Ask YC: Laser Eye Surgery? | Hacker News Reader

Ask YC: Laser Eye Surgery?

27 pointsneilc54 comments

I'm mildly near-sighted, and I've been considering getting laser eye surgery (entirely for cosmetic/convenience reasons). However, I'm concerned about possible long-term effects to my vision because I spend all day looking at a monitor. Obviously, developing vision problems in the future would be a significant handicap to being an effective programmer.

Have any other YCers had laser eye surgery, and perhaps have some anecdotes to share?

View on HN

Guys, if you have never had Lasik, or never looked into the surgery, you really shouldn't give the OP false information.

Like someone mentioned, your result will completely based on two things: your surgeon, and your fit. I have been nearsighted since the 3rd grade, with astigmatism, and getting Lasik done 1.5 years ago was the best decision I have ever made. Here are a few facts most people don't know:

1. Noone has ever gone blind from Lasik surgery - this is a old wives tale 2. You have a higher chance of getting infection by wearing contact lenses than getting Lasik surgery 3. Almost all complications are due to inexperienced surgeons, and they are all correctable 4. You will still need reading glasses when you get old, lasik doesn't correct that. Once your vision have stabilized, your eye sight will not get worse after Lasik (besides the need for reading glasses at old age).

This is a surgery, so find the best surgeon in your area. Find someone who has done over 10,000 pairs of eyes, fly to another city if you have to. Don't try to save money -- it's your eyes! I did mine in NYC, and it cost me around $5k for both eyes (2-3x the going rate), but I also had one of the best surgeon in the area.

I had dry eyes for quite a while after surgery, but it went away after 6 months or so. And I only experience dry eyes when I am on the computer the entire day (when you are using the computer or watching TV, you don't blink as much), if I am out playing sport, it's perfectly fine. But keep in mind, your eyes take a while to heal completely -- it took mine 6-12 months, and now my dry eyes are gone.

Halo and glares are also typically caused by dry eyes, you put a few eye drops in, and they will be gone. And with newer technologies, halo and glares could pretty much be eliminated now days.

Hope this helps with your decision. I definitely recommend it.

I had both of my eyes corrected when I was 20 (8 years ago) when my dad offered to pay for half. I guess I was emboldened by the fact that he had his done two years before. It cost about $3000 at the time, and I went to a small clinic in Santa Rosa, CA (where I lived).

I was in and out in less than an hour. I'm sure technology has increased dramatically since then, but the one thing I recall being slightly uncomfortable/freaky was the eye slicer - literally a blade that sliced off the top layer eye to expose the important bits. I'm pretty sure you don't have to do that now.

I also recall the clinic I went to had a 3d imager of sorts - it was supposed to even out the irregularities of my eye, instead of just one blast. That's how I ended up with better than 20/20.

After a day, I was seeing better than I ever had before, and to this day my vision is great. Getting rid of the glasses was a huge confidence boost, made my long hours at the computer more comfortable, and has probably saved me a collective 3 months in fiddling with contacts (had I chosen that route) - Vision is my mac, I no longer have to think about it, it just works.

While I can't speak to the potential for risk, as you've researched the technology more recently than I have, my resounding advice would be to do it. Vision is your greatest asset - and while I know others who'd disagree, I'd argue that improving it is worth the small risk.

Besides, is putting a foreign object in your eye that you wash with chemicals of unknown safety (http://www.tennesseelawblog.com/2008/05/dangerous_contact_le...) EVERY DAY really that much safer than a one-time medical procedure successfully undertaken by hundreds of thousands of patients worldwide?

Do you remember exact name of the procedure ?

Was there a healing period or did it just go straight to better than 20/20 ?

Did you have dry eyes at all ?

Just curious about the details. Tia.

I had it done about 3 years ago so I could drive or use a camera without glasses. It lets me buy el-cheapo reading glasses & sunglasses (previously needed prescription), so I can have as many pairs as I want. (I'm over 50, and Lasik does nothing for accomodation).

