IOLs have been around since the late ‘40s, but recent developments have made them pretty amazing. The newest procedure involves inserting the lens into the eye with the basic focus worked out. Then, once the eye heals, doctors can direct UV light at highly specific areas on the lens to fine tune the focus. The end result is amazing, custom tuned vision, better than 20/20 in many cases.

Not a new idea, sure, but one that resonated with me. I’ve always thought about getting LASIK, but I’m scared by how once that laser burns away at your retina, there’s no going back. If my vision ever got worse, it’d probably be back to glasses and contacts. I’m sure plenty of you readers have had wonderful experiences with the procedure, but I’m really risk averse.

The amazing thing about most IOLs is that they’re reversible. So if my vision ever changed, I could just get a new lens implanted.

Unfortunately, this new procedure only correct for cataracts and farsightedness right now. Here’s to hoping nearsightedness is next on the list. [Sky News via SmartPlanet via @editorialiste]

We upgrade, update, and customise nearly everything, so why not our vision too? Reach for the stars and all that jazz. And even the tech fits the theme: some more common optical surgical procedures are actually based on NASA technology:

Wavefront technology, originally developed by NASA to aid the focus of the Hubble Space Telescope on distant stars, measures up to 250 spots in the pupil to provide a precise map of the cornea and iris. This offers the potential to correct problems not addressed by glasses, such as halos around lights at night or glare.

Fighter pilots, snipers, long-distance drivers, politicians, supermodels, and your average Sally or Joe Smith are getting eye surgery. Why? Some are doing it for vanity, to no longer have to wear glasses they may consider unsightly, or contacts that may be a hassle. Others are doing it to advance in their careers: some pilots wouldn’t be allowed to fly without meeting certain vision requirements, and others just wantbetter than normal vision.

Gradually it’s becoming more and more common for patients to request procedures which will over-correct or modify their corneas with goals other than simple 20/20 vision in mind. Those pilots might want better night vision and the speech givers want to avoid wearing reading glasses and request monovision. That’s great, but what about that Yankees catcher who gets surgery to see the balls flying at him better? While no one will care much about other cases, there could eventually be argument that his vision surgery is some form of unfair enhancement.

Potential arguments and debates aside, it’s not all just about boosting career aspirations and vanity though. Dr. Julian Stevens of Moorfields Eye Hospital, an expert on laser refractive surgery, gives an example of how “customized” vision helped a patient’s quality of life:

“One of my patients led an active life and had high-quality distance vision. When he became paralyzed from the neck down, his world became smaller – reading and television. Spectacles on your nose become painful if you can’t shift them.” The solution? Mr Stevens made him slightly short-sighted.

I must admit that this particular example made me cringe a little bit. What are the ethics of downgrading someone’s vision at his or her request even if it’s for an improvement in lifestyle. No matter. There’s some great potential for both good and evil in it, so I’ll be paying attention to advances in this whole custom-tailored vision trend, because my death glare definitely needs some upgrading. [Times Online]

Photo by bogenfreund

A whirring sound commenced and my eyeball felt like it was being sucked up and out of my skull, elongated like a green grape between a Roman emperor’s fingers, ready to burst. The bright blue-white light grew closer. As the pressure killed circulation in the eye things went black and I felt an arcing slice in the surface of my cornea—I did not move my jaw or tongue or mouth, but deep in my throat I uncontrollably whimpered, “THAT HURT!” and hoped no one heard me. I hoped the other eye would not feel the same. It did not, as the drops had actually taken full effect by the time it was sliced open with a beam of light. The rest was, as they said in the brochure, physically painless.

A few days earlier on Linda Del Mar beach, a wave knocked me off my longboard. Under the turbulence, both contact lenses were flushed out of my eyes. It was impossible for me to catch any more waves with the remainder of my eyesight. Although I’d entertained the idea for years on and off, it was right there that I decided to get LASIK done as soon as I could. A friend told me he’d had good success at LasikPlus. Coincidentally, my vision plan gave a hefty discount there, so I figured I would try them out. It was them or the LASIK doctor from Family Guy:

I went for a free consultation. Their office was like any other doctor’s office, with one exception. In the middle—behind a giant glass window that everyone in the waiting room could see—was an operating chair situated in between giant boxy machines. They had overhanging beaks positioned as if ready to feast on whoever was strapped into the seat.

The optometrist concluded I was a good candidate for the surgery, based on having light to middle nearsightedness, slight astigmatism and otherwise healthy eyes. She showed me a brochure with all the options I could get: The $US900 base package uses a scalpel to cut open the cornea and then a broad UV laser whose every zap removes tissue 1/500th of a human hair in thickness. I opted for the $US2000 package, which opened the cornea with a laser instead of a scalpel and tracked a custom map of my eye’s irregularities, treating it sector by sector. This wavefront guided analysis is the same tech NASA used to detect and counter irregularities in high-powered telescopes. This would reduce halos around bright lights and “dramatically improve vision.” According to a study I do not know enough about to believe, it was more likely to better than 20/20 vision with such a package than without. The Navy recommends this version of LASIK for its aviators. And if it’s good enough for Top Gun, it was good enough for me, regardless of cost. (These quotes are per eye.)

