Another visit to the Boothe clinic to see how my eyes are coming along. The healing is "perfect" but doc says my eye pressure is a little high which could be because of the Lotemax. I'm due back in another 2 weeks for another check. Tomorrow I switch to 1 x/ day Lotemax finishing up next Wednesday. So almost a full week afterwards I'll go for my follow up. I read the chart again but this time at 20/15!!!! Fantastic. Doc said I could try a night without the Genteal goop to see how it goes. I did it and it went fine! No dryness issues whatsoever. Really nice to be able to wake up without any residual blurriness so this is a treat. I find that I don't really need the tears at all anymore so I'll use them when I think of it just so I'm not going complete cold turkey. I feel "normal" again and the vision is excellent. Now I can say that I am really happy I did this! Although it will take 2 years for the flap to heal, I don't do contact sports so I'll be ok. WOOT!

Some say that the blades used to cut the corneal flap (mechanical microkeratomes) are as good or safer than the Intralase laser. Here is a study that proves that not to be the case:

From NCBI: http://tinyurl.com/yp7nkv

PURPOSE: To compare laser in situ keratomileusis (LASIK) results obtained with the femtosecond laser (IntraLase Corp.) to those obtained using 2 popular mechanical microkeratomes. SETTING: Private practice, Greensboro, North Carolina, USA.

METHODS: This retrospective analysis compared LASIK outcomes with the femtosecond laser to those with the Carriazo-Barraquer (CB) microkeratome (Moria, Inc.) and the Hansatome microkeratome (Bausch & Lomb, Inc.). The 3 groups were matched for enrollment criteria and were operated on under similar conditions by the same surgeon. RESULTS: There were 106 eyes in the IntraLase group, 126 eyes in the CB group, and 143 eyes in the Hansatome group. One day postoperatively, the uncorrected visual acuity (UCVA) results in the 3 groups were similar; at 3 months, the UCVA and the best spectacle-corrected visual acuity results were not significantly different. A manifest spheroequivalent of +/-0.50 diopter (D) was achieved in 91% of eyes in the IntraLase group, 73% of eyes in the CB group, and 74% of eyes in the Hansatome group (P<.01). IntraLase flaps were significantly thinner (P<.01) and varied less in thickness (P<.01) than flaps created with the other devices. The mean flap thickness was 114 microm +/- 14 (SD) with the IntraLase programmed for a 130 microm depth, 153 +/- 26 microm with the CB using a 130 microm plate, and 156 +/- 29 microm with the Hansatome using a 180 microm plate. Loose epithelium was encountered in 9.6% of eyes in the CB group and 7.7% of eyes in the Hansatome group but in no eye in the IntraLase group (P =.001). Surgically induced astigmatism in sphere corrections was significantly less with the IntraLase than with the other devices (P<.01).

CONCLUSIONS: The IntraLase demonstrated more predictable flap thickness, better astigmatic neutrality, and decreased epithelial injury than 2 popular mechanical microkeratomes.

If you've done any research on this subject on the internet you've no doubt come across some very scary information. "The flap never heals", "your vision will regress", "lasik suicides", etc. I decided to research each of these claims prior to my surgery and will post my findings. I determined that the majority of this information is meant simply to scare people. Period. I joked with my wife that it was a conspiracy by a group of ophthalmologists who want to scare people so they can keep selling glasses and contacts. ;)

Myth #1: "The flap never heals"

Quite simply, yes it does! It happens in stages and continues over a long time but yes it does eventually heal completely.

Quoted from http://www.usaeyes.org/lasik/faq/lasik-flap-heal.htm:

Many potential and post-conventional or wavefront custom Lasik and All-Laser Lasik patients are concerned about the degree to which the flap ultimately heals and re-bonds to the underlying stromal bed. Here is a synopsis of current thinking on the subject. Of course, due to individual healing differences, the time-line below will vary from person to person.

Hopefully this information reassures some of you that the flap eventually does heal quite securely, and does not just lie there flapping in the breeze, indefinitely. If you still have doubt, remember that corneal transplants, despite being much more invasive than Lasik flaps and consisting of imperfectly cross-matched cadaver tissue, ultimately heal so completely that they provide strength and structural integrity for the eye. This is additional evidence that Lasik flaps do heal very securely and eventually contribute at least to some degree to the bio-mechanical strength of the cornea.