My night vision is actually better than before. This is because I had to wear glasses before, and if they weren't prefectly clean, I would see halos & streaks. I had difficulty keeping my glasses clean.

There was one minor unexpected side effect. I do some work with lasers & optics, and since the surgery, a laser focussed to a tiny spot looks to me like a cluster of spots, which is an annoyance.

So lots of benefits, and no real complaints. However, looking back on the experience, I'm shocked at myself for doing it, and taking the risk that I could end up with serious vision defects. I was lucky that I had a good result, but my attitude has changed since then. I doubt I would make the same choice now.

Mildly near-sighted? If it's not very poor vision, I wouldn't take the risk.

It's expensive and laser vision correction physically burns off a layer of your cornea to correct the refractive properties, so it isn't exactly non-intrusive.

I thought the newer procedures use a different method?

If it's not very poor vision

It's actually best suited for people with mild problems.

I had lasik about 5 years ago and I've been very happy with the results. I previously had been moderately near-sighted and even after 5 years I'm still at 20/20. The cost was pretty expensive, the procedure was rather intense (remember, it is surgery), and the recovery was fairly quick but nerve-wracking due to the uncertainty of how your vision will end up leveling out.

I've had no long-term problems with dry eyes. The only side effects I really have are slight "halos" - which for me actually mean 3 prongs of light extending above bright light sources. This has changed my night-vision in a significant way but not in a disruptive one. It's simply that bright lights just look different to me at night than they used to. If that might matter to you, it would probably be a good reason to not do it at all.

I would do it again, though. To me the convenience outweighs the hassle and expense of the procedure.

You may consider the gas permeable hard contacts that you wear when you sleep, and remove them when you wake up. It gives you about 12 hours of good vision. Aside of the daily procedure and extra containers when traveling, it is basically life without glasses or contacts. I have been using these for almost 10 years.

Do you mean Ortho-K? (Not sure if that's a procedure or a brand name).

That looks like what it is (my lenses are of a different brand).

Your age also matters. I'm told by my optometrist that you shouldn't really think about LASIK in your 30s, because with current LASIK procedures, your vision will decline more rapidly in your 40s, than if you hadn't gotten this LASIK.

I'm seeing this with two friends who have gotten LASIK and are in their 40s and 50s. Whereas they bragged before how clearly they could see, they both have mentioned needing reading glasses recently.

I'm glad I listened to my optometrist.

I'd just like to add that YMMV, and you'll really want to ask this question of a qualified professional familiar with your eye medical history.

Asking the Internet will not yield you a good answer.

I had lasik 6 months ago from Dr. Goodman in SF, and am extremely happy with the results. It was definitely on the pricier side ($6.5k), but well worth it.

Takes a good 4-5 months to heal completely. For the first month I had halos at night and dry eyes, and my vision wasn't quite perfect yet in my left eye. After about 5 months, all of these went away, and my vision in my left eye is 20/20, and in my right is slightly better than 20/15.

Also, the initial recovery is very quick -- you're supposed to sleep for a couple hours to reduce the pain, but after that, you can get right back on a computer.

I had lasik about 5 years ago and I can't say enough good things about it. I did a bit of research and found a surgeon in Vancouver, BC who had done a lot of surgeries and some original research on eye surgery. It cost about $3000 for both eyes, which I consider a steal.

The procedure its self was quick and painless. There was a contraption for "peeling" the outer surface off the eye which was a little freaky, but tolerable if I didn't think about it too much. Then they did the laser part of it, using lots of little blasts to reshape my cornea. That part was actually pretty cool, like watching blurry fireworks that filled my field of vision. Then they put back the corneal flaps and sent me off to a dark room to rest for a bit. Twenty minutes later I was on the sidewalk gawking at everyone and everything.

