printed instructions.

Then we did all tests again, and we also fine-tuned the vision, so I could see the lowest line with each eye, a vision better than what people are born with, 20-20. Even though this is mostly seamless to me, my brain processes information from left and right eyes in very different ways, so the vision really had to be fine-tuned, to ensure the best results.

After this, they asked for a payment, which we sorted in about 5 minutes.

Then I was seated to wait in line. An hour later they invited me into the operating theatre and laid me comfortably on the operating table.

At operating theatre

The surgeon and their assistant were there. The surgery itself went very quickly, no more than 5 minutes. Quite ironic, considering the amount of preparation.

The following was done for each eye separately:

1. The eye first was practically doused with liquids, including anaesthetic (nothing really changed, I could move my eye, I just don’t feel any pain)
2. The surgeon inserted I a frame inside the eyelid, so I couldn’t close my eyelid. I felt no pain.
3. They told me to look at the blinking LED light of the laser and began a 10-second countdown to turn on the laser.
4. When the laser was turned on, an unpleasant burnt smell appeared, and this is normal. The laser itself is very loud. The laser was on for 10-15 seconds, and within the eye the round LED light began to turn into a kind of snowflake.
5. Finally, the eyelid frame was removed, and a temporary lens is put on the eye (which is required for 4-5 weeks to maintain astigmatism treatment).

(Then, we repeated these steps with the second eye)

Then I got up and the surgeon asked me to read the small text underneath a power switch. I read it with almost no problems, it read something like “Please do not turn on unless inside the room”. The surgeon smiled with their contagious and affectionate smile, and politely walked me out of the room.

Afterwards

I immediately had an almost perfect result. Then they invited me to see the nurse again, where she once again explained what and how to take for the first days, and told me to immediately take 2 Valium tablets. The first-day goal is to fall asleep as soon as possible, as not to feel post-op pain. For the first 10-15 minutes everything was just amazing and euphoric because of good vision. I was sober enough to choose between ride-sharing apps, to order a ride to the parked car, so my family member can drive me home. Minutes later, sharp pain came. Comparable to that of really bad conjunctivitis, but worse, and soon enough I could no longer open my eyes. Had a tried, a waterfall of tears came. When we arrived home, I was given 3 more Valium tablets, but I still couldn’t sleep. Only after a couple of hours did I take another sleep medication and finally fall asleep.

The next day started my endless rounds of medications. Every day, I started having to use eyedrops. Multiple different types, many times a day. The room windows had to be completely sealed off, because of sensitivity to light. I could, with difficulty, read notifications on my phone at lowest brightness and use my laptop at 200-250% text scale, again, at low brightness.

The next day I could already play GTA to kill boredom, if I didn’t aim at all. GTA is easy in this regard.

Soon enough, it was as though life went on.

Long afterwards

• 1 week later, I had a post-op examination, and the eyes healed up very well thus far. Some of the medication changed. I was now deemed safe to drive a vehicle.

• The same day, I had to drive a lot, and admittedly, driving a vehicle in the first day was difficult, because I was still very photosensitive to the outdoors. The next day was a lot easier.

• Some visual bugs (temporarily) remained, but they are negligible, given how good the vision has become.