Eye of the Field-Worker

Happy 2019, Dear Readers!

This was not a post that I was expecting to write. Honestly, who really wants to hear the gory details regarding eye surgery. Well, apparently my Twitterverse is as morbidly curious as I am about such details.

For good reason. In my personal experience, having to wear prescription glasses while doing field work is a huge pain in the sclera: sometimes literally in the event that I got something in my eye. As an aside, I used to have a panic-like reaction to people’s fingers near my eye. I could barely touch my own eye when trying to remove the inevitable cat hair, but someone else’s fingers TOUCHING MY EYE?!?! My poor husband, colleague, and fieldwork partner remembers an incident that involved trying to get a piece of dried leaf out of my eye on a field survey. Despite the seeming protection of my glasses, a bit of crumbled leaf got caught in my eye as I scrambled under a dead fallen tree. Rinsing my eye didn’t dislodge the offending leaf crumble, so he tried to physically remove it. I knew exactly what was happening. He told me everything he was going to do before doing it, but that didn’t stop the illogical panic reaction. I still went into panic mode.

You can already guess that contact lenses were not a comfortable option for me. I wore glasses for the majority of my fieldwork days, with regular summer fieldwork starting in 2003. For a decade I did surveys and excavations while wearing prescription glasses.

The plus side of wearing glasses in the field is that they do act as a bit of an eye shield, although they are NO substitute for actual safety glasses. They acted as a barrier to twigs and tree branches while hiking. There were downsides, however.  One, it was a pain in the pupil to find safety glasses that would fit over my glasses and not fog up while providing full coverage. I ended up having to wear most safety glasses without my prescription glasses to prevent fogging. Two, prescription glasses are expensive, and my lenses would be a scratched pitted mess after every field season, requiring that I drop at least $300-$400 every year on a new pair. I tried having a pair of prescription glasses that I only wore during fieldwork, but they would become un-useable after two seasons. That would leave me the choice of either using my “good” pair of glasses (condemning them to inevitable damage) or stumbling around in a fog of blurry objects.

The ongoing expense of prescription glasses is what helped me make the decision to stare down my fear of people playing with my eyeballs and undergo corrective laser surgery. Well, not just the expense, but this next reason is directly related to the cost of glasses. I was trying to “tough out” my damaged glasses by wearing them for longer than I should. I gave myself eyestrain trying to look through and around the scratches on the lenses. One of my eyes started to overcompensate by focusing on the wrong area when I looked at objects in the distance. My reasoning (at the time): I was simply feeling too insecure financially (with the ever-likely threat of our project losing its funding and becoming unemployed) to drop a few hundred dollars on glasses every year or two.

The conclusion I eventually came to was this: yes, laser eye surgery is an initially expensive procedure, but no matter what happened to me employment-wise I would not have to worry about glasses again for a long time.

In 2012 I started doing my homework.

LASIK versus Photoreactive Keratectomy (PRK)

LASIK – The most common type of corrective laser eye surgery (when I was looking) was LASIK surgery. In this procedure, the laser cuts a little flap in the outer layers of the corneal tissue. Once the little flap is cut, the surgeon lifts up the flap and the laser-ing of the cornea happens underneath. Once the reshaping is done, the flap is put back in place. The flap ends up acting like a bandage for the area, and no stitches or additional coverings are needed. Patients usually heal within 12 – 48 hours, and the whole procedure takes about 15 minutes to complete.

I initially liked the idea of LASIK because of the short healing time. However, during my reading, I came across some cases where the healed edges of the corneal flap can potentially “pop” back up, especially if you take a whack to the head. At the time I was in karate – whacks to the head happen by accident, but they do happen. Also, if I was in a serious accident during fieldwork, the absolute last thing I would want to deal with would be parts of my eye flapping around.

Photoreactive keratectomy (PRK) – I choose photoreactive keratectomy or PRK surgery. There are two tissue layers of the cornea that are involved in the surgery. The epithelial layer is the one that is removed by an instrument (more on this part later). This epithelial layer is the one that regenerates and heals. The underlying layer called the stroma doesn’t regenerate, so this is the layer that gets reshaped by the laser.

