One Down, One to Go

Thursday, June 01, 2006 | 7 comment(s)

The basics are this: laser treatment for retinopathy sucks (plain and simple). It's a painful experience, scary as hell, and I have had some side effects from the procedure, though hopefully they are temporary. I definitely found, however, that of all the fear I had going into the procedure, the fear of the unknown was BY FAR the largest. I write this in detail because that’s what I hungered for going into the procedure – details on what to expect.

Laser treatment is usually done only to one eye at a time. My last exam clearly showed a significant hemorrhage in my left eye, so that’s the one we started with. The appointment started off like most any other ophthalmologist’s appointment: they called me back, a tech puts drops in my eye (only the left eye this time, though) to numb it , another set of drops to dilate the pupil, and please have a seat out in the lounge while the drops open up your pupils, etc., etc. Only this time, while my eye was dilating, I had to sign a rather frightening consent form mentioning potential risks of temporary or permanent(!) vision loss (not the most relaxing things to consider just beforehand). But the doc also came by once or twice while I was waiting to check whether I had any
Which, of course, I did
One question I actually asked was: “how does the laser know to stop and not continue through to my brain?” He didn’t really have a good answer for this, at least not to my recollection.
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more questions about the procedure (which was very nice).

So, in general, I was expecting there to be a bit more precision in the procedure than there was. Something like: “Rest your chin here, press you forehead up against that, okay now we’re going to strap your head in place. Don’t move, your vision is at risk.” But no. The procedure involved me being reclined in a chair and him strapping on a helmet with the laser beam being fired from his
For some reason
He reminded me of Godzilla.
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forehead. The lights in the room are dimmed to further dilate the pupil and a lens is placed on the eye to focus the laser beams that are to be fired. I think the lens is actually on the surface of the eye, but the surface of the eye is numb with drops, so I couldn't tell.

What those numbing drops do NOT do, however, is numb the back of your eye (i.e., where your retina is). So the procedure begins and he warns me that while most folks can handle the discomfort,
There is, however
the option to get a needle to get a local anesthetic, but this will then require a longer recovery period and the need to wear a patch over your eye for a day or so.
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some can not. The laser was indeed bright and while I couldn't feel anything on the first shot, by the 5th shot or so, it definitely felt like someone was pricking me with a needle from behind my eye. Not a pleasant feeling, at all. Both eyes were watering and my ears were filling with tears. I could only stand 5-15 laser shots at a time before I'd need a brake from the procedure. Just a few seconds to catch my breath and to get some blood back into my white knuckles.

The doc started on the left side of my left eye and spent 10-15 min there before giving me a break. The lasers definitely cause
I remember thinking
"Hmm, so this is what it would be like to be blind in one eye," with a truly shocking amount of nonchalance and just pure inquisitiveness.
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temporary blindness. Slowly, as the vision returns, everything is
Literally
Like looking at the world through rose-colored glasses.
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pink. He told me to expect this. I asked him if the pink was due to bleeding, but he said “No.” Apparently, the laser used is an Argon-green laser, and it only destroys the green receptor cones in the retina. Since pink is the complementary color, everything is pink until your able to reach a new equilibrium with regard to the color spectrum. This takes about 10-15min.

He comes back after 10min or so and starts in on the right side of my left eye. At a few points he actually had to place a clamp to keep my eyelid open. And there was one time that a laser actually hit a nerve and that
Reminded me of two movies
A cross between "A Clockwork Orange" and "The Marathon Man"?
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hurt like a bitch.

All in all the procedure lasted about 10-15min per side of my eye. At the end, the doc assured me that my left eye is now much better off than my right eye in terms of long-run vision loss prevention. He told me that there was no
In fact
I went to work the next day, even (although I wasn’t all that productive (but then again, my productivity had been taking a beating for the weeks leading up to the procedure as well)).
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restriction on what I could do after the procedure and said that it was unlikely that I'd recognize any real changes in my vision. He also told me that the most commonly reported side effect was black floaters in my field of vision while the capillaries are shutting down and possibly leaking a little. He assured me that this is normal, should pass, and is nothing to be alarmed about. (yeah, right).

Like usual, my vision was pretty blurry from the pupils being dilated afterwards. There was still a decent amount of pain and a killer headache that I took 2 Tylenol for, and I went home and napped on the couch afterwards.

Side effects I have noticed

There are two major side-effects mentioned in all the literature on laser treatment for retinopathy:
These are EXTREMELY vague!
What does “decreased peripheral vision” and “decreased night vision” vision mean EXACTLY?! Will my field of vision narrow?! By how much?! Will I be able to drive at night?! These are the kinds of details we want!
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decreased peripheral vision and decreased night vision. When I asked the doc about these, he told me that these symptoms generally only show up after repeated sessions of laser treatment (something that has never been mentioned in anything I’ve read elsewhere) and that it was unlikely that I would notice any changes in my vision.

While this wasn’t the case, the side-effects I’ve experienced have been relatively minor. As far as
And Remember
This is just my experience and the plural of anecdote is not data.
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my experience, I noticed
But then again
I already wear glasses and things in my periphery (and thus outside my corrective lenses) are already blurry.
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no change in my peripheral vision, but I have noticed some minor changes in my night vision.