The process of flap healing is similar if the flap is created with a mechanical microkeratome or a laser microkeratome (All-Laser Lasik).

Phase I

Days 1 to 3 post-op Immediately post-op as the flap is re-positioned and the doctor "squeegees" out excess moisture under the flap, a negative osmotic pressure is created that "sucks" the flap onto the stromal bed and holds it there. The flap is held in place fairly well at this time, barring physical trauma such as rubbing the eye or a poke in the eye. Of course, this is a very vulnerable period because any trauma to the flap could easily dislodge it, hence the importance of wearing eye shields at night and similar protections.

Phase II

Days 4 to 14 post-op During this period the epithelium re-generates along the perimeter of the flap, sealing and bonding the flap more securely in place. This is still a vulnerable time, but less so than in Phase I, where only osmotic pressure secured the flap.

Phase III

Days 15 to 60 post-op During this period the re-generated perimeter epithelium lays down a basement membrane that firmly adheres the newly regenerated epithelium to the underlying stromal bed.

Phase IV

Days 61 to 180 post-op During this period the keratocyte cells of the stromal bed and the flap produce an adhesive protein (glycos-aminoglycan) that bonds or "glues" the flap to the stromal bed. By the 180th day, these processes have generally rather strongly secured the flap to the stromal bed. Trauma or surgical instruments can still dislodge or lift the flap, but a good deal of healing and re-bonding of the flap to the stromal bed has occurred.

Phase V

Day 181 to 24+ months post-op During this period collagen slowly begins to form at the interface between the flap and the underlying stromal bed. This collagen includes fibril infiltrates that extend from the flap into the stromal bed, in effect suturing the flap to the underlying stromal bed. At the conclusion of this process the flap is both "glued" and "stitched" into place, as well as "sealed" and secured by the surface perimeter epithelium and basement membrane. Although still not as strong as an untouched cornea of the same thickness, the flap and stromal bed are nevertheless now very securely bonded together. At this time, any trauma strong enough to dislodge the flap would also do damage to an eye without Lasik. It is also believed by many researchers that by the 24th month post-op the flap has begun to contribute to some degree to the bio-mechanical strength of the cornea thus reducing the risk of late-onset ectasia.

The following list was prescribed and recommended by Dr. Boothe. Your doctor's orders may be different.

Zylet - I received a prescription and a sample of this every time I visited the clinic. Not knowing how much of this I'd actually use I filled the prescription which cost $25. In hindsight this was a complete waste as the samples were more than enough. I have 1 unopened sample and a 3/4's full vial from the pharmacy.

Vigamox - same as above with the same out of pocket cost. The samples are the same size that the pharmacy will give you. Again, a complete waste to fill this prescription.

Sustane Tears - The key here was to obtain high quality tears that are preservative free and in individual vials to avoid contamination as you use these more than any other drop. I paid ~$10 per box of 28 vials and bought 4 boxes. On day 7 following doctor's orders to the letter up to this point I have 1 unopened box and 8 vials remaining. I don't yet know if I'll need the 4th box but I probably would have been ok with only 3.
*edit*
No I used every bit of all 4 boxes, got another sample from doc, and still may need more. :-/

Genteal ointment - $10 over the counter at Walgreens. No way around this one for night time dryness protection.

Lotemax - This routine goes for 4 weeks following the Zylet, each week decreasing in number of drops per instillation. I have 1 sample and am tempted to see if I can make it stretch. If I can make it through the next 10 days then I'll ask for another sample when I go to my follow up.

