Team Temple grills these every week. All year. I don’t exaggerate when I say they are the best steaks I’ve ever had. You can use this method for beefsteaks, but why would you? Porksteaks are way more flavourful. It is a sad day indeed when we run out and can’t get more until the farmstand opens on Saturdays. We prefer nice thick t-bone chops with a good mix of white and dark meat and a nice fat-cap (it’ll crisp off).

There are three keys to porkchop nirvanna: DRY, OIL, REST.

1: Marinate

First thing I do is marinate them with a few splashes of Bragg soy/aminos. I don’t marinate long, just enough to get a bit of umami seeping in. Probably if I did longer, they’d be even better. I take the chops straight out of the fridge for this. I don’t bother letting them pre-warm to room temp. I think this helps keep more of the thick chops rare/med-rare while the outside gets the right amount of crisp/char.

2: Dry

Key number one to crispy chops on the BBQ is to dry them off as well as you can. The best way to do this is with a couple pieces of paper towel. If I use the wettest towels on the chops first, working your way to the new, I can get the total down to one small ‘select-a-size’ per chop. Not too wasteful, and the dryness makes a HUGE difference.

3: Salt

Lay the chops in a (dry!) bowl and sprinkle salt fairly liberally on both sides. Koshering salt works best because you can get more coverage. Don’t be shy with it, most of it will drip off, but it’ll really make a difference in the flavour and crispiness.

4: Season

Make up the rub. I just sprinkle some flavours that work well with the chops. Through much experimentation, I’m currently doing the following. Amounts are guesses based on the relative proportions for four large chops. You almost can’t have too much rub, because it will slough-off with the excess oil.

• 2tsp black pepper
• 1 tbsp chili flakes (for citrus high-notes, not spice)
• 1/2 tsp fennel seeds (roughly crushed)
• 1tsp onion powder
• 1/4tsp granulated garlic
• 1/2tsp aleppo pepper (just a touch for the earthiness, not spice)
• 1tbsp clubhouse greek salad seasoning

5: Oil

Key number two is to pour on lots of olive oil, probably half-a cup. Then mix the chops, seasoning, and oil together in the bowl. You want enough oil that they’re well slathered in it, with a bit of standing oil in the bottom of the bowl.

(Aside: Costco’s Kirkland-brand organic olive oil is FANTASTIC, the best tasting we’ve found for under gold-bullion pricing. It’s quite inexpensive, but amazingly good for raw applications, never woody. It’s what we use for cooking too.)

Slathered in oil is the best way to get a good sear on a propane barbecue.

6: Preheat

BBQ prep. Get the barbie REALLY hot. I throw on all burners full-whack with the lid down until the lid-thermometer pegs out, usually over 700f. When it’s up to temp (and the sizzle guards may be glowing orange near the burner), turn off one side of the BBQ, but keep the hottest part going.

7: Burn!

Chops go on the hottest part of the grill with the LID OPEN. Don’t mind if the olive oil is drippy, but don’t bother trying to get extra oil on the chops. Try to put the fattiest parts over the hottest heat. You’re basically trying to render/crisp the fat on the outside as fast as possible. By that time the rest of the meat will have just the right amount of grilling.

Flames will be *much* higher. You'll be too busy to photograph at their height.

Warning! Because the chops are dripping in oil, they WILL BURN! This is the secret to getting those perfectly crispy chops. The oil will burn, turning the chops into a bonfire, but the ablative burning of the oil and fat-cap will actually protect the chops from burning. Or some such. It’s science and it works. Have faith that the divine pork spirits will protect your chops.

Monitor closely, but DON’T PANIC. Watch carefully, because they should only sit in the bonfire for a handful of seconds before the outside is perfectly charred. Also, please don’t burn your house down. Er. Maybe I should have put that warning first. Keep the lid up while the conflagration is happening!

Grill until the outside is perfect, then move to indirect heat. Move the chops around, trying to get each side of each chop to the nicest looking amount of char. It won’t take long at all. Once they look beautiful, move each chop to the side of the grill with the burners off. They’ll still be blue in the middle, but the outside is done.

Total time over direct heat is maybe 3-4min. Keep your eye on the (flaming) prize!

Sear until it looks delicious, then move to indirect heat.

