The title of my story may sound optimistic, but I do not want to mislead anyone. I chose it because I wanted to underscore the sense of true isolation and hopelessness that making the decision to have LASIK surgery has had on my life. I wish I could say that I am obsessive compulsive or hypochondriacal. Somehow knowing that it were merely a case of mental illness would perhaps make it easier to cope with. Instead I find myself wishing I go back in time and talk to myself the day before my surgery, to give the advice I could only know through the painful experience of LASIK. I have to admit that I don’t really want to write this story, because there are just too many bad feelings, too many hopeless moments, too many pain-ridden days that separate me and that fateful day. I wish it could just be a faded memory, just a challenge in life I could put behind me, but it is always there, quite literally in front of my eyes.

I remember the first time I heard about surgery to correct nearsightedness. It was in the mid 1980’s. I saw a woman on 20/20 who was almost legally blind, by her description, who had decided to get RK, or radial keratotomy, to correct her vision. I have to say it perked my interest, as I had worn glasses and contacts since the age of 13. Still, the idea of making incisions in the cornea to spread it out sounded pretty risky to me, and I decided to see what advances could be made before I went about sacrificing my eyes to science. It turns out I was well founded in my caution, as the surgery was found to be not stable long term, with many patients regressing to their old levels of nearsightedness. Also there were alarming reports the surgery could cause scarring, and the patient could see starbursts when looking at any light source.

I was still very comfortable wearing my contacts, and more than willing to go through the morning and evening rituals required of cleaning and insertion familiar to any regular contact wearer. I was religious about cleaning them, always cringing when my eye doctor told me of the potential infections in the eye due to poorly cleaned contacts, or the story of some sad patient who decided to wear them for 2 weeks straight, without taking them out or cleaning them, and thus was unable to wear them anymore. “Why would they mess with something as precious as their eyesight?”, I thought to myself. Little did I know I was doomed to commit the same error in judgment these people had made, all because I didn’t like the way I looked in glasses.

Now anyone who hasn’t had problem vision (nearsightedness, farsightedness, or astigmatism) can truly understand the psychology of those who have to wear glasses all of their life. I myself was a very active kid growing up. I was put in braces in 7th grade, followed by the immediate ignominy of failing the eye exam at school. Braces and glasses at a time when I was already self conscious about my looks and trying desperately to fit in could have been a death blow. Instead, I got contacts almost right away, relegating my glasses to wearing just before going to bed, and reasoned that eventually having straight teeth could be a good thing. I was able to avoid the wrath of most bullies as I was just this side of nerdy. Well the contacts were wonderful. I would wear them for the next 17 years.

During that time I would occasional ask an eye doctor about the progress in refractive surgery. I even talked to one woman in town for an ophthalmology conference what she thought about some of the new laser techniques. The message was always to wait, that the technology is getting better and that it wasn’t worth the risk.

I was approaching 30 when I began thinking about it more seriously. My contacts were beginning to cause problems. My eyes would get very dry if I wore them every day. I went to see an eye doctor who recommend I wear my glasses more often. He described the process as the eye not being able to get enough oxygen due to the contacts and that this was something which many soft contact wearers faced as they got older. I got a cool pair of glasses with high index lenses, and for the first time in my life, a slight correction for astigmatism. I saw better than I had ever seen in my life with those glasses, although they didn’t always suit my active lifestyle. This was my progression - first I would take off my contacts when I got home from work, then it got so I could only wear contacts one day a week – my vanity day. Eventually I could only wear them during physical activity, when mountain biking, rock climbing, or during any of the other myriad outdoor activities I had enjoyed my entire life. I think you’ll agree this is very common sense progression.

One day I met a friend, an ex-boss of mine who I hadn’t seen for over a year, for a beer to catch up. He had wonderful news. He was taking a position with a bank in Singapore and would be moving within the month. Moreover, he was going to get LASIK surgery done before he left and say goodbye forever to his glasses. I was stunned as he regaled me with plans to hike in the Himalayas, and to learn surfing, all without the hindrance of glasses. He like me, had worn them since his teens. I was impressed by his confidence in the procedure, but I was still wary about the technique. I decided to see whether his experience with the surgery would be as painless as everyone was making it out to be.

