My parents have been asking me to have my myopic eyes treated with laser surgery ever since years ago, after my dad and some aunts/uncles have had successful surgery, but I was always afraid and never found the courage… until now. So my husband scheduled an appointment (via email) for me with my dad’s doctor, Dr. Jack Arroyo, at the American Eye Center on July 2, and it all began.
I went through a series of tests to determine my eligibility for LASIK.
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1. Preliminary Screening
* Automated Refraction – computer estimate of my grade
* Corneal Topography – digital image (color map) of the contour or curvature of the cornea
* Specular Microscopy / Pachymetry – determines status of the cornea (count of corneal cells + cornea thickness)
* Air Puff Tonometry – estimates eye pressure. This is where they hit your eyes with a small ball of air, and it always gets a jerky reaction out of me, even if I already knew what to expect after my first experience.
* Oculyzer – evaluates the front part of the eye
2. Manifest Refraction – optometrist determines the eye grade as reference for the laser treatment. This is your classic reading of a Snellen chart, this time with a computer spewing random letters thus eliminating any possibility of cheating by memorizing the letters.
3. Pupilometry – measures size of the pupils in dark conditions to give an idea if you’re prone to experiencing halos and glare at night.
4. Biometry – correlates the refraction with measurements of eyeball length, anterior chamber depth and lens thickness
5. Retinal Screening – They gave me drops to dilate my pupils and had my retinas checked by a retina specialist after 30-40 minutes
6. Cyclopegic Refraction – done the same day as retinal screening as the same dilating drops are used to temporarily weaken my eyes’ built-in focusing mechanism that enables them to adapt to changes in lighting conditions so that my “real” grade can be obtained
Before I go further, let me just define LASIK (laser-assisted in situ keratomileusis) as the procedure wherein the laser treatment to correct error of refraction is applied on the bed of the cornea under a hinged corneal flap. It’s proven to be effective in treating nearsightedness (myopia), farsightedness (hyperopia) an astigmatism. Because the flap preserves the superficial later of the cornea, visual recovery and healing are dramatically rapid, making it the preferred procedure. Patients regain functional vision in 4-12 hours.
After the tests, I finally met Dr. Jack Arroyo who explained the LASIK procedure to me. Though they offered the newer (and slightly more expensive) procedure “All Laser LASIK” which uses a femtosecond laser to cut a flap in the cornea, Dr. Arroyo recommended the classic LASIK procedure for me because he believed he could control it more and fashion a more suitable flap for me. Makes sense because doctors are more used to the classic procedure, plus I could save a few thousand pesos. This traditional method uses an automated microkeratome (a precision surgical instrument with an oscillating blade designed for creating the corneal flap). This microkeratome is placed on a ring with tracks and is made to advance and make a pass across the cornea, making a thin flap, after which it returns to its starting position. Topical anesthetic drops would be administered before the procedure, of course.
Dr. Arroyo confirmed that I was eligible for LASIK, but the only challenge he saw with me was my small, chinky eyes. He warned that he may need to perform a relaxing incision on the outer rim of my eyes so he could comfortably create the flap. I just nodded in understanding. I had faith in the doctor that operated on my father’s eyes. So I scheduled my surgery two weeks after: July 15. They scheduled surgeries on Mondays and Wednesdays at their Greenbelt 5 center, and on Fridays at Shangri-la. I chose to do it on a Friday so I’d have the weekend to recover.
Note that you have to discontinue using soft contact lenses a week before the surgery (longer for hard contact lenses).
I did some research, read about other patients’ experiences, and checked on what I’d need to do or what to expect before and after. Just to give me some ideas and psych myself.
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Do’s and Don’ts on Surgery Day
* DO arrive early – at least an hour before the scheduled surgery time.
* DO arrange for transportation after the procedure – it’s not advisable to drive yourself home. (Actually, you can’t even if you wanted to, you won’t be able to open your eyes long enough)
* DO try to dress warmly – the temperature in the laser suite is quite cold. (You can bring a jacket or sweater, but they’d also dress you in a thick long-sleeved blue lab gown)
* DON’T wear eye make-up or use perfume, cologne or anything alcohol-based
* DON’T smoke cigarettes or tobacco prior to the surgery as the laser optics are sensitive to scents and fumes
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I had lunch with my husband at Shang, then we proceeded to the eye center. I was asked to sign a consent form, which briefed me about the procedure and what to expect after, and underwent another series of tests similar to the eligibility screening. They also asked me if I wanted to settle the bill before or after the surgery – I chose to settle it before while I still had fully functioning eye sight. They brought me into the area outside the laser suite and started to prepare me, but Dr. Arroyo called me out so the nurses removed the preparations. Dr. Arroyo said he’d been thinking about my case (i.e., my apparently very small eyes) ever since he met me and explained that depending on ease of flap creation, he might need to do perform PRK procedure instead of LASIK. Photorefractive Keratectomy uses a laser to sculpt the surface of the cornea. This contrasts with LASIK, which sculpts tissue deeper within the cornea, under a corneal flap. I felt a slight panic, as all my research had to do with LASIK, and PRK wasn’t what I psyched myself for. Plus the doctor said the recovery is longer because essentially it creates a “wound”, and bandage contact lens to be placed after the procedure must remain on until the surgeon removes them. Plus the recovery involved pain – that got to me. Anyway Dr. Arroyo assured me we won’t decide yet until we get to the operating room, and LASIK will still be the first option to try out. He also offered to let hubby join me in the O.R.