At first my vision was sharp but distorted, but that cleared up within a day. After that I had better than 20/20 vision. I had a bit of discomfort in the days following the surgery, but the clinic had given me some eyedrops that took care of that handily. After that everything felt fine, and there was a longer period of healing where I had to be careful about rubbing my eyes and wear special eye guards at night.

Before the surgery I had been using a combination of glasses (most of the time) and contacts (for sports). Now I don't need either, and a real blessing. I do moderate amounts of outdoor sports, and things like skiing, mountain biking, camping, rafting and do on are so much better now that I don't have to worry about keeping contacts clean, switching between glasses and contacts, protecting my face from water etc.

I tend to wake up with dry eyes and usually put in some artificial tears when I get out of bed. If I can't for some reason, it's no problem, my natural tears start flowing after a few minutes. I haven't had any problems with dryness during the day. My night vision is ok. Really bright lights tend to have a very slight starburst effect, in low-light situations I see quite well. I can see the stars much better than I could before the surgery.

My doctor says I'll need reading glasses when I get older, which I wouldn't have without the surgery. I don't care. I've got maybe 20 years of perfect vision, and even then, being farsighted is better than being nearsighted. I'd rather wear glasses when sitting in front of a computer than when skiing.

All in all, it's the best decision I ever made.

I would recommend against it.

I had it done and although technically I have better than 20/20 it took me nearly 8 months to adjust to the difference.

To me it's a different way of seeing and my mind had to come to terms that it wasn't the same (if you switch from glasses to contacts you have an idea of what I'm talking about).

The problem is that I'm not really sure it's better than with my glasses. Definitely better than with my contacts.

I find it hard to distinguish objects as quickly as before in dusk and dawn situations.

Bottom-line, as this is for cosmetic/convenience reasons stay away. You need to be prepared for changes.

BTW - Although I can pass an eye exam for 20/10 or so, I feel that I'm guessing more than I was with glasses, even though I could only do 20/15 with glasses. I can't describe any better than it's a different way of seeing.

I've had laser surgery and it did NOT end up how I expected. I happen to be a special case -- I had only one eye done at a time. After the first eye was done, I had bad vision and it was really bad at night. I remember looking at a turn signal on a traffic light and seeing three copies of the image. My eye doctor told me I had 20/20 vision. Hah. I could easily see that the eye I didn't have surgery with had significantly better vision and more immediate focus with a contact lens that the surgery eye did.

I went back to contact lenses and have never been happier. I have to take them out and put them in, but I'm way happier with them. (barring that the one eye will never be as good as the eye without surgery)

Look, they're your eyes. Lucky I have some redundancy.

I had it done about 5 years ago and it was the best money I ever spent. Not sure why people say go for the best Dr.. What you really need to do is go for the best laser as the laser does all the work. The Dr. just swabs your eyes and lets the machine do the work.

Good point. Although the doctor is still important because they're the ones controlling the machine and other details of the surgery, but the main point is that the machine is the most critical part. Find a place that uses the latest technology, not one that's using a 10 year old machine because they don't want to pay the money to upgrade.

That's NOT true. The surgeon is the most important part of the procedure just like all surgeries. Most complications occur while creating the flap (they cut the front of your cornea), and a skilled surgeon will do it without any issues. However, inexperienced surgeon sometimes cut the flap too thin, or cut a hole in the middle of the flap, etc. Then you are in a lot of trouble.

Skilled surgeon also knows how to react to complications during surgery. The experience of the surgeon is very important - just like all surgeries, definitely don't ignore this variable

Laser eye surgery is a good procedure - if you're right for it. The problem is that it's also a money-maker and that means that (doctors|hospitals) have an incentive to qualify people who aren't good candidates. So, do you trust your doctor to turn you away as a customer if you aren't a good candidate? Good doctors probably have very long waiting lists and much higher fees (since it isn't an insurance covered cost and so fees have more variance).

If you get a bad doctor, they could screw up and leave you with a scar on your cornea or something like that. A family friend of mine is a laser eye surgeon and often has to remove these scars that have occurred because of other doctors.