A few days after the surgery (after the blurry vision started to improve), I checked out my bedroom while I was laying there trying to fall asleep. I noticed that the room seemed slightly darker when looking around with just my left eye -- kind of like it wasn't able to pick up as much of the ambient light in the room as my right eye. I don’t drive a lot, but last weekend I did drive at night for the first time since the procedure. And while I don’t recommend anyone drive down any expressway at night at 70 mph while closing one eye and then the other to try to discern any differences, that’s exactly what I did (and still arrived home, safe and sound (thankfully)). I am happy to report that I didn’t notice much of a difference at all, so I would say that any change in my night vision is rather mild and may even be getting closer to the same ability in my right eye as I get further away from the surgery.

There are two other side effects that I experienced that I didn’t find much in the literature on (but have after some digging) and both freaked me out pretty good. For the few days after the surgery (2-4, maybe), my vision was pretty blurry in the left eye -- but only in the distance. Essentially, my myopia seemed considerably worse. I was extremely upset about this at first, but by about day 3, things started to improve slowly, and I don’t think there’s much of a difference now (though there very well may have been a difference there before my laser treatment – I certainly didn’t check things this rigorously beforehand).

The other side effect I’ve experienced is some visual disturbances in my periphery. I think what I see would be described best as kind of like shooting stars when you’ve been hit in the head, or TV static, or just wavy distortions. Sometimes they’re pink, sometimes yellow, but most often, they’re just white. And they move kinda fast, and come and go kinda quickly. I notice them more when I move my eye certain in directions or hang my head down (like while reading, for example). I’m still experiencing these occasionally, but with less and less frequency. I spoke to a tech at the doctor’s office a few days ago and he told me that this is a common side effect. Some people don’t notice it at all, some notice it for a few days, and others notice it for a few weeks. He said basically there’s scar tissue building up where the retina burns were and that’s what’s causing these little flashes in my periphery. They should clear up when all the healing is finished. (I certainly hope so).

Other minor things I’ve noticed include a migraine headache (which I’ve never really had before) about a week after the procedure, and some sharp pain in the back of my eye (kind of like the original lasers felt like) if I bent over (though I only noticed this for a few days after the surgery – but then I think I just stopped bending over to avoid the pain, as well).

So, I've been a complete freak walking around winking and covering up my eyes and trying to compare and contrast my vision between my left and right eye for a two weeks now, and I’m driving myself crazy. I’m finally ready to just get the other eye over and done with. I originally had the right eye scheduled for Monday, but the appointment was cancelled and pushed back by two weeks (to June 19th).

I know this is pretty detailed, but going in for the right eye to be done will be immensely easier for me because (like I said above) the biggest fear was not knowing what to expect. I definitely think this information is more detailed and useful (at least I hope so) than those generic, cartoonish pamphlets they hand out at the office and not as clinical and obtuse as the research papers I've found on the procedure.

7 Comment(s):

Blogger julia said...

Gaaaaaahhh!! It made my eyes water just reading that. I hope to god I never have to have eye surgery done. I think the doctor would have to knock me out for his own sanity, never mind mine. I don't know how you didn't jump out of the chair.

Blogger Scott K. Johnson said...

Kevin,

Thank you for your very detailed information on this.

I have not had any procedures yet, but I'm pretty sure they're in my future too.

I really get a kick out of your writing - the ability to present very useful information with an entertaining aspect to it.

Thanks again!

Blogger Kevin said...

Thanks, Scott.

I'm glad you got a kick out of it. While it's certainly some heavy stuff, I try to remain light-hearted about it (whenever possible).

Blogger Kerri. said...

I appreciate the detailed information, too. It's a procedure I'm pretty certain to have to go through, seeing as how I'm chalking up to 20 years this September.

Even though it was tough to go through and to write, I'm sure, it was a brilliant read and necessary for giving The Real Deal Story to us all.

Blogger Nic said...

Wow. Thank you for sharing your experience and knowledge, Kevin. All of this is something I've wondered about (and worried about). Having this info should help a lot of your readers feel a little more informed, especially since it comes from a person with experience and not from a doctor. I don't blame you for wanting the next one done and over with. Sometimes knowing what's coming can be as daunting as the fear of the unknown.

Blogger KJ said...

Wow Kevin, this is very helpful! I really find it very interesting to read this from you before any doctor has to explain it to me.

I'm in my 24th year of diabetes and I've been seeing a retinal specialist every 3 months because I'm in the beginning of it. He has been talking to me about laser therapy but it scares the hell out of me. Now that I've read through all your experiences and information, I'm a lot more at peace. Thank you for all this detailed info!

(I just found your blog, you commented after me in George's blog (The B.A.D Blog), and I really like it. I will definitely put you in my blog.)

Blogger gb said...

I just had laser treatment for torn retinas. The procedure was a bit of a discomfort. Much like a visit to the dentist. Weird, a bit painful, but nothing much. The major side-effect is a bunch of floaters floating around in my left eye. But they are more of a problem when i'm tired, or thinking about them. The major concern is to repair the tears in the retina before the retina detaches. According to my doc, torn retinas are a time-bomb that could go off at any moment. If the retina detaches you're in for a big patch-up. I wouldn't take the risk of delay for fear of the procedure.

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