lasik · Uncategorized

Lasik Surgery and Horses

On June 30, I had Lasik surgery to correct my nearsightedness. I did a ton of research, thought really hard about it, planned it as best as I possibly could, and eventually went through. I’m really glad I did it, and since being able to be around horses without glasses was a major motivation behind the decision, and because I wasn’t able to find a whole lot of information specifically about the intersection of horses + Lasik, I thought I’d write about it for posterity.

It’s important to note that I’m chronicling my own research, decision, and experiences. Human beings are different, and your experience might be different. I’m going to do my best to provide some general information that I learned alongside my own personal situation, but you should make your own choices based on your own factors!

Background

I have had poor eyesight my whole life. I first got glasses in fifth grade, and can still remember perfectly clearly what it felt like to press my face to the car windows and marvel at all the leaves on the trees.

My eyesight worsened over the years, as it often does, and it settled in to a fairly consistent -4.25 in my right eye and -4.50 in my left eye, with mild astigmatism in my left eye. Not huge, no, but enough. I used to joke that my life was like a Monet painting; beyond the range of my arms, things started to get blurry. It wasn’t so bad that I couldn’t navigate my surroundings, but it was enough that I couldn’t be truly functional at more than a cautious walk.

58-0011first dressage show with Tristan, spring 2007, wearing contacts

I wore contacts as a teenager, and abused them very badly right through college. I left them in for days (…weeks…) at a time. I got semi-frequent eye infections. I got a smidge better after college – I don’t think I slept with them in except accidentally after junior year – but they were still starting to get uncomfortable. I also couldn’t see as well as I could with glasses. When I was about 27, an eye doctor told me that my eyes were starting to grow extra blood vessels to the cornea to make up for my contact use – they were feeling starved of oxygen. I started wearing my glasses more and more often, and by the time I was 29, was pretty much full-time in glasses again. When I would try to go back to contacts, my eyes just were not happy. They were dry, strained, and so weary I would fall asleep at my desk in the afternoon – I just could not keep my eyes open.

Photo Jun 05, 9 10 56 AMmore recent show, fall 2016, wearing glasses

Research & the Decision

Like most people with poor vision, I’ve wanted Lasik as long as I knew it existed. I have little to no anxiety about medical procedures, so I wasn’t terribly nervous about the idea of surgery, and I’d had contacts so long that I had zero issues with the idea of poking around in my eye.

I first started openly pondering the idea a couple of years ago, and actually posted here on this blog about it. Many of you answered with your experiences, or your family or friends’ experiences, and I revisited and read through that post a lot while I was entering the final stages of my decision. I probably have the responses memorized! So THANK YOU to everyone who commented. In that post, I said I had to pay off my car first, since I knew Lasik was an expensive proposition. Well, I paid off my car in late fall 2017, and began thinking in more concrete terms about Lasik.

One of my biggest hurdles was that the Lasik industry is that – an industry. It’s an elective, cosmetic procedure that is almost never covered by insurance. That means that surgeons who do Lasik surgery often advertise for it in a way that would not be common for any other surgical procedure. There are online ads, glossy brochures, glowing testimonials, and a lot of things that made me really uneasy. It felt more like snake oil than medicine. I didn’t see any objective way to choose a surgeon or center – should I go all the way to Boston? should I just start Googling? how did I know that any of these places were quality medical centers and not just out to make a buck?

I eased some of my nerves by scheduling an appointment with a new optometrist who came recommended and who specifically listed Lasik consults on his website. I got my regular checkup with him in late winter 2018, and laid out my concerns. I was very frank and explicit about my fears about the Lasik industry, and asked him to be honest with me in return. He was – I liked him enormously! – and after we got through the standard risks (about which more in a moment) he was able to offer a personal recommendation for a local surgeon. She’d been doing it for a long time, he had frequently sent patients up to her and seen patients after they had surgery with her, and though it was not his first choice of treatment for nearsightedness (he preferred contacts or glasses) he felt confident in her.

I scheduled an initial consultation with the surgeon and got some of my major concerns answered.

First, they don’t operate on anyone they don’t consider a good candidate. There are a lot of not-obvious things that can make you not a good candidate. Severity of eyesight correction is only one factor. Your corneal shape and thickness also play a role. A friend of mine got turned down because her pupils were too large. Your age, general health, and willingness to commit to post-surgical care are all factors.  So I had to go through a barrage of tests to make sure I was in the right margins for all of that, and I was. I also had to have a stable prescription, ie my eyes could not be changing anymore. I’d been stable since my mid-20s. (The reasoning is that Lasik fixes what it sees in front of it, and if your eyes get worse again after the surgery…well, then your eyes are worse again and there wasn’t much point to the surgery. It’s not that it wears off, it’s that if your eyes are actively changing, they will continue to do so.)