Two weeks later, one day after his surgery, I went to his house. He was moving out and was going to give me an old T.V. and some CDs he didn’t want any more. He greeted me at the door without any glasses. He then asked me in so we could watch his surgery video. Watching the video, I was freaked out by the apparent smoke I could see rising off of his cornea. He said despite the outward appearance, the whole procedure had been pretty painless. I left his house that day convinced that I should do some research on LASIK, that it could potentially be right for me.

Everyone who has had this surgery and been hurt by it knows what happened next. I went online in an attempt to get some objective information. There were a lot of websites that had information on LASIK, but almost every one of them seemed to a doctor who did the surgery and was hocking it. At the time this didn’t raise the red flag for me that it should of. I did feel I was learning something for the first time about my eyes. The websites explained the concepts of nearsightedness and astigmatism, and how the laser would “gently” re-shape my cornea with a “cold” laser. I never really took time to think back to my college physics class to realize that all lasers are by their nature hot, that’s how they can burn the corneal tissue. This would be one of many highly touted features of the procedure I would come to realize were just marketing terms.

After looking online I thought I would ask my current ophthalmologist, the one who had fit my glasses, what he thought about the procedure. He said that with around 4 to 4.5 diopters of nearsightedness in each eye, with almost negligible regular astigmatism, and a dilated pupil size of only 6 mm, that I was probably an ideal candidate. Still, he said he himself only performs PRK. Since at the time I had read about the pros and cons of PRK and LASIK, and thought I had determined LASIK was newer, more advanced, and less painful than PRK, I thought I would find a doctor who performs LASIK for an evaluation. Since my friend had had good luck with his doctor, a person who I found learned was well respected and had quite a lot of experience, I decided he was someone I could trust my eyes to.

I called the doctor’s office (hereafter referred to as Doctor X.) Everyone in Doctor X’s office was very nice to me on the phone. They made the whole process seem as easy as getting your teeth cleaned. When I called to set up the evaluation, they even asked me at the same time if I wanted to go ahead and schedule the surgery. I told them I didn’t want to make that decision yet and they said I could always make after I saw the doctor for the evaluation.

I went to Doctor X’s office, which, surprisingly, was the same office my other ophthalmologist used, Doctor X just rented the space from him once a week. I found out that Doctor X’s regular office, as well as the surgical facility, were across the bridge in the suburbs. This did not concern me at the time, though later it would prove inconvenient when I had problems. At any rate, I have to say I only talked to the doctor for about 10 minutes that day. The whole preliminary examination with dilation and topography was done by his assistants, all of whom seemed to have had the surgery themselves. When I finally did get the doctor in the room, he check my refraction numbers and dilation width and determine I was an “ideal candidate”. Still I grilled him very specifically about the odds of certain complications. I also asked him very pointedly about the fact that I am a computer professional, one who uses the computer upwards of 6-8 hours a day. He said this wouldn’t be a problem. I trusted him from that exchange well enough to set up a date for the surgery 3 months in advance– January 12, 1999. What I thought would be my day of independence and celebration would end up being the beginning of a nightmare that I still feel hasn’t ended to this day, almost 3 years later.

As I approached the date I was excited. I had arranged to pay for the surgery using my company’s health care expense account which allowed you to use pre-tax dollars to pay for uncovered medical expenses. Since LASIK was considered elective surgery, none of it was covered by regular insurance. Still, what a deal I thought. I get perfect eyes, and the government foots the bill for half of it. Man did I think I was smart!

After being promoted to a new higher profile position in the company right before the end of the year, plus impressing my new boss with my programming expertise and hard work, I took off on Christmas vacation. It would be a week and a half off, during which I would visit my father in Iowa and see two friends get married over New Year’s in Philadelphia. I think these might be the last truly happy times in my life. At least I tend to view them that way, in retrospect. They were the last truly pain-free weeks of my life and I don’t know how to think about them now, except with some kind of nostalgic sorrow.

