The Real Cost of LASIK Eye Surgery – Is It Worth it?

On Thursday, June 23, 2011 at about 11:30am, I had LASIK. It took years of coming to terms with the idea that if something failed I may end up blind for the rest of my life. Having come through the procedure successfully, and with practically no issues whatsoever so far, I wanted to give a basic heads up on what’s involved in having LASIK, and what you should expect based on my experiences. The monetary cost of LASIK is steep, but in my experience, it’s well worth it.

I had worn glasses since the 4th grade and probably needed them in the 3rd. I’ve tried contacts and countless different types of “thinner” lenses. When I finally decided to get LASIK, my prescription was a -8.0 in one eye and a -7.5 in the other. Wearing glasses was a must for me everywhere I went.

Consultation (~ half hour)

Choosing a place to have LASIK is the only decision you’ll have to make. For me, I polled some friends to see where they had been and 2 here in Orlando suggested Dr. Magruder — including one who had successfully had LASIK there the year before. An optometrist friend of mine suggested the same place, and for me that settled it.

Consultations are typically free, so this the time to shop around if you want to. Prior to talking with the doctor that will be doing the procedure, you will have eyes mapped out, your prescription checked and your tear generation measured. These measurements, coupled with a few basic questions, let them know if you’re a good candidate for LASIK.

The only part that is uncomfortable is the tear generation test. Small tissue-like papers are put under your eyelids and kept there for a minute to measure your body’s automatic response. Most people tend to have dryer eyes after LASIK, so if your eyes are already extremely dry according to this test, it’s a warning sign.

If you’re a candidate for LASIK, you will probably talk to the doctor that will be performing the operation next. In my case, Dr. Magruder was extremely personable and seemed to want to stay and keep prodding me for questions to make sure I’d asked everything that was on my mind. This the typical part where he’ll go over the format of what to expect.

The Cost of LASIK Eye Surgery

If you’re interested in going forward at this point, you’ll end up talking with someone who sets up the appointments. They’ll go over the billing details and any discounts or financing available. In the case of the place I went, the procedure would be $5,000, which includes the pre-operation appointment, follow up appointments for a year and any adjustments necessary in the first year. They also offered a $500 discount if you schedule your operation within a month of your consultation (although the discount cannot be used if you use financing).

They listed out some dates they have available and went over what the next steps would be if I did decide to have the procedure on one of those dates. I didn’t feel pressured to make an appointment right then and there — instead, they gave me all the information I’d need to make it on my own, and call back to schedule it. I called back and made the appointment a few days later (after Mrs. Minafi had confirmed taking a day off to help me).

If you have an HSA or an FSA through your work, LASIK is an absolute great use for it. In the month or two before the procedure, I put 100% of my income into my HSA to max it out for the year. This 25% discount saved me over $1,000 in taxes on the final bill. If you have tax-advantaged options, you may want to look into them prior to any consultation to plan ahead.

I’d been wanting LASIK and thinking about it for months – wavering more due to bodily fear than financial fear. Taking the plunge and scheduling it meant it was on.

Types of LASIK

The Wikipedia Article on LASIK goes into much more detail, but the two forms flap creation (might want to read the Wikipedia article if that term isn’t familiar) was either by laser or blade. I went the laser route – at least I think. Everything happened so fast it’s hard to be sure.

Do You Wear Contacts?

Depending on what type of contacts you wear, you may need to stop wearing them for some time before the actual procedure can be performed. This ranges from 14 days up to 2 months for harder lenses. If you don’t wear contacts there is no waiting period required before proceeding

Homework before the Pre-Operation

After calling in and scheduling the procedure and the pre-operation, they called in two prescriptions for me to pick up at my local pharmacy along with an over the counter lid cleaner. 7 days before the procedure the lid cleaning began twice a day. The two prescriptions they gave me were:

• FML Forte – Used for treating inflammation (swelling, warmth, redness, pain) of the eyes and eyelids.
• Ofloxacin Ophthalmic Solution – Used to prevent infection

Both of these eye drops were started 5 days before the surgery and taken 4 times per day.

Pre-Operation Exam (2 hours)

The pre-op is the most intensive eye exam you’ve ever had. Think of this way – if after LASIK you discover you have XYZ wrong with your eye, it’s difficult to prove if it was a result of the LASIK or not. Their protective response to this is a very long examination of every millimeter of your eye.

• Re-scan and mapping of your retina
• Thorough eyesight test (the “which is clearer, #1 or #2?” test)
• Numbing drops following by measuring your cornea (used for creating the flap later on)
• Tests for blind spots in your vision
• Eye dilation followed by thorough investigation with a head-mounted magnifying glass

In the last part, they were able to uncover that have I small holes in the back of my retina, which is why I occasionally have seen floaters in certain parts of my vision. I rarely ever saw these, but it was interesting to know the actual cause of them.

After the op is over, you’re given the usual sunglass shields (to protect your dilated eyes), and are now set for surgery whenever that day comes.

Operation Day (2 hours total, 5 minutes of action)

You won’t be able to drive home, so you’ll need someone to accompany you the day of the procedure. After getting there, they’ll go over things once more, and give you instructions on what to do in the time following the procedure. For me this included:

• Don’t expose your eyes to bright sun.
• Go home and sleep for 6 hours.
• Take the 2 eye drops you have even more often (FML Forte every 2 hours, Ofloxacin every 4).

Once you know what you’re in for, they give you a Valium to calm you down. Having never had Valium, I didn’t realize just how much it would affect me. At one point in the waiting room I’m pretty sure I had slipped down out my chair to where my back was on the seat, but hadn’t noticed.