Today was officially day 7 after surgery. The most critical healing period has come to a successful end. Today is the last day I'm required to wear my safety goggles outside and the last night I have to wear my shields. I started the Lotemax drops and had a single dose of Vigamox this morning. Today was was the first day I actually felt normal, aside from the hemorrhage still visible in my eyes. I never felt like I needed the tears but I used them hourly so the frequency is decreasing. The blurriness is completely gone and I didn't feel like one eye was stronger than the other. My vision is incredible. I'm almost ready to dance that jig! ;)

1/31
No itchy eyes today, just goopy and a little blurry. I noticed a drastic reduction in starbursts and halos on the way to work this morning. Tail lights now just look like glowing red shapes. Even with my glasses I had some star-bursting on these. Way cool!! Today is the last day for the Zylet and I'm really regretting filling the prescription for both the Zylet and Vigamox. I still have an unopened Zylet sample and the Vigamox sample is the same size as what the pharmacy will fill. These were $25 each for me so word to the wise, just use the samples! If I had a 2nd Lotemax sample I bet I could make it last to the end. :-/

1/30
Eyes are back to being slightly itchy and irritated this morning. I gooped them up pretty heavy last night before bed. The red "bruising" from the intralase is starting to clear up with portions of white beginning to break through. Went to 5-day follow-up today and waited an hour before getting called back. The waiting room was packed. They did a couple of tests and the ophthalmologist (not Boothe) looked at my eyes through the light scope to make sure healing was on track. He said it looked "perfect." woohoo! I was able to read the 20/20 line a little better with my left eye but still wasn't crystal clear. Glad that picking my lashes didn't cause any problems. ;) My new drop schedule is to slowly phase out of the Zylet and Vigamox then into the Lotemax for several weeks. Genteal will continue and I'll be done with the goggles/ shields tomorrow.

1/29
My eyes feel a lot better overall today. I've broken the rules and carefully removed gunk from my eyelashes. It was caked, cylindrical, and rigid, and I think was irritating my eyes. Halos driving in the morning were much reduced even better than when I wore glasses. The vision in my right eye still looks sharper than my left. I think it's slowly catching up but isn't quite there yet.

1/28
My daughter was up all night so me and my eyes are tired today. My eyes are pretty itchy today and feel like they need a good rub. ;) Can't do that though. What a true luxury the ability to rub ones eyes is! I don't know if it's the ointment or healing that is causing the itching. My eyes are still pretty red but vision is good. It was dark when I drove to work this morning and managed ok with the brake/head lights. The halo's and starbursts have dramatically diminished. Still a little blurry but this could be ointment remnants. I called Boothe today to make sure the itchiness wasn't a problem. They said to put tears in the fridge and WOW how refreshing. Still itchy but bearable.

1/27/08
I woke up around 3am with my left shield not on my face. Uh oh! Found it stuck to the sheet in the bed. Too much ointment made the tape less sticky. Ripped it all off and started over fresh. Back to bed.
The Genteal ointment doesn't seem to want to go away in my right eye today. VERY annoying as this eye is very blurry today. Tears aren't helping. It's also a little itchy which is hopefully due to healing as this eye looks the most beat up from the intralase step. Everytime I blink more ointment gets spread across my eye which is good for moisture but really sucks for vision and this is making me very irritable today. My bottom lashes are goopy and shiny and there's absolutely nothing I can do about it. I hope this wears off soon. I went to Lowes today to pick up a few things and my eyes were HIGHLY irritated even with my goggles. I made the mistake of not bringing any drops with me so I grab my items and ran out of there as fast as I could.

1/26/08
I drove myself to AM follow up to get contacts removed. These contacts are seriously bugging me and remind me an awful lot of what wearing corrective contacts used to feel like. Also reminds me of why I stopped wearing contacts! The wait to get these out is agonizing!!! I finally get put in an opthalmology room and wait another 20 min for Boothe to come in. He takes each contact out with a pair of surgical tweezers, no pain. Rubs some yellow schmutz on both eyes then looks at them with the light scope. I read the chart and am confirmed to be 20/20 with both eyes, 20/20 in my right alone, and not quite there yet with my left. Tells me to switch to 3 hr intervals for the zylet/ vigamox and use tears every 15-30 mins. Also wants me to pick up some Genteal ointment for overnight. I collect a t-shirt, set my next follow up for this coming Wednesday and I'm on my way. Vision is still a bit fuzzy today but overall very good. No issues with dryness or pain. My eyelashes are seriously getting gunky so I've resorted to using a q-tip to VERY carefully wipe underneath my eyes to collect the most heinous of build-ups. I had a hard time getting the Genteal in my left eye before bed, kept hitting my eyelashes. Major buildup is occurring. Finally got enough in and tape my shields to my face.