I returned from my vacation, refreshed and ready to take on the new year. I also looked forward the surgery a week away, thinking how great it would be to never use glasses again. I told my boss about the surgery, and he expressed some reservation. He just thought it was weird I would let them cut my eyes with a laser. I tried to re-assure him that it was really no big deal, that he wouldn’t even notice the difference afterwards, that it would be just like I was wearing my contacts all the time. I also figured since he himself had never had problem vision, that he really couldn’t know how wonderful it would feel for a nearsighted person to see 20/20. My roommate warned me as well, thinking it sounded risky. I tried to placate him with the fact that my other friend had gone through with no problem. God if I had just listened to the two of them.

As the big day approached I began the pre-surgery ritual, I hadn’t worn my contacts for two weeks prior, and I had used the drops precisely as directed. I am going to be the perfect patient, I thought, with the perfect result. I convinced my roommate to drive me to the surgery facility and to drive me home afterwards. We went to the clinic first thing on a Monday morning. I was scheduled to be the first patient the doctor worked on that morning (in retrospect this was probably a really bad idea.) They double checked my refraction, put some numbing drops in my eye, and set me in a waiting room. As I entered the surgery room, a volunteer said she would hold my hand through the process if I wanted to. I told her yes, that would be nice. I was placed in the chair, and the doctor came in quickly, checked my chart, calibrated the laser, and began the whole procedure almost immediately.

He said he would work on the right eye first. He placed the speculum and suction ring on my eye to keep my lid open, then marked my cornea with two exact circular dye markers where he would make the cut. The microkeratome made a high buzzing noise as it cut through my cornea. I remember that cutting the flap on the right eye was uncomfortable, like maybe the numbing drops weren’t quite doing the trick. He saw me flinch a little and asked “Did that hurt?” I didn’t really respond, I just wanted him to get on with it. He lifted back the flap, said I would see black for a moment, and then clearly as I prepared to focus on the dot. This happened and when the dot came into view, I thought everything would be fine. He began firing the laser, but for some reason I had difficulty fixating. He had to stop the laser once, telling me I was moving my eye. I attempted to focus on the dot. It was better this time, and he was able to finish the treatment. The process for the left eye went much smoother, with no hitches. He was able to pulse the laser continuously, probably 8 or 9 pulses and it was done. His work on the flaps seemed very elegant, I could tell he was very skilled at this at he delicately smoothed the flaps over with a paint brush like instrument. I would later find out he did an excellent job on the flaps, and never had any complications due to them.

Still I worried about my right eye. Out of my left eye I could already tell that I was seeing things better. My right eye seemed a lot blurrier, but I was told that the healing response can vary a lot, and that I should go home and get some rest. My roommate drove me home, where I took some Tylenol and passed out in bed for 6 hours.

I was very good about not removing the protective eye covers or touching the eyes at all. I performed the post surgery drop regimen exactly as I was told. The next day I was to return to Doctor X’s office downtown, since Tuesday was his city day. He removed the patches and refracted me. I was 20/15 in my left eye, and 20/20 in my right. He was very happy with these results. The only problem was that with my right eye I was seeing two versions of everything. One image for every letter, and a fainter image directly below it, displaced almost the full height of the letter. This is commonly called ghosting, and I would later find out that it is due to irregular astigmatism induced by the surgery. I told him I was very concerned about this, that it was driving me crazy. He said he thought it would resolve with time, and that I shouldn’t worry as my eyes had just started to heal. I headed home with the hope he was right. I was planning to return to work the next day.

Well I got into work the next day, and found that despite being able to see my computer screen, the ghosting in my right eye made it very hard to focus. It caused eye strain which, over a period of days, caused a constant throbbing pain below and around my eyeball. It felt like the muscles were attempting to adjust to this vision, but couldn’t quite rectify the image. Furthermore, this pain was not resolving at night when I would go to sleep. I was scheduled to see the doctor in a week, but I couldn’t wait, I had to go see him on Friday, four days after the surgery.