Second, the cost. They quoted me a total of $3,790 for the surgery for both eyes, and an additional $300 for post-op visits (of which there would be three). I could potentially avoid the $300 by scheduling the post-op visits with my own optometrist and billing my insurance, but I wanted to stick with the surgeon, so I made the choice to pay the extra $300 – for a total of $4,090. When I made the decision to go ahead, I got financing through CareCredit – 0% interest for 24 months. (After that, they screw you on interest, but I already had done the math and knew that I could make the payments plus would be funneling quite a bit of extra money into it from other income sources. The plan is to have it all paid off in about 18 months, possibly sooner.)

I also heard a lot about the risks of the surgery. They are not insignificant. It’s eye surgery. You only get one pair of eyes, and you should not shoot a laser into them lightly. They want to be very sure you understand that before agreeing.

You can google a lot about the risks, though I don’t recommend you do; what was more important to me was the types of side effects they have seen themselves in their practice, and what the incidence rate was. They assured me, first that they have not made anyone blind. Which was good to hear! Their biggest side effects were dry eye, glare and/or haloes from light, light sensitivity, and some vision anomalies – some blurring, floating specks, etc. They said that they do about 1,200 surgeries per year and each year have about 10 people that they continue to work with past six months to resolve those problems.

I scheduled the surgery, and then a week later read this New York Times article and freaked out. I called my surgeon back and specifically asked about some of the problems in the article. They answered all my questions clearly and calmly, and gave me a lot of the information I’ve already included above – especially about the careful diagnostics to rule out any eye factors that might make some of the side effects more likely. They said they had read the article and never had anyone in their practice experience such severe side effects. So that helped.

Surgery

The day before the surgery, I had about 2.5 hours of pre-operative testing and counseling. I had to go through most of the tests over again to make absolutely sure that all the initial readings were correct. They triple-checked the shape/architecture of my eye with their laser machine. They triple-checked my prescription. I met my surgeon for the first time, and was able to ask her any questions I had. I came away feeling good about the whole thing.

That night, I filled prescriptions for antibiotic & steroid drops, and Valium. I started taking the steroid drops, as well as some vitamins (multipurpose, but with higher levels of Vitamin A and E) and fish oil pills. I’d done a little bit of reading and they were supposed to help. I started the drops that night, getting in two doses, and then another dose the following morning. They stung a little bit and made my eyes blurry for a few seconds, but nothing too bad. I also bought the preservative-free eyedrops that they recommended and that I would use for many weeks to come as my eyes healed. (I bought two boxes and then a few days later bought two more.)

The morning of the surgery itself, my husband drove me up. They did all my final tests, and strongly recommended that I take at least a half a tab of Valium. I did, though I actually wasn’t feeling too nervous. I’m honestly not sure why, but I just wasn’t.

For the actual surgery, they put in some numbing drops. They laid me down on a gurney. They lowered something down to my eye – I didn’t see it, but it put pressure on my eye. This was the most discomfort I was in the entire time, and it just felt like maybe someone was pushing in on my eye for a few minutes. They taped my eyelids open. Then they put me under the laser the first time; it made the incision and created bubbles under the surface of the eye to basically lift up the flap. Then the second time. I stared at a blinking light for 25 seconds. This was the most nervous part – I had to hold very still and concentrate on the blinking light. I was incredibly focused. They counted me down from 25 seconds. Then it was done, and we did the same thing for the other eye. I was in the room maybe a total of 10 minutes.

I was able to walk back to the room, where they looked carefully at my eye to make sure the flap had come down correctly. Then I put on some super-ugly goggles and walked out to the car. My vision was blurry, but a different kind of blurry from what it had been previously – more like I was underwater. Some things were almost-sort-of-sharp, and some things were blurry. I only kept my eyes open long enough to get to the car, and then kept them closed for the drive home.

IMG_3805Not the most attractive picture ever taken, but the goggles I had to wear for sleeping. It was still hard to focus on my phone, as you can see, on day 3.

Recovery

Day 1: I spent the entire day on the couch listening to audiobooks. I only opened my eyes to put in my drops, every 2 hours for the steroids and every 4 for the antibiotics, and every hour (or more frequently if I felt like it) for the lubricating drops. I missed a lot, and the drops were all very sticky, so my eyes felt gross. I had some mild stinging – like I’d gotten shampoo in my eyes – for the first few hours. I also took ibuprofen around the clock, as I would for the next four days, to fight any possible inflammation.