8: Bake

After all chops are moved off the direct heat (and any flash flames have died down) keep the one side of the grill still burning, but close the lid for indirect heat finishing. You’re going to essentially bake the chops until their internal temp is 105°F. Check the internal temp regularly.

(Aside: The best thermometer I have found is the ThermoWorks Thermapen instant-read thermometer. The ThermoWorks DOT is the best leave-in thermometer, which will make every roast and turkey easier and better. These two are in my absolutely essential kitchen kit.)

Sometimes the chops are different thicknesses and will cook at different rates. I put the cooler chops higher up to cook a little faster. My BBQ has a rack along the back of the grill, and on the indirect side, the top part of the rack will get more heat than the grill surface (lid-closed the heat fills from top down).

I like my chops medium-rare, and taking thick chops off at 105F will result in them being closer to medium, but with rarer bits right near the bone. Thinner chops can cook faster, but I don’t like to take them off before the others, because they’ll start to cool. You want them to retain their heat so they can finish cooking while resting. If some are done early, I move them to the cooler parts of the grill (on my grill up at the front corner opposite the side the burners are still going).

Note: The indirect baking accellerates as it heats up. It can take a while for the chops to get from 80-90, but from 90-120 can go fast!

Total time for indirect baking is probably another 4-5min. Less if you don’t open the lid frequently, which I do often to check the temp.

9: Rest

Key number three: they MUST rest to finish cooking. Quickly remove chops to a plate, piling them together to best retain heat (porkies at the bottom of the piggy pile will cook more). Quickly cover tightly with foil and remove to small insulated space. The microwave is a perfect little resting box. Er… don’t turn it on. ;)

After at least 10 min of resting (20 is ideal, we eat salad while they rest), the high heat on the outside will have sunk in to the middle, finishing the cooking to tender perfection. If you cut into them at 105F, they’ll be pretty blue, but after 10min resting, they’ll be at least med-rare. Sometimes I overshoot medium-rare, but they still wind up super tender with this resting method. Plus, with thick, bone-in porkchops, you’ll always have less well-cooked bits near the bone.

Pink pork is good. We buy good pork, and you haven’t really had to worry about rare pork in the past few decades (statistically it’s safer than beef), so we don’t mind it quite rare near the bone. Dial it in to your tastes.

10: Enjoy!

Try not to make obscene noises (unless your dining partner’s into that). And most importantly, I’d love to hear how it goes!    

The post 10-Steps to Porkchop Perfection appeared first on is this your homework?.

I have written quite a bit on the differences between Lasik and PRK (Primer on PRK vs Lasik and Lasik vs PRK: What the Lasik Doctor Doesn’t Tell You – Short story: Run screaming from Lasik, it’s dodgy as hell, the very definition of a ‘quick-fix’), and I’ve written about my own PRK experiences (My Laser Eye Surgery, Part I: PRK Pre-Op Preparation, My Laser Eye Surgery, Part II: The PRK Operation, My Laser Eye Surgery, Part III: PRK Post-Op Recovery), but I haven’t yet spoken much about my own side-effects from my laser eye surgery.

Six-plus years after surgery, I’m still incredibly happy with both the recovery and with the results (vision I think is still better than 20/20, but as I age it’s naturally deteriorating). I have suffered (and still ‘suffer’) one side-effect: haloing. Halos can occur regardless of whether you’ve gotten Lasik, which cuts a flap in the cornea (never get Lasik!), or PRK/Epi-Lasik/Lasek (note the e in Lasek), which do not cut flaps in the cornea.

What is Haloing?

Haloing is an effect where your pupil opens wider than your corrected zone on your cornea (effectively a lens carved into the cornea itself). The image hitting your eye is simultaneously well-corrected and uncorrected. This results in an faint (typically less uncorrected light is getting through) overlapping blur, often with a starburst-like effect.

For me, before surgery, I would look at lights in the city night sky and see some form of haloing even with my contacts and glasses. I researched what it could look like and compared with what I was already getting. Hopefully the reader can make the same decision process.

I knew going into my surgery that my absolute widest pupil diameter was about 8-8.5mm. I measured my own in a *completely* dark room using a camera with a flash that would bounce off the ceiling and capture the pupils at the instant before they reacted to the flash. My laser doc measured my pupils in a semi-dark room and got about 6.5mm.

My highly scientific pupillary measurement process.