I drove across the bridge (he was in the suburbs that day) in a complete panic, thinking this is something which would remain unchanged and unfixable. When I saw the surgeon, he refracted me to 20/15 and 20/20, the same as the day after the surgery. When I complained of the ghosting he told me to give it time. When I told of my extreme difficulty at work, he said he felt this too, would improve with time. At the end he said “See you in a month.” I left his office with a feeling of impending doom.

I tried to remain optimistic. I returned to work on Monday, but nothing had changed. Over the next month I would tough it out at work, pretending that everything was okay, all the while silently enduring the pain that would become my closest companion over the coming months. I now know this pain more intimately than I have known anything in my life. It is not an intimacy which I cherish.

The eye was not getting better and I was getting more miserable every day. I went in for my one month check-up with the identical complaint I had after the surgery – the ghosting and the pain are still there and work sucks. To which Doctor X said “You are still seeing well on the chart. See you in six months.” What a *******! I knew then and there that he didn’t really care about me or my vision. I felt betrayed. I thought short of physically assaulting him there was not much I could do on that day, so I decided to head home, with hope of securing a second opinion from another doctor.

I made an appointment with my old ophthalmologist, the one who had told me he could perform PRK. I was a mess, hoping he could at least tell me what was wrong. He said I was refracting well, and that he didn’t know about the ghosting, that my operating surgeon would be able to offer the best opinion on that. When I told him Doctor X didn’t care, he was taken aback, but said there was little he could do for me as this was not his specialty. He recommend I see another refractive surgeon, one at UCSF where he himself had studied ophthalmology. I looked up refractive surgeons at UCSF’s clinic, and set up an appointment with one of them in two weeks.

Personally, I was a wreck. Work was getting harder and harder every day. I tried not to let on to my boss that something was horribly wrong. Also, when going out with friends I tried to keep a smiling face. “Look, no glasses!”, I would say. I had told everyone I was going to have the surgery, and didn’t want to feel like a chump that it didn’t go well, so I began to use cognitive dissonance as a defense measure. I was seriously close to losing it for the first time in my life. I called my mom in Phoenix. She said she had some time off accrued so she wouldn’t mind coming up to take care of me for a week, and then go see the doctor at UCSF with me. I was thinking at the time OK finally I am going to get somewhere with this.

We went to see the doctor. The atmosphere in the UCSF clinic seemed much more professional and serious than Doctor X’s office. I was again refracted and my topography was measured. A very young doctor with quite amazing educational credentials saw me. He looked at the topography and said “It looks like you might have looked up during the treatment on that eye. The zone of best correction appears somewhat inferior to the direct center of your optical zone.” He went on to explain that the ghosting is caused by irregular astigmatism in the eye, a type of aberration in the corneal tissue that is not correctable with glasses. He said that there was nothing he would do surgically, given the current technology, that could help me. He said if I wanted to get rid of the ghosting, I would have to wear a hard contact in that eye.

Finally some answers I thought. I made an appointment with an O.D. to get a hard contact lens fitted, but found it was going to take 4 weeks to get in to see him. In the meantime I thought I would pull out all the stops and get an appointment to see a doctor at Stanford for a third opinion. This was a doctor who was recommended as the absolute expert on corneal surgery, one of the top two or three surgeons in the whole country. I held out hope he would have some surgical solution which would rid me of the ghosting and pain forever.

My 30th birthday passed during this time. It was a day I thought I would really be looking forward to, what with my awesome glasses-free vision and all. Instead it was a lifeless affair for me. Despite going to my favorite restaurant with my mom and friends, I was miserable and in pain. I tried very hard to not let on how miserable I was. I had tried almost everything for the pain – every kind of over-the-counter analgesic. Hot and cold compresses. I even tried tri-cyclic medication from an old TMJ prescription I had. Sometimes I would stick ice on my eye just for some temporary relief.