Prepped for the operation
Hubby offering moral support
Hubby and I were dressed in blue lab gowns complete with shower cap and feet/slipper covering made of the same material as surgical masks, and hubby was given a surgical mask to put on. We entered the laser suite which had a big LCD TV where one could see the procedure done on the eye. I laid down the bed and tensed. They taped my left eye so they could do my right eye first. I was given drops of water and topical anesthesia. They taped my eyelashes away, and pried and kept my eyes open with a metal speculum. It kinda hurt when they did that, but when my eyes were steadily open there was no pain anymore. More drops of water and anesthesia, and the doctor poked to confirm that I felt nothing anymore. I was told to “look at the green light” and keep my head steady always. And so I always focused on the green blinking light. I heard the machines being prepared and when they mentioned that the “suction” was ready they placed whatever it was onto my eyes and I felt the pain when the suction ring “stabilized the position of your eye and increased the pressure to a level that is needed for proper functioning of the microkeratome”. Of course back then I didn’t know what it looked like or what it was for, I just associated it with the pain and I remember muttering “aray aray aray aray arauy”. Dr. Arroyo asked me to tolerate the pain. And I thought this was a painless procedure. I felt my vision fade to black when the created flap was pulled back, and I could hear the whir of the laser that would correct my grade. This site does a good job of putting the procedure into simple words and illustrations.
The speculum to hold the eye open
However, after the laser started to do its magic, they stopped with the procedure, and at first I didn’t realize they didn’t mean to stop yet. I could hear low voices talking to some sort of technician (I assume) over the phone, something about restarting the machine and other laser-related discussions. Back then I had no idea the laser hung at 40% completion, leaving a -2.50 grade on my right eye. When they returned the flap, removed the speculum, and taped my right eye I thought my right eye was done. Then they moved to my left eye and performed the same procedure. I muttered “aray aray aray” again when they used the suction, and this time Dr. Arroyo told me to be quiet (perhaps I was distracting him with my mutterings but I couldn’t help it, it was painful). This time the laser finished correcting my error of refraction. I closed my eyes.
That purplish thing is the laser doing its magic
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DAY 0 - POST-OP
They removed the tape covering my right eye and replaced with a sort of gauze to cover both my eyes. They guided me out the laser suite and made me sit with my eyes closed for about 15 minutes. Then when they removed the bandage they put drops in my eyes which I could barely open, feeling my eyelids were very heavy. Then transparent protective shields were taped over my eyes – I was supposed to wear them overnight and I wasn’t supposed to wash my face that night to avoid anything getting into my eyes. They said I could wash my face the next day as long as I kept my eyes closed, as water (or any other particle for that matter) should not get into my eyes. The nurse provided instructions for the eye drops but my hubby was the one keeping them in mind as I was still slightly disoriented with not being able to open my eyes. I read from the consent form that I was going to possibly experience excessive tearing, sensitivity to light, night glare/halos, dry eyes, and foreign body sensation in my eyes after the surgery.
Protective transparent shields
I was told to return the following day, at their Greenbelt 5 branch, for enhancement on my right eye. They explained about the laser malfunction which was out of their control. At least the flap was already created – that was the painful part, so I didn’t have to go through it again.
Hubby guided me outside the center (where he later told me everyone was looking curiously at me) and onto the parking lot. I stayed on the backseat so I could hide from the sunlight that would stream through the front seat after we get out of the parking lot. I felt like a vampire, hiding behind car pillows as the sunlight was glaring even with my eyes closed. Most patients sleep after the procedure to minimize discomfort but I wasn’t sleepy so hubby played an audio book of Rick Riordan’s The Throne of Fire which he especially prepared for me in anticipation of my lack of visuals after the surgery. It was my first time to hear a novel’s audio version. He also put the three sets of drops onto my eyes every 4 hours:
* Vigamox – anti-biotic
* Econopred – anti-inflammatory
* Systane – artificial tears
I couldn’t eat by myself either, so hubby fed me like a child. After dinner hubby wiped my face with Clarins Water Purify One-Step Cleanser and proceeded to play the audio book until it was time for us to sleep. All that time our room was kept in the dark, with only a couple of night lights on.