I knew that the system’s true correction zone (ignore any taper zone, that’s worthless, as I’ve written about in my Pre-Op Preparation article) was about 6-6.5mm, so I knew that I was going to be susceptible to haloing under very dark conditions. And I am, and will be forever. Unless I get my eyes done again in later years after my vision naturally deteriorates (and assuming these future machines have wider treatment zones).

In my case, I have say 6-6.5mm of great corrected vision, but a donut-shape of another 2mm of uncorrected vision. So in very dark conditions (and only in very dark conditions) I will get 70-80% of the light entering my eye and hitting my retina being corrected perfectly, but overlapping that, 20-30% of the light will be blurry, virtually the same blurriness as it was before my surgery.

This results in excellent vision of objects, with a faint after-image. But only when haloing will occur.

When Does Haloing Occur?

In practice, I only notice it when there is a rather bright object in a very dark setting. When the setting is very dark (driving at night in the country), but the object is not bright enough (pretty much everything except headlights and retroreflector cat-eyes on signs/road/etc), the halo is too faint to see, it’s below my visual acuity. And when the setting is bright enough (driving in the city), the ambient light from orange streetlights is more than enough to contract my pupil to 6-6.5mm (still quite wide), and all the light hitting my retina is corrected, so there are no halos.

I really only notice it in the countryside. Very bright stars have halos, but fainter ones do not (their halos are too faint to detect). Cat-eyes on the side of the road and reflective signs in the distance (small size) have halos, but large size signs or the moon do not (maybe because their size and brightness contracts my pupils?).

And I can make all the halos go away if I turn on the map-light in my car. It’s a fairly dim light, shining only on the dark console between the seats, but that’s just enough ambient light to contract my pupils. I can actually play with it. A distant road sign will have a halo, and when I increase/decrease the brightness in the car just enough, I can watch the halo shrink/increase as my pupil contracts/dilates.

Anyway, it’s interesting. But not really disturbing. I’d prefer not to have it, but I haven’t actually changed my behaviour any way. I don’t drive with any lights on in the car cabin (even though the light is still quite faint, just enough to have my pupils go from Extremely Wide to Very Wide). It simply never bothers me enough to bother about it. It’s kind of interesting though.

How Likely are Halos

From what I understand, the best laser systems as of this writing (2017) offer a true treatment zone with correction (ignoring taper zones) of about 6-6.5mm. And since typical human pupils can expand to around 8mm in very dark conditions, some degree of haloing is fairly likely to occur in most people who undergo laser eye surgery. However, that does not mean that all haloing is considered equal, or that each person will experience halos under the same lighting conditions. Slight changes in pupillary response can dramatically increase the frequency of haloing.

Should I Worry about Halos?

Absolutely. If you think about it, how your pupils react to different lighting conditions, and how bad your prescription was before surgery will both have a big effect on your haloing.

If your pupils go Extremely Wide (beyond the treatment zone, ignoring taper, etc) under relatively lighter ambient lighting situations (say driving at night in the city), then you’re going to experience haloing much more frequently. If I saw halos on every bright object (remember only the bright objects have enough light for their 20-30% halo to even register) in the city, then I may not be happy about that. Some folks who undergo laser eye surgery, especially on machines that have smaller true treatment zones (broken record: taper zones mean nothing, ignore them), will experience halos even under fairly bright ambient lighting conditions, like city driving at night.

There’s a big difference there. If you only experience haloing when it’s very dark, you’re going to experience very few cases where there is a bright enough light to halo that triggers one. However, if you experience haloing (if your pupils expand beyond the treatment zone) when it’s not completely dark, like in a city, then there are going to be LOTS of bright lights creating that ambient light, and you’re going to experience a lot of haloing.

Uncorrected vision before surgery will also affect how large the halos are. If, before surgery, the light causing the halo would have been only slightly enlarged from blurring, the faint haloing will only be as large as that after-surgery (under halo lighting conditions). But if your vision was so poor that oncoming headlights would have been blurred out to the size covering half your vision, then that diffusion of the light through your uncorrected cornea will still enter the eye. It will likely be fainter, but could be very large.

Summary

It’s essential to know what your true treatment zone (the fully-corrected, non-tapered treatment zone) will be. And it’s important to know how wide your pupils get in dark and semi-dark conditions.

