s e v e n i s a j o u r n e y

Thursday

The appointment wasn’t until 1:30, so I had a morning to kill. I investigated possibly going to the Willowbank wildlife park, had the Antarctic Centre recommended to me (but Stephen and I had been there in ‘99, and I didn’t think it would have changed much), and ended up just grabbing a bus pass and going back into town. The weather was fantastic. I hit the little street market they have in Cathedral Square during the summer & snagged a new hair stick, had breakfast by the river (fending off mooching gulls), and generally wandered around a bit. Managed to find the bookstores again, and picked up a couple that I had waffled about the day before, along with a nifty blue suede topcoat from a junk shop next door.

The Procedure, yes actually

The first thing they did was give me a multi-page consent form to sign. They seemed very keen to make sure I understood what presbyopia is (that long-sightedness you get when you get old), and that it’s got nothing to do with eye surgery. Then they took my credit card details. Oh, and they offered me a mild sedative, and had me sign a separate consent form for that. There was some waiting around, then they stuck a gown on over my clothes, and a showercap thing over my hair. They don’t want any lint or anything that might affect the laser. The floors of the inner waiting rooms aren’t carpeted, and the chairs are these big overstuffed leather things. You’re not supposed to wear makeup or perfume, or heavy spray deoderant. They put the first of a couple of different anaesthetic drops in.

WARNING: Okay, if you have an eye squick, or are generally squeamish, you may want to skip down to “Afterwards”.

PRK, the way they first started doing laser surgery, involves using a laser to essentially abrade the surface of your cornea down to a better shape. It takes a while to heal, I’m told. Lasik is a little different. What they do, is they use a machine with a really sharp blade to slice a little flap in the front of your eye. They peel that up, then use the laser to abrade the eye underneath, then put the flap back down. It heals a lot faster — the flap sticks back down almost immediately. The cornea has some kind of natural “breathing” thing that it does that “sucks” the flap into place, and they put the “hinge” at the top, so when you blink, your eyelid is going in the direction that would also tend to smooth the flap in the right direction. The reason they measured the thickness of the cornea is that they need to make sure there’s enough there for them to take off the right amount to correct your prescription (and the worse your prescription, the more they have to take off) *and* have this flap, *and* leave enough left over to still be structural to your eyeball. The measurements they took of my dilated pupil also figure in — they want the flap (and the surgery site) to be big enough to overlap the width of the dilated pupil, so every part of your cornea that you’re ever going to see through had a consistent contour. If your dilated pupil ends up wider than the surgery site, you’ll end up getting some of your vision through the corrected part of your cornea, and some through the ring outside that, and you’ll have two different focal points at the back of your eye (sort of like astigmatism). The effect is that your night vision (when your pupil is dilated) will be crap. My dilated pupil without the special dilation drops was around 5mm. With drops, it was 8mm. As mentioned previously, my corneas were a bit on the thin side, which meant it was going to be tricky to get the flap big enough to keep my night vision good *and* have enough room for my rather large correction. (I mentioned that my nearsightness generally put me between -5 and -6, but the astigmatism combined with that meant that some parts of my eye were as bad as -8 ). They worked around this by making the flap as thin as they could get away with.

So, they gown me up and lead me in. The table is padded and pretty comfy, with a wedge for under your knees. Once you’re on the table, things move pretty quick. They do one eye at a time, and cover the other one with a shield so you can keep it open (which helps keep the one they’re working on pointed in the right direction), but can’t see out of it (which keeps whatever you might see out of that eye from being distracting, which also helps you keep the eye they’re working on pointed in the right direction). Amidst putting an assortment of drops in your eyes — anaesthetic, antiseptic — they swab all around your eye with betadyne (which doesn’t sting, on account of the anaesthetic), tape a drape around your face, tape your eyelashes back, and shove a speculum in to keep your eyelids pried open. Kind of uncomfortable, that. Helen apparently had some bruising from this, but I didn’t. The whole time, you’ve got this little blinking red light to fixate on. The machine that slices the flap has a suction cup that grabs onto your eyeball to hold it still, which is good, but also pretty uncomfortable, and pretty scary as well. The pressure makes your vision go dark while it’s on, so for a mercy you can’t see it actually doing the cutting. It takes all of maybe ten seconds, and after that you can sort of see again, but not really, because now everything’s all smeared and grainy.

I think the most nerve-wracking part of this was that, apart from the suction cup on the slicer, you have to hold your own eye still. What if I twitch ? What if I SNEEZE ?!! (Apparently, the laser has sensors on it that track your eye movements, and if it moves too much or too fast, it stops. But still.) They peel back the flap and the smeary red light expands out into a broad, uneven blob of flashing red grains. I pick a patch of slightly brighter grains that are mostly in the middle of the blob, and try to fix on them. I try to sing a song in my head and focus on that, but have trouble stringing the words together, probably because of the sedative. The laser makes a sort of ticking noise, and there is (as they warned me there would be) a disconcerting burning smell. It goes in 15 second increments (which helps the eye-holding-still anxiety), and Stewart reassuringly calls out how far along we are after each little burst – “22 percent !”, etc. The lasering takes about 60 seconds or less, all up. I can see Dr. Kent carefully smoothing the flap back down with a little plastic paddle, and the grainy light goes back to being merely blurry. They put some drops in and leave me there for three minutes while the flap sticks itself back down, before taking the speculum out and letting me blink. Everything is still blurry, because of the eye drops.