It's a great surgery - if you're right for it.

> The problem is that it's also a money-maker and that means that

...and that means that unlike highly regulated surgeries that are performed my surgery monopolies like hospitals, the rate of improvement in laser eye surgey has been astounding, as has the drop in price.

It's a nice contrast - sort of like comparing web 2.0 startups to massive EU-subsidized plans to create "a European Google".

Oh, it's totally true that laser eye surgery has progressed faster and cheapened in price incredibly compared to other surgeries.

But it's a ton different from a web 2.0 startup. web 2.0 startups can (pretty much) handle as many customers as want their product. If a million people want to use reddit, it's better than if 100,000 people want to use reddit. On the other hand, if a million people a year want surgeries from Dr. Goodman, it isn't better for him than if, say, 100,000 people per year want surgeries from him since he can't do even that 100,000.

So, in web 2.0, everyone can use the best (with variance for preference). In medicine, if we ranked doctors from best to worst, some people would end up on the lower end of the spectrum. Those doctors on the lower end of the spectrum are more desperate for customers (since they don't have a line waiting) and are (therefore) more likely to qualify patients who are ill-suited.

Doctors don't scale and therefore not everyone can have the best. Just like any business, those at the bottom are more desperate for customers. In the web 2.0 world, that sometimes manifests itself as lying about features, people can try it out and then defect to a different service. Medicine doesn't provide such an easy situation.

/This is why I'm a web programmer and not a doctor ;-)

No matter what, find the best surgeon you can. Even if it ends up costing you as much as $6-7000. It's a lot easier to do this with an experienced surgeon than to do it with a bargain one, especially since it's so much harder to fix mistakes than it is to not make mistakes in the first place.

Personally I couldn't consider it at all. I only have one problematic eye and another better than 20/20, so only having to deal with a single contact lens every day is great to me.

(Also it's worth noting that you should take breaks and set up your work environment so it's comfortable to you.)

My dad formally had massive eye issues and needed to have laser surgery multiple times to not go blind. He ended up having to replace his Corneas.

Anyway, he has stated many times that he would never tell anyone to go through the pain of laser eye surgery. This guy has been through a ton of painful stuff, but this was the topper for him.

On top of that I know someone who had Lasik and their vision got worse and their eyes wouldn't stop watering. I believe they went to some cheap place, but it ended up costing a ton of money to not be in pain any longer.

My father's been through similar (well, except the corneas), and he said it was the best thing to ever happen to him since his post-op vision is so much better. It wasn't lasik for what it was worth, mostly just to fix very badly detached retinas in both eyes and cataract surgery.

I do software development for a living and about 5 years ago, I had lasik so that I could get rid of wearing glasses. Although my vision went to 20/15 after the surgery and although I did my homework, went with a name brand surgeon in my state but according to my surgeon, I happen to had fallen into the 1% category that reports 20/20 vision or better but I see artifacts in my vision. I don't see halos or blurriness, instead, it looks like I'm seeing artifacts that are highlighted by light. My theory is that I've seeing scarring from the procedure. The artifacts are really close looking like floaties but I know what floaties look like and these aren't them. Whenever my focus changes from looking at objects from up close to far away or vice-versa, these artifacts move with my vision and come into my vision from the sides. So the times that it really affects me is when my vision is tired like when I stay up late at night, have a headache or when I'm sitting in a dark room looking out a window to a sunny day out. Overall, I'm ok with having lasik, but there are those days when my vision is really bothering me that I somewhat regret having it done. I wish everyone the best in your decision to either have it done or not. Cheers.

Everyone's throwing out anecdotes, so here's mine:

I knew a guy who got it done, and several days layer his retinas became detached. (Luckily, a surgeon corrected them, and the lasik was otherwise okay.) Here's the thing: The surgeon insisted that the lasik was not responsible.

So...I'm wondering what percentage of foul-ups are covered-up by the medical establishment.

