Diary of a Lasek patient

This year, I cracked. While packing the contact lens and eyewear paraphernalia to go on holiday, I had a sudden vision of a summer dogged by the on/off of glasses/prescription sunnies and thought, ‘no more’. Why do I go blind in the swimming pool, grope for my cereals in the morning, or endure tired, red, dry eyes at night, desperate to take my contact lenses out?

Until now, I felt my -2.75/0.75x180 R&L was advantageous for slit-lamp biomicroscopy and would stave off presbyopia. However, a near point of 32cm isn’t really very useful.

So, decision made, I went to have Lasek. I have worked for Julian Stevens, refractive surgeon at Moorfields, since February 2002. I used to wear contact lenses during these sessions and was always a little vague about ‘not needing’ refractive surgery. I can’t pretend I wasn’t nervous, but I had complete faith in my surgeon.

I did wonder that if something was to go wrong, had I wanted it so badly that I was willing to gamble my vision? Quite frankly – no. But the risk of sight-threatening complications is minimal and I had the advantage of being familiar with the laser room, which minimised some anxiety. Patients can request a sedative, but all measurements are taken beforehand and then 30 minutes allowed for an anxiolytic to take effect.

I had had a full refraction, controlling accommodation to obtain my least minus prescription. On the Pentacam my pachymetry measurements were recorded along with my IOP (by Goldmann), pupil size and wavefront scans, the latter taken several times in mesopic light levels.

Now officially nervous, I sat in the chair as it was reclined. My left eye was covered to assist fixation, proxymetacaine instilled in my right eye and the lids clamped. Last year, I held the hand of a friend during her Lasik, and recalled this was the moment she really squirmed. But I barely felt them.

My head was moved a couple of degrees. Chatting away about my recent Peru trek, I had my cornea marked up. I saw the metal ring coming in, and felt the pressure in my skull. Then my view went watery as the 20 per cent alcohol was poured into the well, dissolving the tight junctions between my epithelia and my basement membrane. Then I saw a gloved hand brandishing a scalpel and thought, somewhat manically, ‘That will be Julian scraping away my poor epithelium’.

Then the VISX wavefront guided laser (with iris recognition software) started its work. The loud and rapidly firing sound I was accustomed to. I had expected to see nurses in my peripheral vision, but my view was completely filled by a red spot in the centre of a vivid electric blue circle and everything in between was black. During the time the laser ran, that red spot became increasingly hazy and the blue circle seemed to turn green. I also became aware of the delightful smell of burning. As the laser was pulled away the room came back into view. My cornea was rinsed with balanced saline solution and Julian scraped back my epithelium, only about 70 per cent of the cells still viable. A silicone hydrogel bandage contact lens was draped over and chloramphenicol and dexamethosone instilled. One down, one to go!

Afterwards, I was checked on the slit lamp and could binocularly read the 6/12 line. Then a nurse gave me the discharge instruction, which I confess I took no notice of, as I was more concerned whether my husband had arrived with a taxi (no tube travel permitted). My big bag of drops (a bottle for each eye) went into the fridge. An hour or two later the anaesthesia wore off and I’m sure I could feel each and every one of my corneal nerves firing pain signals. I could not read the colour coded N14 instructions and my husband proved utterly useless. We did not find the cyclopentolate or proxymetacaine, but found the oral voltarol and topical diclofenac.

I was also using 0.5 per cent chloramphenicol, 0.1 per cent dexamethosone (Maxidex) and hypromellose hourly, but became suddenly intensely photophobic and could barely open my puffy eyelids to get the drops into my streaming red eyes. An uncomfortable night was spent wearing some rather attractive goggles and in the morning we drove back up to Moorfields for a Day 1 check up.