Hubby was so squeamish during the procedure earlier that he thanked God for his good eyesight when he prayed that night.
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DAY 1 – POST-OP
I woke up, opened my eyes, and I could see the time on the wall clock. I was always not able to read the time so I’d always rely on my iPhone placed beside my bed. For the first time I could see the time on the clock. Later on I’d realize that my right eye still had blurry vision. Not allowed to rub my eyes, we used cotton buds to remove morning stars from my eyes. When I looked in the mirror I was taken aback at how red my eyes were, like my scleras had been splashed with red paint. Later during my research I learned they were subconjunctival hemorrhage (bloodshot eye), caused when the pressure from the suction ring that is placed on the eye prior to the microkeratome pass caused some blood vessels to burst. The subconjunctival hemorrhage will normally clear over the next couple of weeks and is of no visual consequence. Most LASIK patients got them. It wasn’t painful at all, more of just an aesthetic problem. All the more reason to wear shades.
I washed my face and didn’t open my eyes until after patting my face dry. I used goggles when taking a bath. Light wasn’t so glaring any more, though I still had the foreign body sensation in my eyes, usually caused by dry eyes which is an expected effect after surgery and was bound to go away eventually. I continued to listen to the Throne of Fire audio book after breakfast until noon. Hubby bought me shades from Shopwise to protect my eyes from the sun’s glare and any foreign particles. We had lunch at Greenbelt 5 then proceeded to the eye center for my enhancement procedure.
At the center I was made to sign the same consent form. They did another series of checks on my eyes, pretty much the same set of tests. I was supposed to have 20/20 vision already on my left eye, while my right eye was left with -2.50. Then I was prepped for the surgery. I wasn’t as scared this time, knowing what to expect, and relieved the flap creation part would not be done anymore. My left eye was taped closed. Drops of water and anesthesia began the procedure. They didn’t tape my eyelashes anymore and used the speculum directly to keep my eye open. My eye was sore so it hurt a bit when they used the speculum, but once my eye was steadily open it was fine. Then the doctor re-opened the flap, shot the laser, and closed the flap again. After 15 minutes of being bandaged closed, my right eye received the medicine drops. They also gave me a DVD copy of the procedure. Then I was allowed to go home using my shades, and they just gave me another transparent shield for wearing when I sleep that night. At home, I continued to listen to the Throne of Fire audio book.
This is the flap that was re-opened to perform the enhancement surgery.
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DAY 2 - POST-OP
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DAY 3 - POST-OP
I went to the office wearing shades. Of course I removed them when I was at my desk. I just use them whenever I need to go around. Didn’t want to scare people off or have them assume I had contagious sore eyes. I gave my spare contact lens solution, still sealed, to my office mate. After work I walked to Greenbelt 5 for my post-op check-up. Another series of tests and my eyes were deemed 20/20. I was told that clarity may sometimes fluctuate at this stage, especially with the dryness, but would get better in time. I didn’t mind, I was used to visual clarity fluctuating when I was using contacts, for the same reason – after long hours of wear they’d get dry. Usually crying, washing my face, or putting lubricant drops would restore the clarity – anything that gets moisture in the eyes. Of course in this case I had my artificial teardrops every four hours or as needed. The other two drops – Vigamox and Econopred – were to be used every four hours for the first week.
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DAY 8 - POST-OP
I went back for another post-op check-up, went through the same series of tests, and supposedly got 20/20 vision on both eyes. At that time my right eye had better clarity that my left, though I could still read the letters with my left eye although I need to focus more and the sharpness was not as optimum when it came to the 20/20 letters. But using both eyes, I could read, though with a need for effort, the 20/15 letters.
I checked the DVD they gave me and it contained only the enhancement procedure on my right eye. I’ll have to check with them when I could get a copy of the original procedure done at Shang, which I was entitled to.
So far, no regrets, and I love being able to see clearly without my contacts or glasses. And I still need to sell four packs of sealed Freshlook colored contact lenses, grade -4.75 (my contact lens grade was lower than my -5.50 error of refraction).
To read on how my vision was eight months later and the complication that followed, please check out my update at
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American Eye Center
What kind of laser was used during the procedure?
The Excimer laser is a cold laser which works via photochemical ablation. Unlike other lasers that utilize thermal energy to burn tissue, Excimer lasers make use of an argon-fluoride gas mixture to break the molecular bonds of corneal tissue. As a result, fragments of corneal tissue rapidly expand and are ejected at high speed from the corneal surface. The Excimer laser is computer-controlled, allowing precise removal of tissue to the micron level.
Consultation and Screening: Php 900
Retinal Screening: Php 750
LASIK: Php 70,000 for both eyes, with 12% discount, becomes Php 61,600 net