I was born with congenital cataracts and have had several operations on my eyes. My vision is around 20/30 with contacts, but I'm legally blind without them (20/400).

I know my condition isn't quite the same as yours, but here's some advice:

1. Do not get surgery unless it is absolutely essential. If you're only mildly nearsighted, then stick with glasses. Your eyes are very intricate, and any amount of surgery is going to do additional damage.

2. Sending time on the computer, even 18 hours a day (as I sometimes do), won't have major long-term impact on your vision. I specifically asked my doctor about this in May when I went in for a new contact prescription. Time on the computer will make your eyes tired, but that's all. Just take a break and you'll be fine.

Keep in mind I am not a doctor, and you should consult your own ophthalmologist.

It's a tough call. I almost pulled the trigger a year ago and then cancelled my appointment two days before the surgery. My reasons:

1. Google around for LASIK horror stories. Most people are happy, but I did not want to become a statistic.

2. Dry eyes. According to my research, it is a major complication that the surgeons do not mention. Anecdotally, a friend of mine who had LASIK has dry eyes now. Another friend does not (although he says his sight deteriorated since the surgery).

3. Alternatives. It's a little distressing that few civilian surgeons perform PRK. I understand that they don't want to deal with patients for four months, but my research suggests that it's the more reliable procedure in the long term. The Navy seems to trust PRK more for its pilots because it does not trust the flap's structural integrity.

I don't know much about Lasik, but I do know about contact lenses.

If you're not aware of them you might want to look at getting the new-style night-and-day contact lenses. Unlike the older ones which had to be taken out every night, some of the new types can be left in all night. Not only does this save effort, it also reduces the chances of eye infections.

I my lenses all the time, and only have to take them out once a month, when I put in a fresh pair. It's pretty much the next best thing to having perfect vision. I can't imagine Lasik being much easier.

Word of advice: get the best surgeon out there. Don't skimp-your eyes are worth more than the money you save.

My SO worked at the #1 west coast lasik office. She said that a lot of people came in for corrections 2-3 yrs after their original surgery because they went to "budget" eye centers. The cuts were sloppy, quality of original surgery was horrible, scarring, etc.

Also, don't put blind faith in the surgeon's claimed years of experience. Many surgeons do not work full time and thus have less experience than those that do.

I had an appointment for Lasik, but chickened out at the last minute (the idea of shooting a laser into my eyes was too much). But then I continued to abuse my eyes with cheap contacts and ended up with a corneal infection which left one eye legally blind. So, glasses are my only option now. Make your choices wisely, and go with the best. I think that contacts are not healthy for your eyes over years of use.

I'd wait 5 more years to see improvements in the field. It is major surgery, and your eyesight is pretty important. I'd wait until they made as many improvements as possible before going for it. Wear contacts if you don't like glasses.

I was actually planning on doing this at 25, but then changed my mind. Even if there is only a 10% chance your eyesight will get screwed up, thats still too much to take a chance on

is there a 10% chance? that sounds high

there are plenty of people whose vision got worse because of the operation. It varies from not being able to see at night, to getting worse vision, to going completely blind. Since for most of us our entire businesses require us being able to see, taking that chance for nothing more than vanity(lets face it, most people want to get Lasik because they don't like how they look with glasses)

You could always wait another 5 years, right? I would suggest consulting with an eye doctor and surgeon and figure out if you can get the results you want right now or if it will require waiting for a few years.

I can get the results now, sure, but there is no guarantee the operation will be a success, and your vision is the last thing you want to be messing with

Use contact lenses - your vision doesn't seem too bad (compared to mine - I have astigmatism but I can still have lenses) and they're much safer.

I haven't seen it said yet so:

If you're worried, get just one eye done.

If you were a bad candidate and you are one of the extremely few unlucky that takes poorly to lasik, hey, you've got a spare! If it all works out with the first eye, you'll know you're a pretty good shot for the second.