Then they do it all over again on the other eye.

Next up: Afterwards

The Procedure

The way this clinic does it, you fly in (assuming you’re not local) on Wednesday morning. Sometime Wednesday, you have the final two hour full exam, where they take all sorts of measurements and confirm that yes, it’s safe for you to do this (if you bail after going through this big exam, they charge you a couple hundred bucks for it, otherwise it’s included in the overall price of the procedure). If you elect to go ahead with it, they schedule you for surgery the next day. Then Friday AM you have your first followup exam, and then fly home. Helen, who got hers done at a different clinic, says her schedule was similar. (The surgeon does cataracts on Monday and Tuesday).

Wednesday

We got up at the regular time, and Stephen dropped me off at the airport. The plane was a bit late getting out, but since my appointment wasn’t until nearly 4, I didn’t particularly care. I hadn’t been able to get a B&B in Christchurch, as they were all booked (my original plan had been to find one near the clinic and walk to the various appointments). Partly this was because half the country takes their holidays in February & partly (the hotel staff told me) it’s because this was right around the seasonal staff turnover point for the Antarctic stations, so a lot of people were “coming off the ice” or else going out to it. I don’t know about you, but on any given day, I don’t tend to think about Antarctica at *all*, never mind expect it to affect my accomodation plans. Wacky. Anyway, the eye clinic has a special deal with one of the local hotels: special rate, and they shuttle you to and from the clinic. More expensive than some of the B&Bs, but reasonable for a hotel and the B&Bs weren’t available anyway. Bonus: they give out free passes for the bus than runs into the city.

I got into the airport, rang the hotel for a pickup, ditched my bag (the room wasn’t ready yet), and hopped the bus into town, where Helen took a half-day (well, a bit more) off work to guide me around the local book shops. Whee !

The Eval

Back at the clinic, the promised two hours (which actually was closer to three, I think) was actually a series of short 15 minute segments separated by stints back in the waiting room. The eye surgeon (David Kent), an optometrist (Theresa) and two clinical assistants (Lisa, and Stewart again) shuffled the various patients around between them, running us through the battery of tests and consultations. It seemed pretty efficient, and although it was obvious that this was something of an assembly line, and that each of them had given their set spiel a gajillion times, they were all quite nice, seemed genuinely friendly, and generally had a good vibe. Actually, I think the standardized routine-ness of it was kind of reassuring — they’ve done billions of these, they do them every week, it’s not big and scary, they’re old hands at it, you know ?

They gave me a full eye exam — “Which is clearer: one… or two ? Three ?… or four ?”, read the eye chart, etc. — to nail down my current prescription. They did take down my previous two prescriptions at this point, so it was good I had them with me. They also asked for the names of my current optometrist and clinical practitioner. They ran me through all of the same tests Stewart had given me back in Wellington, with the yellow rings and the rubber-eye poking stick (that was was last), and stuff, plus another scan for “higher order anomalies”, which I didn’t have, but which they could have corrected if I had. They did another test which involved looking at a little drawing of Mount Fuji (complete with cherry blossoms) which they pulled in and out of focus. I think that was the iris mapping, which the machine that guides the laser uses to make sure your eyeball is lined up the right way. There was another staring down a tube thing that measured how big my pupils were, both constricted and dilated — they did that one both before and after using those dilating drops. They did most of them at least twice, to make sure the results were consistent.

Then they went over again all of the explanations and descriptions that Stewart and the printed info had explained already, went over again what to expect, blah blah etc. They want to make sure your consent is very thoroughly informed. My appointment was made for 1:30 the next day.

Dinner

Helen, bless her, had finished picking up some groceries next door and was waiting for me to get out of the somewhat over-run appointment, after which we managed to get ourselves stuck in the magic no-busses-for-another-hour window. Ugh. Helen gave up and phoned one of their flatmates to come and pick us up.

Helen and Duncan, for you folks Playing at Home, are SCAdian friends we met through Stephen and Jennifer. I had a standing invite from Duncan to do the bookstore thing if I was ever in town, and when I indicated I’d like to take them up on that offer, they invited me to dinner as well. Actually, they invited me to stay with them, but I took the hotel room to take advantage of the shuttle service. Renting a car wouldn’t have been an option, since you’re not supposed to drive immediately after the surgery (or having your eyes dilated, for that matter), and I didn’t want to screw around with taxis or buses.

Dinner was late, because we were, but it was yummy, because they are foodies (they frequently cook the feasts for SCA events). They rent a gorgeous antique house right across from the river. Duncan showed me his shoe-making techniques, and loaned me another stack of books, to add to the pile I’d bought that morning. We watched Cold Case while we digested, and then Helen borrowed a car and drove me back to the hotel.

Next up: The Procedure.

I know I said that last time, but I need to do this in little pieces, or else it won’t get done at all. Sorry !