After the PRK surgery is complete, your stroma is basically open to the elements like a scrape or a cut, so you need a soft contact lens bandage to cover the altered area while the epithelium layers heal over. This contact lens bandage is left in place for a few days while healing occurs. The recovery process for PRK is apparently a bit more uncomfortable than for LASIK (more on this later).

My Experience with PRK Surgery

Those are the basics of the surgery. Now I’ll tell you about what I remember of the process. We stayed at my sister-in-law’s Julie’s place for the duration of my procedure and the recovery. She made a special treat for us in honor of my surgery.

882466_10151517414720907_1442191918_o
The image is a little fuzzy, but these are sugar cookies decorated to look like infected eyes made by my sister-in-law Julie They were delicious!

Pre-Screening and Examination – The process takes two days, even though the surgery itself is completed in 15 minutes or less. Day 1 is set aside so that the technicians can perform an eye exam prior to the surgery. I filled out a complete medical history and went through a series of very thorough vision tests. This was to establish what needed correcting for my vision. The examination took most of the morning. One of the things they test is your corneal thickness: if your corneas are too thin, there’s not enough cornea to remove for the reshaping. There are other reasons that you may not be a good candidate for corrective laser eye surgery: your regular optometrist will answer your questions on this. My optometrist had a corneal thickness measuring device, so even before researching my surgery options, he was able to tell me that I might be a good candidate.

Usually, the technicians give the OK to officially book you into an official surgery slot that week right after the examination. However, during my examination, the technicians discovered that my eyes weren’t focusing the way they should be: one eye was skewing a little to one side. In my opinion, I blame this on my trying to see through damaged glasses for three years. The technicians said that they had to get the surgeon to look over the test results and that they would get back to me that afternoon with the decision.

That afternoon Rich and I met up with our advisor (we were both still in graduate students at the time) to catch up. I honestly can’t remember what we talked about. I was angry at myself for mucking up my eyes and ruining my chances at receiving this surgery just because I didn’t want to drop money on new glasses when I needed them. I must have obsessively checked my phone every two minutes. This went on for about two hours, and then at around 2:30 pm I received the call: I was cleared to have my surgery that week.

With the surgery, you can decide to have one eye done at a time (two separate surgeries) or to have both eyes operated on at once. I felt as though I only had enough nerve to go through this process once, so I opted to get both eyes done during the same surgery.

Surgery Day – I remember this being an all-afternoon event. We were at the clinic at around 2:00 pm. I was both nervous and excited: nervous because PEOPLE WERE GOING TO TOUCH MY EYEBALLS, and excited because this procedure would allow me to be glasses-free. Rich and Julie came with me for moral support. Before the surgery, there were a few more forms to fill out (I filled out a lot of forms during this process). We saw a lot of people coming and going, both patients and their support systems. The clinic began to empty. My surgery was scheduled as one of the last ones for that day.

About 20 minutes before my surgery, a technician came out to meet me and my team. I was given a small dose of an anti-anxiety drug: apparently, it’s normal for people to be nervous before this surgery. The technician then asked Rich and Julie if they wanted to wait in the waiting room, or if they wanted to sit in the observation room and watch the surgery on a monitor.

My family is the best, and by the best I mean their eyes lit up at the chance to witness this eyeball-themed spectacle. There was a resounding yes to the offer to watch my surgery. Both Rich and Julie said that they were going to give my surgery a proper Mystery Science Theater 3000 treatment.

normal view
Mystery Science Theater 3000 episode of “This Island Earth.”

Movies are a big part of our family, and Rich, Julie and I are huge MST3K fans. Just knowing that they were going to be there, riffing every gory detail of my surgery, was supremely comforting for me. That’s love.

At this point, I was led into the pre-surgery room. I changed into a hospital gown and waited for the surgeon to arrive. When the surgeon arrived he examined my eyes, and then took a felt-tipped pen and drew on my eyeballs. Yes, you read that correctly. I didn’t feel any of this thanks to the anesthetic drops, but seeing the felt pen come towards my eye was a bit disconcerting. We made small talk whilst he drew guidelines on my eyeballs, and then I was ready for the surgery.

I was led to a comfy reclining chair in the surgery room. However, above the chair was a huge apparatus. I’ll admit: my brain did briefly jump to those alien abduction shows. I laid back in the chair. The surgeon asked if I had anyone here with me. I said “Oh yes! My husband and sister-in-law are in the observation room. They’re going to MST3K my surgery!” I think I confused the poor man.