I never could quite understand why people get them both done at once. Is it just to save $? Seems to me a very simple way of mitigating risk.

I wouldn't recommend it. A former roommate had it done about a year ago and he constantly has to use eye drops. He also wasn't supposed to watch TV or use a computer for a month for any extended period of time because apparently you don't blink as often. He was also mildly near sighted and said that the improvement wasn't all that great.

Drops are a refresher and I use them roughly 1-2 times a day. I can tell you first hand that I'd much rather deal with eye drops than fumbling around with clunky glasses.

"... Have any other YCers had laser eye surgery, and perhaps have some anecdotes to share? ..."

I had a doctor give me tips on algorythms and programming and ended up using VB, DCOM and Excel for a cross platform spreadsheet system ~ http://news.ycombinator.com/item?id=287851

i had it done 7 years ago. it was $4k, and absolutely worth it.

when i had it done, they told me: 1) there are no serious risks; no one has gone blind from it 2) in the worst case, your vision will return to normal over time

i was 19 at the time, and they convinced me that, since i would need reading glasses around age ~40, then was the best time to do it, to get as many glasses-free years as i could. yeah, it was a salesman-style line and i bought it, but i am glad i did -- the advice people are giving about waiting a few more years likely just means that you are getting less for your money.

i had 20/100 vision and am now 20/20. if yours is not so bad as 20/100, i can't say whether or not it's worth it.

i have some "starbursting" effects, but they are minor, and in any case, definitely a small price to pay.

oh, and that $4k included any touch-ups i may need in the future, if my vision does start to revert (i haven't needed any yet).

You might find this link interesting, I had the choice between PRK and LASIK and went for PRK based on Professor John Marshall's concerns:

http://www.guardian.co.uk/lifeandstyle/2000/jun/06/healthand...

Was it worth it? For sure! No problem for few years except floating strings around my eyes (got used to it).

Would I do it again? Probably not. I still have memory of the corneal suction ring coming slowing into my eye. At least the surgery was short.

I'm very nearsighted (prescription is something like -6.75, whatever that means) and I've heard it doesn't work as well for people with very bad vision. Anyone have any experience or knowledge with this?

My prescription was approximately the same as yours... I thought my vision was so bad that it couldn't be done. I had -6.00 in one eye and -6.50 in the other and LASIK was the best decision I ever made. Shop around for quality doctors, and do your research... I found that given the degree of nearsightedness, it really came down to your eye's topology, which if examined correctly(through a 3-D wave imaging system), explains the features of your eye in detail and profoundly assists in determining whether or not you're a candidate... here's a short bit on it: http://www.lasikaide.com/Lasik-Wave-Front.aspx it's very similar to brain scanning systems and MRIs...

This is just my experience. But FYI, nearsightedness is exactly what these procedures are designed for. Farsighted folks, to my knowledge, do not qualify for LASIK.

My friend Laura's dad had LASIK in both eyes; one eye was made perfect and one eye went blind. Another friend had PRK in both eyes with no ill effects. Just two anecdotes for you to make your decision.

Best money my wife and I ever spent was on Lasik!

My wife and I both had lasik done around 10 years ago. My eyesight was 20/300 and hers wasn't much better. Neither of us has had any issues whatsoever. I'm a programmer and she works in an office with accounting software. We were around 40 at the time.

At one time, I worked on medical computers for eye surgery and witnessed several myself. This type is painless. Why anyone could not watch TV or use a computer for a month, I don't know. Mine was done on a Friday morning and I was back at the screen Monday morning.

Both our vision is still 20/20 though we both are getting farsighted as a result of age, not the surgery. We do not use drops for any reason.

Lasik does NOT correct farsightedness though I was once told this can be done now, I haven't looked into it.

Im sorry, why is this on first page?

Eye hacking, duh.

"... Eye hacking, duh. ..."

Reads more like swapping "beauty tips", "hand holding" and "circular arguments". Where is the science?

Reply on news.ycombinator.com