[medical talk] an update on my eyes

[seventhe]

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.

Comments

[shanaqui]

I would go for the implanted lens. I -- well, I don't know if you do know, it feels like we haven't talked properly in so long, but, my mother's going blind, and I'm probably in the genetic firing line too, and I would do almost anything to avoid looking at what my mother's looking at now.

If it's going to make things that much better, go for it. Seriously.

[seventhe]

I feel like I just haven't been AROUND in forever! - but yeah, I have read some of your thoughts on your mum, and I actually was thinking about her/that a few weeks ago when I got my original eval. Because I could be going that way, if my eyes go bad - my grandfather did. It's terrifying.

<3

[shanaqui]

Yes. I'm watching Mum go through it and just -- anything I can do to stop it happening, I'll do. So I'm definitely behind the implanting idea -- it sounds more beneficial in the long run, and less likely to cause its own problems.

♥

[seventhe]

Eyes are... a really terrifying thing, which I am sure you're aware of. I really want to fix this, but I'm scared of something worse happening -- but I'm also scared of what happens if I get older and I just can't be corrected at all.

[shanaqui]

Well, it sounds to me like this guy knew what he was talking about, and had your best interests at heart. So that would be another reason why I'd go with his advice.

[owlmoose]

Totally agree that, especially since the difference won't break you, money shouldn't be the main factor here. Sounds like you have a good, conservative, thoughtful doctor here -- if it were me, based on the vibe you described, I would be inclined to trust his recommendation. Sounds like you have more long term options with the lens.

The implantable contact lens reminds me of what my mom had done to fix her cataracts. In that case, they actually replaced her lenses with the contacts, but they were able to correct her distance vision to better than 20/20 (she still needs reading glasses). She is super-happy with them.

Good luck, whatever you decide!!

[seventhe]

It's actually based on the cataract surgery! It's the same / a similar concept; they've done it for cataracts for years, but only recently have they had the materials to be able to do it for corrective lenses too.

[whitemage]

Yes! It's what I'm looking forward to in about 3 to 5 years. XD

Honestly, yeah, I would go for implantable lenses. And yes that will technically make you a cyborg. But, I mean, how fucking cool is that? (TELL EVERYONE IT HAPPENED IN A BODACIOUS LAB ACCIDENT THAT MAY OR MAY NOT HAVE GIVEN YOU SUPERPOWERS!) In all seriousness, I think you are right, and this is something awesome to do for yourself.

[crankyoldman]

All I can imagine when you say implantable lenses is that level up Geordi got in the Star Trek movies where he didn't have to wear a visor anymore. But I say go for it!

I'm so glad my eyesight is a really minor correction compared to you (and my sister, who has had bifocals since high school). I think it would really improve your life, and it sounds like this guy knows what he's talking about.

[novel_machinist]

Is it possible to get a 2nd opinion?

If it were me, I would probably do the implanted lenses. It makes sense that it's a lot easier to correct small changes down the road with your vision when you have a "buffer" of sorts in place. It's like an insurance plan I suppose. Yeah, it's 2k more and you may never need it, but lets say your eyes do get worse down the road and then you need all the cornea you can give?

Plus shorter healing times means you can STILL take 2 weeks and ENJOY some of that time.

[lassarina]

I would go for it. Yes, it's really expensive--but insurance might cover some of it (and if it doesn't, you can put money aside pre-tax in a flexible spending account, which at least takes the tax bite out--you pay up front and get reimbursed.) More importantly, though, this actively affects your quality-of-life and you've mentioned it repeatedly. Especially if it's something where they can implant the lenses now and later, they could be fixable with regular LASIK.

(Says the girl who can't stand people touching her or going to doctors or any of that shit, but seriously.)

[wallwalker]

I have to agree with, um, most everyone else here? The implants do seem like the best way to go - being able to correct your eyes later would be a very good thing to be able to do! And judging from what you've said of the doctor, he really is trying to advise you of the best option, I think.

That said, I also agree with novel_machinist - when possible, a second opinion is almost never a bad idea.

[ifotismeni]

humm, well, i am myopic as well but i am about a -5 in both eyes? which makes me completely non-functional without glasses or contacts but i've never investigated lasik, though i have known people who have. the surgery in all cases has really improved their quality of life. i can only assume it'd be the same for implantable contacts given the benefits of the work.

i strongly feel that, though it is a luxury in the states especially, you never want to skimp on a medical procedure (a sentiment you feel as well, judging by your entry here). often times when you go for the cheaper option just because it's the affordable one, it can only get so-so results and the benefit's not as clear. so for me? i'd say go whole-hog or not at all, because you can live with glasses, but if lasik is only /kinda/ successful it WILL drive you batty.

the expense is not a small issue, but you are right that if you don't do the best you feel you can, you will be bothered by it for a long time in the future. unfortunately i have seen this happen to many people in my family :(

[first-seventhe.livejournal.com]

Yeah, that's a lot of my fear - if I pick something to save money I might as well not do anything, I think, because that's safer and better than hitting that middle ground of "half-fixed but I can't do anything about it" :/

[ifotismeni]

exactly. because you'll have gone through all of the bother and will gain little benefit. i saw this happen with joint replacement surgeries for my relatives for example - they got the cheaper hips or knee replacements that wore out more quickly, so they were unable to walk for months due to the surgery healing time, plus because the joints were cheaper they were still in ENOUGH pain that their lives were not really improved, and THEN after a few years they had to get it done all over again :( finances were the issue though, those surgeries cost a lot of money, so they didn't have a choice.

[albijuli]

>>My eyes are worth it.

And there's the deciding factor. I'd say go for the implanted contacts, the full nine yards, the sure thing, because this has been something that has been bothering you for quite some time.

And the body is one of the few things the "cheap" option is not acceptable for, IMO.

[jennyclarinet.livejournal.com]

Just based on how you worded everything, it sounds like the implants are the way to go for you. But it's not like you have to get it NOW, or even in the next year. You can take your time and save up for it. But it sounds like it will be worth it. Hopefully the surgery to implant them won't give you the heebie jeebies!

[salarta.livejournal.com]

Cocks.

Whoops, I mean, uh, do what you think works best for you. It sounds like most of you has decided that implantable contact lenses are the way to go, and what's holding you back is worrying you might regret it in some manner, that you might feel stupid for spending that much money on something for your eyes or that you might feel it was too much of a risk/hassle.

It's ultimately your choice, I just get the impression from your LJ entry that you've almost already made it. :P

Plus theoretically you're doing something for when you're 60 anyway. Addressing a vision problem in advance that could get worse with age. Would you keep wearing glasses after getting implantable contacts? If not, then assuming your vision doesn't change too much, the cost of getting new glasses/lenses is absorbed into the cost of implantable contacts.

The only concern to me is that the idea of an implantable sounds so permanent. Like it's impossible to reverse, despite the eye doctor saying it could be. I'm guessing that's another hang-up you have.

[fireholly.livejournal.com]

It's your eyeballs. You use them every day. I would say having them is highly important to your quality of life, more so even than your nose or teeth. They're going to be embedded in your face forever.

For that reason, pay the extra, and get the better treatment. It's hard, but it's eyeballs. You cannot afford to skimp on eyeballs.

[yi-sen.livejournal.com]

Whatever you decide, I got your back.

I also respect the fact that you recognize that going for the best option is worth whatever it costs because YOU are worth it and deserve to be healthy and happy.