Day 2: I woke up able to see. It’s as simple as that. It wasn’t perfect – a little blurry around the edges – but it was very much like wearing my glasses. I was able to drive myself to my follow up appointment (where my eyesight tested as 20/15) and back, and stopped for groceries on the way back. That was a little too much, honestly. I went home and laid down for an hour or two, listening to more audio books. The pattern for the next two days became to rest my eyes about 2/3 of the time and to get up and do simple things the rest of the time. Looking at my phone was hard, from both the light and the intense focus. So I did a few other things that didn’t require a lot of focus, like tidying up a bit around the house.

IMG_3824One of the things I could do was sew, so I made this bag for myself to hold all my post-surgery supplies: goggles, eyedrops, ibuprofen, tissues, vitamins.

Days 3: Very much the same. Lots of resting, with slightly more and more activity. At this point, I didn’t feel like I needed the rest. I was just being incredibly careful. Every time I put my drops in I would keep my eyes closed, and rest them for at least 15 minutes. Sometimes I would rest for longer.

Day 4: This was actually my first bad day – I went back to work. I couldn’t look at a computer for a long time, but we had a big day-long event so I didn’t need to. But by mid-afternoon I was dragging. I was tired, and had a dull, throbbing headache from eyestrain. I felt mildly queasy, possibly from drinking too much caffeine, possibly from the headache/exhaustion. I was prone to headaches from eyestrain and light exposure before the surgery, and this definitely fit in that category. I did call in to the surgeon and they said as long as I didn’t have any specific, acute pain in either eye and as long as my vision was clear, I wasn’t in any danger. I started wearing my sunglasses inside, and as dumb as I looked, it definitely helped. I did this for the next two days.

Days 5-18: The eyestrain definitely started to ease up, and by day 8 was entirely gone. At day 8, I was off my medicated drops and on to just my lubricating drops every hour. On day 10, I had my one-week surgical follow-up, and got a glowing review from the surgeon. She said the flap had healed incredibly well, and I had no inflammation. I talked to her about some of the things I was experiencing, and she said it was all well within the bounds of normal and would continue to improve.

My dry eye is slowly, slowly easing, as is my sensitivity to light. I’m able to tolerate a little bit better every day. I’m still doing lubricating drops hourly, but honestly mostly because they say to do them even if you don’t feel like you need them. The surgeon said that dry eye can lead to regression, so I’m pretty fussy about making sure I get drops in hourly, and more frequently if I’m at a computer. At the end of the day, my eyes feel an awful lot like they did with dry contacts – sort of dry and tired and thick, almost? Except I can’t take my contacts out and rinse my eyes. Instead, I just use a few more drops. And it’s getting better and better every day. On days without screens, I’m at about 85% of normal.

In terms of computer and phone use, I’m mostly back to where I was pre-surgery. One major thing has helped with this, and I can truly almost feel a physical easing, and that’s blue light filtering reading glasses (with no prescription). I’d heard of them before the surgery and ordered a pair from Amazon to try out. And, wow. They make a HUGE difference in how much screen time my eyes will take. (Again – I was prone to screen-related eyestrain before the surgery already.)

IMG_3809wicked super dorky but also REALLY effective blue light glasses

Overall Pros and Cons

Pros: I CAN SEE. YOU GUYS. Perfectly. Better even, a little bit, than with my glasses. And all the time. In the morning. In the shower. In my peripheral vision. In some ways it’s an awful lot like wearing my contacts again. In other ways, it is profoundly weird.

Cons: Anxiety. A lot of it. Constantly guarding my eyes and worrying. The eyedrops are sticky and gross – my eyes seal shut overnight and I have to drip around the edges to loosen them up in order to open my eyes. I definitely have dry eyes, sensitivity to blowing air (my husband does not love that I can’t tolerate having the AC on all night), sensitivity to light, and haloes and glare related to light. All of that was expected, and all of it is slowly easing, but it’s still very much present. Night driving is tough, honestly, but on day 4 I had to hold a shirt over my head even as a passenger in a car; on day 14 I drove us back from the movie theater in the dark with minimal problems. (Like I could notice that the lights weren’t right, but they didn’t hurt or distract me.)

And – on a more existential note – I spent the last few weeks of wearing my glasses feeling somewhat grateful for them. Grateful that I knew what it was like to navigate the world without seeing perfectly. Grateful that I could take them off and zone out. That I could get respite from interacting with the world constantly. Honestly, that’s something I miss sometimes. I never used to put my glasses on until I left the house. There was a strange comfort in slightly fuzzy familiar surroundings. I know that sounds weird, but there you have it.

On a really superficial note, my haircut no longer works without my glasses. :/ I have to sort of rethink that.

IMG_3800Last pre-surgery photo with glasses, taken the morning before

Yes, yes, but what about horses?