I struggled on at work until the appointment with the Stanford doctor. My mother and I drove down there from the city. Again, everything in their clinic was exceedingly professional and serious. I began to realize the true gravity of this surgery and how lightly it had really been taken by Doctor X. I was refracted, topography was taken, etc. etc. Then the doctor came in. He confirmed the diagnosis by the UCSF doctor, and said I would probably need to use the contact in the meantime, until the technology could develop to point where they could treat irregular astigmatism. “It’s just not there yet. To do further treatment on this eye at this time would be irresponsible.” He got me an appointment with an O.D. in the city he really trusted and who was able to see me sooner than the other O.D.

I left thinking that the hard contact, though inconvenient, was at least a solution until they figured this stuff out. With the technology advancing all the time, I thought it wouldn’t take long for them to develop a treatment for it. I mean there had to be other people out there, right? I couldn’t be the only one! Well, I found out that this promise of improving technology is a little bit of a red herring that is thrown out by surgeons not really knowing how to deal with miserable patients. After some time I would find that nearly everyone who has complications from the surgery that aren’t easily rectified – these people are eventually ignored by their surgeons. The surgeons aren’t interested in people they can’t help, and they aren’t interested in learning more about complications and how to treat them. They found it was a lot more lucrative to get a bunch of new patients in the door rather than help those with problems. To this day I find this behavior incomprehensible. This realization had truly shaken my faith in humanity.

Eventually I was fitted with the contact. It did help rectify the ghosting, but I found it extremely difficult to tolerate. The whole reason I had the surgery in the first place was because I had become intolerant to contacts. I could only use it for two hours at a time. What’s more is that it didn’t resolve the pain. I tried it for two months before giving up on it. I felt it caused more discomfort than it solved.

My work was becoming so difficult that eventually I told my boss I would have to go on disability. It was just too painful to look at the computer screen, even for 15 minutes at a time. He felt bad for me, and was really sad to see it happen because I had done such a good job. He really depended on me. I felt like I was letting him down. I felt like I had screwed my whole life up with this one decision. I thought I would never work on a computer again.

I decided to see if time away from the computer would help the pain go away. I remember crying when I couldn’t even see my tax return well enough to fill it out. My Mom had to help me. Eventually she needed to return to Phoenix for her job. I said goodbye to her with a sense of dread. I didn’t have any way to cope with this. For the first time in my life I was faced with what I considered an insoluble problem.

I became deeply depressed. I had difficulty sleeping because of the pain, but once I fell asleep I would try and sleep as long as possible. I remember some days getting up at 1 or 2 in the afternoon. Then I would try and eat something. The pain still throbbed in my head. After a few weeks of this I started to fantasize about suicide. It seemed like the only real solution to end my suffering. I would think about it when I first woke up in the morning. I imagined getting both of my hands cut off and bleeding to death. None of these thoughts ever progressed to action, however. At least not immediately.

It was nearing 6 months after my surgery, so I decided to go see Doctor X for the 6 month follow-up. I didn’t expect much, but I couldn’t work, and I hated being alone at home all day. I told him what was going on, that I was in pain and on disability from work, that I couldn’t work on a computer or read without pain, that the ghosting remained as ever. He took a fancy new picture of my eyes with an Orbscan, the most up-to-date topography device at the time. He had just gotten it installed that week. When he showed me the pictures, it seemed clear that my left eye appeared perfectly normal, while the right eye looked like the correction was two low. It didn’t look as bad as some of the topographies for de-centered ablations I had seen on the web, but there was a marked difference between the two eyes. He said that the difference wasn’t enough to cause the problems I was having. He asked me if I had extra stress at work. I reiterated that I hadn’t been working for a month because of the pain. He told me maybe I should take up Yoga.

As I drove home I started to think about the most painless way to kill myself. I had heard that carbon monoxide poisoning from leaving your car running in the garage was painless, kind of like going to sleep. When I got home, I closed the garage door behind me. I let the car run for a while. I was curious to see how quickly it would build up. I remember seeing the air turning gray around me. Eventually I freaked myself out a bit, stopped the car and got out. I guess I wasn’t ready to go yet.