I knew before my surgery that my eyes would expand wider than my treatment zone under very dark conditions, but that my pupils were not wider than the treatment zone under moderately dark conditions. I was okay with this, understanding when I would see halos and when I would not.

To be honest, as with all aspects of laser eye surgery I discuss on here, I’d prefer if the surgeon gave all the information on the topic that a prospective patient would need to make an informed decision. I understand that many prefer not to know all the nitty-gritty details, and would prefer to go into the surgery with their eyes closed (ha!). That’s obviously not me. And I’m assuming that’s not you.

That said, I understand why the doctors typically measure your pupil in a ‘mostly dark’ room. That more closely simulates the environments you’d be most annoyed if you had haloing. It’s not often that we are in extremely dark settings that have very bright lights. Driving at night in the dark countryside is one of them. And even then, at least for me, it’s more of a science experiment than an inconvenience.

Of course each prospective patient is going to have to ask their own questions, get their own answers from their doctors, and come to their own decision about haloing. About all aspects of the surgery.

Good luck, and keep me posted on your journey!

Continued Reading

Here are my posts on PRK and laser eye surgery, continue reading or, feel free to join the discussion in the comments below!

Laser Eye Surgery Primer: Lasik vs PRK
Lasik vs PRK: What the Lasik Doctor Doesn’t Tell You
My Laser Eye Surgery, Part I: PRK Pre-Op Preparation
My Laser Eye Surgery, Part II: The PRK Operation
My Laser Eye Surgery, Part III: PRK Post-Op Recovery
Halos: A Likely Complication of PRK or Lasik (You are Here)
    

The post Halos: A Likely Complication of PRK or Lasik appeared first on is this your homework?.

In July of 2011, I had PRK laser eye surgery done. Shortly before, I wrote up a Primer on PRK vs Lasik that the reader may find interesting (TL;DR: Lasik is a dodgy quick-fix, avoid it, stick with PRK). Since then I expanded on the differences between PRK and Lasik, which hopefully provides the reader with all the questions they should be asking their laser eye surgeon: Lasik vs PRK: What the Lasik Doctor Doesn’t Tell You.

Before I went into the surgery, I did a great deal of research and found a dizzying array of variables that the prospective patient should take into account before choosing whether to have the surgery and where to have it performed. Resulting from this research I detailed the critically important questions that need to be asked before going under the laser: My Laser Eye Surgery, Part I: PRK Pre-Op Preparation. In a subsequent article, I described the PRK procedure itself: My Laser Eye Surgery, Part II: The PRK Operation.

Here, at long last is my account of my Post-PRK recovery. I’d written some of this in the months following my surgery for a friend who was considering the procedure, but for unknown reasons never posted it here. Well, here it is, some six-plus years later. And yes, I’m still extremely happy with my PRK experience. I would do it again in a heartbeat (though I’d look into the new epithelial-flap (not corneal-flap like Lasik!) methods like Lasek (note the e) or Epi-Lasik.

Day 1

No pain, just a little dryness. Feels like you’ve had non-breathable contacts in overnight (which you have). Overall, the eyes were scritchy, but I was happy playing Ray Charles in the blacked-out apartment. I listened to a few audio books, took lots of drops constantly (never did the pain ones as I mentioned), and chewed gum to try to get rid of the awful taste of the antibiotic drops as they drip down the back of your throat (you’ll love that bit!). Got driven by my friend to my 1-day follow up and everything was looking good. It was a very bright trip, but not as bad as immediately post-op. I took another half sleeping pill that night, not so much because I was uncomfortable, but because I didn’t do anything all day and wasn’t really tired. I wanted to make sure I got a ton of sleep though, as that helps the healing process.

Day 2

No pain but slightly more discomfort, you’re now at 48h wearing the same non-breathable bandage contact lens. I didn’t take any drugs (not even ibuprofen). Boredom was the worst part, but I entertained myself with frequent trips to the bathroom to pee from all the water I was drinking, by eating, with more audiobooks, and by listening to a couple DVDs with my eyes closed. I used my computer a tiny bit, but it was really bright, I couldn’t see very well (huge magnification required), and the strain wasn’t super good for me. That night I took another half of a sleeping pill for the same reasons.