My first day back at the barn was day 4 after surgery, mostly just to pet Tristan on the nose and say hi. It was very hot, and there was a good wind coming up from the valley. I got pretty nervous very quickly about my eyes, and left after only a short time. I visited a few more times in the following week, mostly to check on him, because 5 days after the surgery was when he started in with his hives.

My surgeon had cleared me for riding in the first week after surgery, but it was blisteringly hot – too hot for serious riding, especially on a senior horse who hadn’t acclimated to that kind of heat – and then the hives started. In retrospect, I was glad I didn’t try to ride in the first week after surgery. I needed that time to rest and relax and focus entirely on healing, and one week off is not the end of the world.

I started Tristan back into work 10 days after surgery, with some longeing. I felt okay about the dust that kicked up, though nervous. I used my eyedrops every 15 minutes or so, and was very, very careful about how I handled myself around him.

IMG_3938FUCK YEAH NO GLASSES. Day 15.

I rode in the indoor next, for about 35 minutes, and that was way too much dust. My eyes definitely felt drier than they would have otherwise, but they weren’t irritated. I just stopped and put in eye drops during my walk breaks. It was more that it made me nervous. I washed my face carefully when I got home – I didn’t want any grit to get into my eyes after the fact – and put eyedrops in and closed my eyes for a bit when I got home.

Since then, I’ve done my rides outside on the grass, and I’ve had zero problems at all. I’ve been wearing sunglasses because really bright sunlight is still tough. But no problems in terms of riding. I’ve had three or four rides outside in that time. My surgeon grew up with horses, and explained to me that I had no real medical restrictions. The problem would be if I really hit my head and dislodged the healing flap, and if I then got some dust or something in my eye.

So, I don’t know if I would go back to jumping right away, or really galloping. I trust Tristan a great deal, and knew that I could handle what he had to throw at me – and that I could read him well enough to spot trouble coming. On a less reliable horse or a trickier horse I might have chosen to stay inside, even with the dust.

I’ve been a little picky about doing some things right now. I stopped doing Dursaole on his feet because WOW do they have some dire warnings on the bottle about getting it in your eyes. I also asked someone else to do his fly spray, and put in his big bit for riding outside even though he hasn’t used it yet this summer. Basically, I chose to err on the side of overcautious every chance I got, and I don’t regret that.

I do know that riding without glasses is fantastic, and I feel zero problems riding on the grass, especially with sunglasses. Especially now, entering week 3, when I can go longer and longer without feeling like I need to do eyedrops. (I always carry a vial in my breeches, just in case.)

IMG_3900sunglasses + eyedrops = essential right now

Anything else?

I think that covers everything that people have asked me about. Any other questions I can answer?

 

horse finances · lasik · surgery · Uncategorized

The Best Money I’ve Ever Spent

I had Lasik surgery about 10 days ago. I’m going to do a whole wrap-up post about it next week, after I’ve gotten a few rides in and can report reliably on that part (because when you google “Lasik + horseback riding” there basically crickets? which was not helpful for my brain?).

Lasik is not generally covered by insurance, which means that I paid for the surgery out of pocket. Or, more accurately, I arranged for financing through Care Credit, and will be paying for it for another ~18 months or so. I planned carefully, did my research, evaluated my budget, and felt comfortable taking on that amount of debt for that amount of time.

A lot of people have asked about the money part. Honestly, it’s pretty much in line with any other surgery. I didn’t find it agonizingly expensive, not for the return on investment. But the reactions veer between “that’s so expensive, I can’t believe anyone would spend that!” and “isn’t it the best money you’ve ever spent?”

I’ve thought a lot about that in the last few days, for some reason. Yeah, I’m happy with the money I spent! Seeing clearly for the first time in my life is pretty great!

But is it the best money I’ve ever spent? For some reason, that question – which was surely intended to be rhetorical! – has stuck in my brain.

No, it’s not the best money I’ve ever spent.

I have an easy answer for the best money I’ve ever spent: Tristan’s coffin bone surgery.

img_3394

almost exactly six (!) years post-surgery

If you tally up the actual procedure + hospital stay, it cost almost exactly the same as my Lasik surgery. If you include everything related to that injury it was 50% more, over the course of about nine months.

It was life-saving surgery. Not at the time – he wasn’t going to keel over – but surely it was a matter of time before the infection in the bone went septic and then systemic. Certainly he would never have been sound again if it had chewed away more of the coffin bone.

So, yeah. Easy call. Keeping him alive, sound, and happy was an easy call, financially. It certainly helped that I had an emergency fund that covered the surgery + vet bills, and steady employment that assured me of replenishing the emergency fund, but even if I’d had neither of those things, it still would have been an easy call.

But the average person who asks me that question does not want to hear about my horse, much less his surgery, so I usually just smile and say “it’s pretty great!”