After waiting 20 or so minutes, and with absolutely no fear at that point, they led me into the operating room. There are three stages to the procedure, each taking a very short time.

Creating the Flap

In reading about LASIK, or watching The Discovery Channel, this always looked like the worst part of the procedure. They put a corneal suction ring in place around your eye to hold it in place while using a laser to cut a hole and in your eye and fold it back. While this sounds like a highly invasive part of the process, I actually had to ask the doctor “Did you just create the flap?”. There was no pain, and no discomfort – I didn’t even know what hit me and the process took only a minute or two.

At the place I went, they had one chair for flap creation and another for the procedure. They led me over to the second chair, but I could still see alright even with the flap created. I imagine this is because I had IntraLASIK rather than the steel blade method.

The Procedure

After laying down in the chair they lowered a large machine down over one eye at a time. They asked me to stare directly at the green light at the very center while the red lasers that took up most of my vision did the work. At this point, my vision became so blurry that all I could make out with a red haze, but I tried to keep my focus on where I thought the green light used to be. The equipment is smart enough to track your eye to impressive accuracy (4,000 times per second), so it’ll stabilize for minor movements. Do you know that smell when you’re at the dentist having your teeth drilled? During this stage, I was able to smell the same thing.

My perception of time might be off, but the entire procedure couldn’t have taken longer than 5 minutes. (I later learned it was about 20 seconds per eye).

Repositioning the Flap

After everything is set, the doctor took what felt like a very damp paintbrush and lightly brushed the flap closed. This only took a few seconds.

Immediately After the Operation

I kept my eyes closed for the drive home, but I wasn’t feeling any pain at this point (thanks, Valium!). My eyes weren’t itchy, but I took their advice and downed a Tylenol PM and went to sleep. The 6 hours immediately after are considered the worst, but it’s easy to knock yourself out for that period. Your eyes heal best when they are closed, the more sleep you can get, the better off your eyes will be.

6 hours later I woke up and could see insanely well. Over the next few hours vision returned more and more to where I was seeing almost as well as with glasses. Things would occasionally go slightly blurry and my eyes would have trouble adapting – similar to the feel when you wake up in the morning before your eyes focus.

First Follow-up

The day after the procedure, they wanted to schedule a follow up to see how things were progressing. This is a really quick followup where they do an old fashion eye test (the big E test) and the doctor asks you a few questions. The day after the procedure my vision was 20/20 in my right eye and 20/25 in my left. According to the doctor it takes a few days for the swelling in your eyes to go down, and in that time your vision will improve. The best thing to do in the meantime is stay on top of your eye drops.

Adjusting To the Change

For me the hardest part of the entire experience came after the follow up. This is when your eyes are most sensitive to light and your body hasn’t yet adjusted to the new vision you’re now seeing. After 6 more days when I discontinued the anti-pain/inflammatory drops my eyes went through withdrawal for a night. They were both extremely itchy and all I wanted to do was rub them. By the next day the itching had subsided.

The night visor only needed to be worn for the 6 days after the procedure. This is just to prevent you from rubbing your eyes in your sleep or sleeping on them wrong. Unfortunately “sleeping me” wasn’t cooperating and would tear this visor off as soon as he could.

Side Effects of LASIK

The only side effect for me was that my eyes are now a little dryer than they used to be. Unless I was wearing contacts, I never needed to use eye drops before. After LASIK, I was using them once or twice a day (at most). This lasted for about a year before I stopped using any rewetting drops. I do stare at screens 12+ hours a day, which might have something to do with it. The oddest realization was that the feeling of having “dry eyes” seems to feel different than it did before. It’s a tough change to explain, but it’s not uncomfortable to the point where eye drops have ever been urgent, or even required.

By the Monday after the surgery I was back at work programming all day without any problems.

Getting An Adjustment

Remember how I mentioned that my doctor would do an adjustment if my vision didn’t end up being 20/20? Well, it wasn’t. After about a month, my vision was good, but it was still equivalent to wearing -0.5 glasses – still farsighted and not able to read tiny text in the distance. One eye was -0.25, but the other was a little worse.

I was given the option to stay as is or give it another shot. I booked another appointment and went through the above dance a second time! To be honest, it was very anticlimactic the second time around. I took some eye drops for a week, went in, had 2 valiums this time, got my eyes improved by lasers, went home, slept, woke up and realized things were good!

After the 2nd time through, my vision was 20/20 or better in both eyes. It’s now been 6 years since then, and they have help up. I don’t need glasses or contacts, and my vision is still 20/20.

Changes in Vision

One of the biggest concerns I had when I was looking into LASIK was that my vision would be messed up in some way and I wouldn’t be able to see for the rest of my life. Nothing like that happened, but I do think there have been tiny changes to my vision. These are extremely hard to verify though. Imagine playing a game of magic eye with 2 similar pictures – but one you’re looking at now and one is a memory from a while ago. How sure can you be that you’re not just imagining a difference?

With that caveat, there were two things I think I see differently: shades of darkness and a very specific color of orange. For the darkness one, I think I used to be able to determine more gradients within darkness. Now things tend to go from light to black faster. Like I said, I could be completely imagining this one.

For orange, this is one that I can verify – as one eye sees a specific share of orange as more yellow than the other. It’s slight, and I may not have even noticed it unless I was looking for differences between my eyes.

These are so extremely minor that I’m lucky enough to say there have been no negative impacts on my vision due to LASIK. I’d recommend it to anyone who wears glasses and wants a break from glasses and contacts.

Would you get LASIK, or have you already? Do you have any concerns about getting it done? If you’ve had LASIK, was it worth the cost?