Day 3

This is the only day that was bad. My eyes were very dry, I’d now been wearing the same non-breathable contacts for 72h and my eyes were really dry and really scratchy, even with the constant lubrication of the eye drops. This is where the nickel really dropped on the preservatives in the eye drops, as my eyes were really dry and scratchy and they were no longer providing much relief at all, almost making it worse. I took a T3 in the morning and it was a lot better. I went to my 3-day follow-up. I took the skytrain and bus over there. My light sensitivity was not crazy bad, but I did have two pair of sunglasses on and a hat. My progress was going well, they lowered the frequency of the steroid drops on one eye, and kept the other at the same level. Best thing was that they replaced the bandage contact lenses with a new pair. Hallelujah! That felt a hundred times better. With the new pair, the pain and discomfort didn’t make its way past the T3s. I kept on the T3s every 4h or so, when the pain would come back (ever had super dry eyes? It’s like that), and then my wife came home with the new preservative free drops. That made a huge difference, and I was finally over the worst of it that evening. I took another half of a sleeping pill that night, just to make sure I got a good night’s sleep through the discomfort, but I did sleep well.

Preservative-free drops are absolutely essential.

Day 4

This day was easy. You’re back to boredom though. Your eyes are a bit dried out and scratchy (mostly due to the new bandage contact), but the new drops do the trick. I may or may not have taken a T3 that morning, but I don’t think I did. I started to get pretty stir-crazy this day, but I kept entertained by going from couch to bathroom all day for water, urination, and drops. I snuck a few minutes on my computer to see how the world was doing and post something pithy and only mildly self-pitying on my social media, but I still couldn’t really bear it much. To deal with the boredom, my wife and I went for a walk that night when it got dark, and it was glorious to get out of the house. I did without the sleeping pill.

Day 5

By now, your eyes are back to drier than a nun’s… well, they’re dry, and scratchy. I couldn’t really detect any traces of the ‘healing pain’ and ‘rawness’ I’d felt over the past few days, so I was pretty sure all the discomfort was from the 48h of wearing the bloody contact lens. I went to my 5-day post op appointment (again by myself on Skytrain and bus), and man did it feel great to get out of the house again. The first part of the checkup was the removal of the accursed bandage lenses, and immediately, I felt like a million bucks. All the pain and discomfort vanished. The checkup went well and the doc stopped the drops in one eye, and told me to do once a day on the other eye for two more days. The photosensitivity was pretty much under control by that point, and I took the tinfoil down either that afternoon or the next morning.

Week 2

No pain, no discomfort. I used the no-preservative eye drops when I’d feel a bit of dryness, but this was pretty infrequent. I kept a little 1ml blister drop back in my pocket at all times, but only really used them when I was staring unblinking at my computer or walking around outside. By the end of week two, I was still carrying them, but rarely used them.

During all this time though, actually right from Day 0, my eyesight wasn’t very good. It was much better than I was without my contacts, but it was still not good enough to pick out really any details on anything, no matter how close or how far. The vision wasn’t near-sighted, it was as if you were trying to look through a slightly blurred lens. It’s hard to describe, but it’s as if your focus capability is great, but your resolving detail wasn’t there. I could see things equally poorly at 1m and at 10km.

Over this first two weeks, as I’d anticipated through my reading, the vision ‘cured’ up gradually. After about a week and a half, the detail was coming along pretty well, but by then I was experiencing slight double-vision, “ghosts” as they’re called. This is where, due to the swelling and healing of the epithelium, there is a slight, faded double image that is slightly offset from the main image. What made it challenging was that the ghost would be offset in different directions for each eye. So, there’d be a faint double image at 2 o’clock on one eye, and another faint double-image at, say 6′oclock on the other eye. The result: treble-vision.

Again, this was expected, but it made the detail in the world all but impossible to see. I could walk around fine, see shapes, signs, etc, way better than I could before surgery without glasses, but it was hard to make out details. As a result, I was walking around in a bubble of awareness that was just large enough to keep me from bumping into people and tripping over things. My world felt small, so the cabin-fever effect was still there from the 5 days of being a shut-in. I actually played a game of ultimate on Day 7 post op. (cleared with the doc and wearing safety sunglasses of course). I couldn’t really see the disc and was pretty ineffective, so I stayed on the sideline mostly. Still, I got out of the house.