Over the next couple weeks I would fantasize about other ways of killing myself. I wrapped a sheet around my neck one day, just to see what it would feel like. I pulled it hard enough to make myself gag. That seemed too uncomfortable a way to go. I also remember thinking about jumping in front of the subway train. If I did it at the last second, there’s nothing the driver could do, I thought. People always say that suicide is a selfish act. They may be right, but I think if they really understood the anguish and desperation of someone in that situation, if they had these feelings themselves, they would understand completely.

I decided to try and see a psychiatrist. Maybe I could treat the depression independently of the pain. Through my health plan I set up a meeting with a doctor. Unfortunately, they couldn’t get me in for 3 weeks. I decided it would be something to look forward to. The day came and I went to see the psychiatrist. He worked out of his home and had an address unfamiliar to me. I went to the address. There was no answer at the door. I was anxious and desperate. I tried to call the doctor on my cell phone, but got his answering machine. I eventually drove off in frustration, thinking the medical community had failed me again.

When I returned home I telephoned a close friend in Colorado in tears. I told him I worried about being alone, that I might do something stupid. He said I could come stay with him in Colorado. I thought the change of scenery would help. For some reason, I decided to drive there from San Francisco (obviously I wasn’t thinking too straight.) I did make it there in a day and a half. I tried to console myself with the company of my friend and his wonderful family. The pain was still intense. Four days later, I broke down completely. I started to pack my stuff into my car to return to San Francisco. It was approaching evening, and my friend tried to convince me that that wasn’t such a good idea. I was at wit’s end. I felt the pain would never go away, and that I had no future. I couldn’t work, couldn’t enjoy life. I had hoped I could get out on the road somewhere, alone, maybe I could end it all. My friend asked if I wanted to go to the emergency room, that way a psychiatrist would have to see me right away – no three week waiting period. I relented.

At the emergency room the admitting L.C.S.W. asked me all kinds of questions, including whether or not I had thought of harming myself. I told him about my suicidal gestures. He said I had done the right thing by coming in, that typically someone in this pattern is dead in two weeks. At least that was something to be thankful for. I had finally made a good decision, I thought. They decided to keep me in the hospital for four days, to start me on an anti-depressant, and if I was feeling better, eventually release me.

When I got out I was feeling a little better, but the anti-depressant made me feel pretty weird, plus it dilated my pupils which made my visual symptoms worse. Still, my sister-in-law had agreed to fly out to Denver so she could drive back with me to San Francisco. We had a decent trip, although the pain was as strong as ever. I was glad to have her along. I don’t know how I would have survived any of this without my family and friends.

Eventually, after another 4 months (about 9 months post-op) the pain started receding. I eventually found I would be able to get back to work. I had accumulated some debt while on disability, but was just thankful to work again. My eyes still got tired much quicker, but as long as I regulated my computer time I could manage.

That was two and a half years ago. I thought eventually I would be able to taper off of the medication. I have tried this twice, but both times the pain has returned again very strongly, taking many months to go away again. Right now I am in the middle of my third spell in three years, hoping it will go away like before. I plan to stay on my medication indefinitely in the hope that it will keep the pain away permanently.

My visual symptoms have not improved. The annoying ghosting is still there, and now my vision has actually regressed so that I am a little nearsighted again. Glasses don’t make my vision perfect, but do correct me pretty well. I can’t get over the fact that I could have avoided this whole mess if I had only known the true risks. I now wonder if my life will ever be the same again. Will I ever truly enjoy my life, or will I live in fear that the pain will control me. Each day is touch and go, and I still think about suicide from time to time. The only difference is I’ve been through it before, and have survived, so I know there can be some upside eventually.

So that’s it, the road less traveled by. Unlike Robert Frost’s road, it isn’t the one that has made my life more distinguished or unique in a positive way. It is more like getting the wrong trajectory and being caught on the dark side of the moon forever. Always out of touch with others, finding it a challenge to be happy. I used to consider myself an optimist - always looking for the good in people, the good in life. Now all I can say to myself each day is that I’m alive. At least I’m still alive.