Then came the eye stabilization equipment. There are several videos on the clinic’s website that show you, step-by-step, the procedures and describe every detail so that there are no surprises. However, personally experiencing this equipment is different than watching the procedure as a third-party. An eye speculum was applied to the first eye: it’s a metal ring clamp that holds your eyelids open so you can’t blink. It also holds your eyeball in place. Next, a small ring was placed over the cornea. The ring was there to act as a cup to hold a solution that was then squirted on to my eye. This solution was applied to soften the epithelial layers. At this point, I have to take Rich’s word for what happened because everything went blurry. I didn’t see any scary equipment coming to touch my eyes (thus sparing me potential nightmare fuel).

Why did this area need to be softened? Here comes the fun part (and the part were Rich and Julie’s riffing apparently kicked into high gear). The now softened epithelial layers are scraped off with what looks like a tiny metal hockey stick. Once my epithelial eye gloop was scraped away, it was time for the laser to reshape my stroma. Again, all I saw were blurry movements, and I didn’t feel anything.

I think I asked, “Aren’t you going to strap down my head so that I don’t move and mess up the surgery?” The surgeon replied that there was no need to worry about that. Heck yeah, I was worried about that! I wanted my head strapped down using medieval-looking devices so that there was no chance of me flinching. But no, my head was free and mobile.

The laser began to snap and crackle. I felt my nerves jumping at every snap. The surgeon must have seen the flinching because he, very gently, placed a couple of fingers on my forehead. THAT’S IT? I thought, That’s how my head is going to be restrained? It seemed to do the trick despite my incredulity. While I found the sound unnerving, the smell was fascinating. Oh yes, there was a smell. It smelled a bit like burning hair.

Once the surgery was complete and my contact lens bandages were in place (my first time wearing contacts) the technician said that I could take however much time I needed to sit up and move around. I felt fine, but I guess people can be a bit shaky after the surgery. I waited about a minute before getting out of the chair. I changed and met up with Rich and Julie in the post-operating/waiting area. A technician followed along with me to make sure I didn’t have the post-operation shakes and collapse (I suppose), and I waited in the recovery area while the prescriptions for my eye drops and pain medication were completed.

I could technically see at this point, although things were a bit fuzzy and bright lights were uncomfortable. I waited for my prescriptions and drank orange juice while Rich and Julie regaled me with Tales of The Gloopy Eye Scraping. I filled my prescriptions and we were out of the clinic by 4:30 pm.

Post-Surgery Care – I had three prescriptions for my post-operative care. One was the pain medication. Another was a bottle of steroid eye drops that I had to apply a few times a day. Another was a bottle of numbing eye drops that I could apply as needed (up to a few times a day). I was also sent home with breathable eye shields. I was instructed to tape these over my eyes at night for at least a week so that I didn’t scratch or rub my eyes in my sleep. I looked (and felt) like a giant insect. I was told to avoid screen time (computer, TV, smartphone, etc) and reading for at least two weeks, and to limit screen time for another two weeks after that.

I slept a great deal during the day for the next two days. My eyes were closed for the most part anyway, and the pain medication made me drowsy. While I was drifting in and out of sleep I listened to audiobooks. Julie found an awesome soft headband with built-in headphones that I could wear as an eyemask (over my buggy eye shields) while I was dozing. After the third day, I didn’t feel as though I needed the pain medication: the prescribed schedule of numbing drops seemed to do the job. I wore sunglasses when we would head out during the day.

On the third or fourth day Rich, Julie and I went out for dinner. We were chatting and laughing, when OH MY OWLS THERE WAS SOMETHING IN MY EYE. It was quite uncomfortable. I figured that something this uncomfortable would have to be visible, so I excused myself to the washroom and checked my eye. I saw absolutely nothing in my eye, other than the thin line of the contact lens edge. The initial discomfort was gone, so I really didn’t think much of it. I was sure that my blinking had worked out whatever it was. I felt fine…until my progress check-up.

The Post-Surgery Check-Up – I had my five-day progress checkup at the clinic. The technician examined my eye.

“Hmm,” she said, “There appears to be something behind your contact lens.” She brought out her large magnifying ring light. “Oh dear! There’s a hair caught behind your lens!”

“Oh, THAT’S what that was!” I exclaim.

