February 2, 2010
Under The Knife
Frickin' Laser Beams, Part 2
(NOTE: The pictures linked in this file include some images some may find a bit disturbing. If the idea of seeing surgery on an eyeball creeps you out, please don't click on the links. Special thanks to Tracey at the 20/20 Institute for taking the pictures while I was on the table being very still.)
I'm sitting here typing about 14 hours after my procedure. My glasses are sitting on the table. Yes, LASIK surgery is a modern miracle, one that has given me "normal" vision without glasses for the first time since I was in third grade, but making that miracle is something of a mystery. While millions have had the procedure, millions more have no idea what goes into it. While the real interest I have in this series is figuring out the enhancing effect the procedure has on baseball players, it was driven by the idea that maybe I wouldn't have to wear glasses. In one small way, I'm just like Greg Maddux.
After extensive tests to ensure that my eyes were candidates for the procedure, the day of the surgery came up quickly. The offices at the 20/20 Institute in Indianapolis are arranged to be calming, right down to Norah Jones on the CD player, but it's also something of a factory. This isn't a criticism; most surgical facilities of any type are arranged in much the same way in order to increase efficiency and maximize the valuable time of the surgeon. I arrived about an hour before the procedure, where I got some final checks, signed the informed consent, and paid the freight.
As I sat waiting for the Valium to kick in-yes, they offered me one to help me relax and who am I to turn down a legal Valium?-they explained the aftercare. I'm one of those people that has a hard time with eye drops, but the next few weeks are going to be filled with them. One is a simple antibiotic, while the other is a prednisone-based corticosteroid designed to reduce inflammation, keeping the healing on track. I was also given some artificial tears. The biggest complication after LASIK is dry eyes, which I have actually had for years without much problem or inconvenience. All in all, there's not a lot of problem in the aftercare, aside from remembering to put the drops in. For a ballplayer, this would be a bit more of an issue, but not that much of one.
Why not much? Frankly, ballplayers are babied a bit by their trainers. It's not quite like having your mom around, reminding you that it's time, but it's pretty close. Different trainers obviously work in different ways, but even with a non team-controlled procedure like LASIK, there would be some notice if a player is dealing with dry eye or any sort of issue in-season. The immediate aftercare is on the player, just like the rest of us. The trainer would also make travel easier. While my small kit of drops will have to go with me to spring training as checked luggage, charter flights make travel a lot easier.
After 20 minutes of chilling out and listening to a combination of Norah Jones, Jack Johnson, and Jason Mraz-enough to make me consider a lobotomy instead of LASIK-the doctor was ready. The operating room is purposefully built. There's a low table that the patient lays down on and slides under a device that bridges over. There are two computer terminals and what looks like a microscope at the top. The doctor is seated, just 'above' where the patient's head is. The guided LASIK procedure is mostly a computerized operation, making the cuts with the excimer laser automatically, following the map, but you still want an experienced doctor there.
My doctor, Mark Golden, has been doing LASIK literally as long as it has been around. Having done over 18,000 of the procedures and knowing he's a White Sox fan made me feel pretty good about my choice. With everything in place, Dr. Golden started. He placed a small device that held my eyelids open, which of course made me think of A Clockwork Orange, but I pushed that out of my mind. He asked me to focus on a small blinking green light, which would be my target throughout the procedure. Dr. Golden then placed a small device directly over my eye, which had some sort of suction. He told me to hold still and that things would go dark. This was the cutting of the flap in my cornea. It took about ten seconds, I think, but while it's not painful, it's an uncomfortable situation. My vision went blurry, then dark, then back to very blurry.
I could feel Golden doing something, which I later figured out was the lifting of the flap. He warned me that the laser was about to start and that there would be a smell. The excimer laser does have a distinct odor of burning hair, perhaps the least pleasant part of the procedure. I could see flashing lights in the periphery of my vision while the nurses called out numbers which, I hope, meant something. There was another brief moment where I could sense Golden doing something, but laying on the table with very blurry vision in one eye and a patch over the other, I was more focused on staying still than figuring out exactly what he was doing.
Almost as quickly as it started, it was over. Golden was flipping the eye patch from left to right and the procedure began again. Because I am left-eye dominant, there was a bit more to be done to this eye, and it took slightly longer. There was also a bit more swelling there, but nothing alarming. About ten minutes after I laid down, I was off the table and heading back. They checked my eyes one more time, handed me some sunglasses, and I was out the door. The worst part, I am told, is the first four hours, when the eyes are irritated and itchy. Since you can't rub the eyes for risk of moving things, it's better to just sleep through it, which I did. When I awoke about three hours later, my eyes were itchy, but not terribly so. I would say it's about the same as having spent a night in a smoky club and waking up the next day, asking yourself "Why did I stay in that smoky club so late?" minus the hangover.
Speaking of not touching the eyes, there's an interesting fact about LASIK that I came across while researching these articles. While we've taken a look at how it affects baseball players, I wondered if similar research had been done in any of the other major sports. The answer is a pretty resounding and surprising no. I reached out to a doctor about whether he knew of any, and he told me one of the scariest things I've heard. "I can tell you why you don't see a study on football players," she told me. "They can't have it." "Why not?" I asked. "The hits. Even six months after the procedure, the hits they take can tear the scars in the cornea. It just doesn't work for them or anyone in a high-contact occupation." I asked what another high contact occupation might be. "Heavy machinery, jackhammers, things like that. There was a while where there were some question about military personnel getting the procedure, but the plusses outweigh the minuses for them, if they can afford it."
By the time I woke up from my initial post-LASIK nap, I could see. We have one of those clocks that projects the time onto the ceiling, and previously, it was a nice nightlight for me. Without my glasses, it was a purplish blob. As I looked at it now, it was 6:20. How's that for immediate results? It wasn't a crisp vision, though. There was some blurring, which I realized came mostly from my dominant left eye. It stayed this way through the follow-up appointment the following morning.
The follow-up came dark and early Saturday morning, a required check of how the procedure went. Dr. Fisher, the optometrist, checked the surface to see how the laser-made cuts were healing and then put my eyes through the paces. "E". Yep, I can see that one. My right eye was actually a bit better than 20/20 less than 12 hours after being unable to make the letter out clearly without glasses the day before. The left eye was still a bit fuzzy and "doubled," a normal condition after surgery. I'll go back for yet another follow-up on Wednesday.
So what does this have to do with baseball? For that, you'll have to wait another couple weeks. Prior to the surgery, I took three tests to measure my visual function, reaction time, and a functional test. I'm no great hitter, so instead of hitting baseballs, I'll be trying to identify a half-inch number put on baseballs and fired at me at 80 mph. I won't pretend that this test will be anything more than a poor proxy for a baseball player's changes, but it's more than we have now, and it gives us some guidelines for what we can expect when a real ballplayer has the procedure. In the meantime, I'm going to go watch Castle in HD, without my glasses.