I was surprised to discover when I went in later that others were getting the basic surgery. I winced as one lady’s eye was cut by a scalpel in a device akin to a carpenter’s plane. Another lady—whose husband was getting it later depending on how hers went—complained about night vision problems but didn’t opt for the costlier halo-reducing procedure. I found this astounding considering the banners on LasikPlus’s site offering 0% financing.

Someone asked the nurse what the difference was between the cheap and the expensive LASIK and she said something that might not have been exactly endorsed by the company: The expensive one was like high-definition TV and the cheaper one was like standard-definition, but they both get the job done. I thought to myself, “Like hell standard definition gets the job done!” Yet everyone in the room nodded as if they were still using VHS at home.

On the Saturday before the lasering, I had gone surfing with my contacts but was told to wear glasses for the next three days to ready my eyes for the operation. Hard lenses need to be left out for 4-6 weeks before surgery since they greatly affect the shape of the eyeball.

Wearing my glasses again, I appreciated the nice titanium frames and ultrathin glass. I realised there was a lot to be said for how glasses made me feel. In 7th grade, I’d noticed difficulty making out the blackboard, but avoided getting them and got through math class by squinting. The teacher reported me to the nurse, and I got stuck with some hideous gold coloured ones with horn rimmed earpieces. I felt self conscious in them, almost diminished.

That feeling went away as I grew up and earned some nerd pride, but I have always allowed myself to say geekier things and do more socially awkward things when wearing them. I could futz with my phone instead of carrying on in a group conversation, push my glasses up my nose and laugh slightly louder than usual at slightly stupider things, and expect people to chalk it up to nerdiness. I think I might miss this, for all the advantages of having laser-enhanced vision.

On the day of the operation, the doctor spoke to the patients in the waiting room. The entire procedure would take about 15 seconds per eye. There was nothing we could possibly do to cause the surgery to fail, but please do not shake our legs. (?!?) Lisa asked me at least 5 times if I was scared. It made me wonder if I looked scared, because I didn’t think I was scared and if I looked scared that means I was so scared I didn’t even realise it. Which all freaked me out. A lot.

Once my corneas were cut open and I experienced that initial pain, I was definitely frightened, and escaped to a corner of my mind where I would not think too much about all the things they were doing to my eyes and what my life would be like if I happened to be the “less than 1%” of patients with vision-reducing complications.

I was already in this mental cone of silence when the doctor lifted up the covers of my eyeball flaps using what looked like metal chopsticks, mixing around a stir fry while I watched, first-person perspective, from within the wok. I was shifted under the largest machine in the room, its eye a flashing red/orange light. It reminded me of a Discovery Channel feature on exploding stars. There was a sound, a clicking like that from a Tesla coil, and the smell of ozone, which went on for 15 seconds as the nurse counted down. My eyes were clamped, and I felt I was being burned alive (even though LASIK’s UV laser does no thermal damage to tissue). I was told not to attempt to move or blink, which of course, makes you move and blink. The muscles in my eye fought the devices holding me steady, and before I could calm myself down, the laser had already stopped.

The doctor finished my second eye, and had me sit up. There was fog everywhere and contrast was abysmal, but my vision had improved by measures of sharpness. I slept in the car ride home as Lisa drove, and as the painkillers wore off. The hard part began: I was to avoid all optical stimulation and sleep the rest of the day. At one point, I could handle it no longer and I checked my email. All of it.

I was told that the next morning I would have a miraculous, life-changing experience as I woke up without any need for glasses or contacts. Actually, it was not so miraculous. My healing eyes could see somewhat sharply but with a lot of haze. It was similar to sleeping with my contacts in. I took off the racquetball-style eye shield I was to sleep with for a week
, and began the steroid and antibiotic eye-drop treatment, which I’d also keep up for a week. I got dressed and went for my check up appointment. And that was when the miracle happened.

I got in front of that damn eye chart and, even through the haze, smoked the exam’s 20/20 line. Had my eyes been clearer, I would have read the letters on the 20/15 line, too. Not bad for $US4K, a laser in my eyes for less than a minute and a day’s worth of healing.

After I get used to the sharpness, I am sure I will be worried about being one of the few percentage of people who walk away from LASIK dissatisfied. (Wikipedia cites four studies that indicate post-op satisfaction anywhere from 92% to 98%, but that’s still a lot of people pissed off.) Even if things go perfectly, they say it will take 3-6 months to heal completely, during which my vision will be irregular. Eyeballs might be dryer at times than I’d want them to be.

None of this bothers me much, save the fact that newer, better, safer technology will come around sooner or later, and my eyes may end up as out-of-date as back-to-school iPods. And I do not know if my eyes will be forward-compatible, having already been sliced. Still, for now I remain top-of-the-line, and I would gladly endure 10 times the (mostly imaginary) pain of LASIK to gain the quality of eyesight found in elite Major League Baseball pitchers.

[Thanks to Lisa for feeding me, driving me home and taking that video.]