Medical talk about my eyes, ahoy! Skip if you need; otherwise please give me some GD advice.
Yesterday I went in for an evaluation with Dr D, in consideration for laser surgery (LASIK or PRK). I went through the barrage of tests - and I am serious, barrage; my appointment was at 9 and I didn't actually see Dr D until 10:30 - and got my eyes dilated (spoiler, if you've never had it done: it sucks. Your long-distance vision isn't so bad, but anything closer than 10 feet is all out of whack, you have NO depth perception and can't read anything, including your own phone, trying to look at your fingers gives you a headache, and oh also all light is now a minion of hell itself). I sat there for a bit while Dr D looked at my charts and looked in my eyes a little bit and HMMed.
There was a lot of HMMing. He talked to the [nurse? assistant? secretary? i dunno, they'd taken my glasses so I couldn't even tell you what color hair this person had] for a while and flipped through some charts. He talks to me a little bit as he looks into my eyes, and then he asks the assistant-person to go and get [a new doctor, who is training with him]. "She should see this consult," he says, and basically explains that my eyes are so bad it will be a good learning experience for his new trainee doctor. Ugh. So I sit and blink into space while she arrives, and then they finally give me my glasses back, and there is some more HMMing.
And then he says, "No, you're not a candidate for PRK at all."
Okay, I say, slowly. But the other doctor told me I wasn't a candidate for custom LASIK either because my eyes were so bad, and said PRK would be better.
Technically, says, Dr D, PRK is better -- up to a point. But on a patient like you? On a patient with -11 myop? If we did PRK on you, you'd have halos and floaters for the rest of your life, you'd never fully recover from it. We'd have to take off too much, it's coming way too close, and even if it fixes your vision you're going to lose all your night vision and your sensitivity. I don't like it. I've done 37,000 surgeries, and I'm not going to do PRK on you.
Please note at that point that my eyes are actually too bad for both custom LASIK and PRK. I win?
But, says Dr D. That doesn't mean you don't have options. You have two options, and I want you to listen carefully, because one isn't what you're going to expect.
My first option is standard LASIK, the LASIK they did back in the 90s before it all became super automated plug-and-play - that's custom LASIK, and I can't have that. The thing is, says Dr D, custom LASIK and standard LASIK both operate taking a certain thickness of your cornea per myop of your eyesight. Custom takes a little more, standard a little less. For somebody who is a -3, the difference is maybe 15 microns? Not a lot. For someone who is a -11, the difference is more like 100 microns -- which is what rules out custom LASIK. My corneas aren't thick enough to handle the amount of correction my myopic script needs.
Standard LASIK, however, where Dr D would do it himself, is still an option. It's a little... not great of an option, though. He'd be pushing the LASIK to its limits, and if my eyes started to change as I aged, we wouldn't have a lot of options, because I wouldn't have a lot of cornea left to work with. I could do it, he says, I've done hundreds of patients with eyes just like that and it works fine. But I'm not thrilled by it.
Your other option, says Dr D, is an implantable contact lens.
Basically they make a biocompatible contact lens to my prescription and then surgically stick it in my eye, below my cornea but above my iris. And it stays there. The procedure is meant to be permanent but is technically reversible - if there are complications or changes, they can remove the lens and replace it, OR I'm only left with a couple tiny microscopic holes in my eye and glasses. It isn't permanent, like LASIK.
Of course it's more expensive - about $1K more per eye - and it's terrifying (does this make me a cyborg???). But the healing process is way better than PRK's 2-3 weeks / 6 months, and there are a lot of benefits.
The biggest benefit here, says Dr D, is that we can easily correct you -- this procedure can correct up to a -20 -- easily and permanently, and completely, to 20/20 or maybe better. And then, if your eyes change as you age... he says, let's say that as you age to 45, your eyes start to change and suddenly you're a -1.5. We could pull out your implant and give you a new one, but that's pretty intense - what we would do is just LASIK your eyes to fix the -1.5. You've got plenty of good cornea for a -1.5, and we could have you fixed up in 15 minutes.
He stops for a second, and then he says to me. [Sev.] If you were my daughter, almost 30 - actually, I have a kid who is 27, and if you were my kid, and I was going to be working on your eyes, and your eyes had this prescription and this thickness, what I would give you is an implantable contact lens.
He says, if you come to me and you say, I really do want LASIK, I will do it and I think you'll be happy with it. But if you're here for an eval, for my advice and my opinion, I think you should get implantable contacts.
So now I really do have a choice to make.
Here's the thing. I'm not going to pretend that money isn't an important factor here; it isn't like I can just casually plunk down these thousands of dollars without blinking (pun... maybe intended?), because I can't: even with my good paycheck I can't just throw around chunks of money that large. It's a big deal. However. I do not want to make this serious decision about my eyes and about my quality of daily life based on money. I want to choose what's actually best, and then make the money work around that. I don't want to get to be 50, 60, and be frustrated because I chose something for my eyes to save $2grand. I want to make the right choice for myself and my eyes, so I am trying to not consider the increased cost. My eyes are worth it.
Here's the other thing. I had been trying to decide, going into this eval, whether or not I actually wanted to do this -- this being, doing anything to correct my eyes. And... okay, I'm pretty incapable of making decisions, but I had pretty much decided that... I want this. I want to do this. I want to do something to get rid of this physical disability that bothers me every day of my life. I want to fix this. I'm a pretty conservative person and I don't take a lot of risks especially with my body, but... I thought about it, and I thought, you know what? The bulk of my best adult years have already fucking flown by; I've spent my entire 20s going to school and working to support my own ass and it's been fun but they're almost gone. Going into my 30s... I could do this, do something to make my quality of living so much better. We already have to do so much, give so much up at 20, at 30, to "save up" for when we're 60. Doing something for myself, for now, was attractive in a very solid way.
But now I've got two choices - no, three choices, really. I can spend the extra money and follow the doctor's advice and get an implanted lens. I can choose to get LASIK. Or I can choose to do nothing and stick with my glasses.
(On an unrelated side note, I have... apparently really been looking forward to the 2-3 weeks I would have to take off of work for the PRK surgery. Because one of the most depressing things about all of this is that I don't get that break. what does that say about my life? I don't think it's healthy.)
So that's that. And that's what's on my mind now.