“This must have been so painful! You didn’t go to the emergency room?”

Honestly, I was a bit baffled. “It really wasn’t that bad after a few minutes.” I had spent a lifetime fishing cat hair out of my eyes, so this seemed like no big deal to me. I was about to change my mind.

“I’ll remove your contact lens and use these nasty pokey tweezer-looking things (that’s not its technical name, but that’s how I remember the tool) and lift off the hair.”

I was more nervous here than I was throughout the entire surgery. Some numbing drops were applied, but it wasn’t the surgery-level anesthetic. My flailing and flinching started when the lens was lifted off. I don’t think that I impressed anyone with my stoicism at that moment. It took the technician several tries to remove the hair. I’m sure that my fingers left permanent divots in the armrests.

The epithelial layers of my cornea had started to heal around the cat hair and was in danger of leaving a permanent hair-shaped scar across my surgery area. I was instructed to stay on the steroid eyedrops for an additional few days to completely heal the hair-affected area. They changed my contact lens bandages and scheduled my next check-up.

I was given the all-clear on my second follow-up to have my one-month checkup by my local optometrist. When you leave the clinic after receiving corrective eye surgery, your driver’s license will still say that you need prescription glasses for driving. You are given a card by the clinic that provides an update to show police (until you get your license renewed) and to present when you get your license renewed.

Rich drove the entire 8-hour trip (I did most of the driving on the way out to the clinic) back to our home base. I settled in for a two-week period of being at home…with limited screen time and limited reading. This was difficult: my downtime consists of reading, watching movies, and knitting. I passed the time by making cheese (wearing a huge pair of safety glasses just in case I splashed my eyes) and listening to Planet Earth.

My one-month checkup was good. My eyes were healing well. There was still a faint hint of the cat hair scar, so my optometrist wanted me to stay on the steroid drops for an additional week as a precaution. Otherwise, my vision was a little better than 20/20.

Was It Worth It? – It has been six years since I had corrective laser surgery, and all I can say is HECK YES. I should have done this years ago, but realistically I wasn’t in a position until 2013 to finance such a surgery.

I have noticed some minor side effects. My eyes dry out more easily than they did before the surgery. I make sure to carry a small bottle of regular eye drops for long driving trips. I also have a little trouble focusing when I am driving in twilight conditions: oncoming traffic lights have large light halos. This one may not be related at all to the surgery, but I also have to be careful to not spend too much time staring at my phone screen (my computer and tablet are fine) as it gives me eyestrain. Other than that, I have not experienced any negative side effects.

I do have to be more careful while I am hiking, as I no longer have my glasses acting as an ersatz eye shield. In 2014 I was doing a field survey in a remote mountain creek canyon. The terrain was full of boulders and twiggy understory growth. I grabbed a dry branch to push it aside, and then WHACK! a bunch of dried bark flew off of the branch and hit me in the face. My eyes were open, so the bark also hit me in the eye. I immediately let Rich know so that he could pull the bark out of my eye. He looked and looked…but there was no bark in my eye. I rinsed my eye several times, but could still feel bark in my eye. It was uncomfortable, but it wasn’t getting in the way of doing the survey.

Once we got back to the vehicle, my eye was still bothering me. We had a second leg of the survey to explore, but the drive would take me past the house, so I asked to be dropped off so that I could examine my eye in a controlled setting (my bathroom). I STILL couldn’t see any bark in my eye, so when Rich returned I requested a drive to the emergency room.

The doctor put a temporary dye in my eye, and Rich could immediately see the scrape that the bark had made on my cornea. It took about a week to recover from the scrape, and I needed to be on antibiotic and steroid eye drops during the healing process. I also had to wear either an eye patch or an eye shield over an absorbent gauze pad. I opted for the eyepatch this time.eye patch

The moral of this story is to PROTECT YOUR EYES. It might feel goofy hiking with safety glasses, but if you are going to be plunging headfirst into dense undergrowth it’s a decent safety precaution (if it’s not already required by your institution.)

These, of course, are my personal experiences with corrective laser eye surgery, and your mileage may vary. I’m glad that I had the procedure and feel it has improved my quality of life, especially with fieldwork. If you’re considering a similar procedure for similar reasons, I hope that this post will provide a bit of information as you make that decision.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s