Generally the vision and ghosting would be pretty good in the morning, and as the eyes would dry out more through the course of the day, it would get worse. From day to day, it would improve, usually better in the morning than it had been the day before, but some days it would slide backwards. Each eye was on its own schedule. I expected this, complete with setbacks, but there was some frustration involved as you’d wake up and think you’re done with the visual artifacts, only for them to come back by the end of the day.

Throughout this week, I was on the computer a fair bit, but it was a bit of a pain, it still required giant font sizes, but less and less so over the course of the first 2 weeks. I probably could have, but I didn’t feel comfortable driving by the end of Week 2.

Week 3

I played another game of ultimate at the start of Week 3 on Day 14. By now I could see quite well, but still had the ghosting fairly noticeable. I had optimistically hoped I’d be back to normal 2.5 weeks after the surgery, for a big ultimate tournament, but I still had the ghosting fairly strong. I could mitigate this somewhat with the eye-drops, but not entirely and only for a little bit. I took a couple discs off the face that weekend, but I had fun. I had optimistically hoped that I’d be back on my ice-skates playing goal by then, but that would not have worked.

Right around the three week mark, as if a switch was thrown, my ghosting disappeared. My vision felt super-human. Whether it was three weeks of not being able to see or whether it was actually better than with my contacts previously, I felt like I could see details that I could never see before. I had set up a few benchmarks before the surgery, little eye tests I could give my self, and it looked like I was indeed better than my pre-op correction ever was. I could see detail on the trees at the top of the North Shore mountains from Downtown, license plates and road signs at greater distances, and the registration marks on the cargo containers at the rail yard across the street.

By now, my computer screen was back to normal size, and I had been driving since the 2.5 week mark. At the end of Week 3, I was forgetting at times that I’d had the surgery done. I wasn’t using any drops any longer, as for the past week or so, they were just to keep the ghosting under control.

Aside: A cure for eye dryness?

Also of note was that my eyes, even when I wouldn’t wear my contacts for a week or so, would always be relatively dry and red. I’d often wake up with little crystalline ‘eye crusties’ and have to rub them away when waking up. Surprisingly, since the surgery, this has disappeared altogether. After the first week, once I stopped wearing my sunglasses all the time, my wife was really surprised at how much whiter my eyes were. The redness that was always there previously was gone. I wondered if this was due to all the drops I was taking as part of the regimen, but it’s held out all this time. The dryness of my eyes is improved across the board. I woke up maybe twice with dry eyes in the first few weeks, but that was a more acute, painful dryness (soothed by the lubricating drops) than the general dry-tiredness that I’d usually wake up to. Other than those two occasions, I haven’t really noticed my eyes being dry at all in the 6+ years since the surgery. Only if I’m being very bad to them, staying up late staring at a computer screen, but even then, much less severe than pre-surgery. I had heard that this isn’t altogether uncommon in PRK surgeries, for it to help cure dry eyes, but I simply hadn’t really thought of myself as somebody who even had dry eyes before surgery. There you go.

Of course, Lasik can have serious complications with Dry Eye (to be fair there are very rare cases with PRK too). This isn’t your typical eye dryness that I experienced before surgery when I’d wear non-breahtable contacts overnight. I experienced this painful dry-eye in the days following the surgery. It’s extremely painful. It’s a lot more frequent with Lasik (PRK too in some extremely rare cases), because Lasik cuts that flap into the cornea, and when doing so, there’s a chance of cutting a nerve that helps keep your eyes hydrated. One so-called ‘solution’ to this with Lasik is surgically implanting plugs into your tear drainage ducts. This helps keep your eyes flooded more. I don’t know about you, but to me that doesn’t seem like much of a fix!

Weeks 4-5

My vision didn’t have any more artifacts, but kept improving slowly and steadily over this time. When I went in for my 5-week follow-up, I was measured in my left eye at a little better than 20/20, and the right eye was at 20/15 (better than 20/20).

5 Month Checkup

I had noticed my eyes had kept improving over the first few months and when I went in for my 5-month both eyes were at 20/15 (actually the right was a little better). I really felt like I had super-human vision. I still do. Whenever I talk to people about my surgery, we test our vision against each other, and I’ve always been a lot better. It’s pretty nice especially being able to make out street signs a half-block earlier.

Summary

I really feel fortunate that everything went just about perfectly for me. Other people take a lot longer to heal up and for their vision to settle. It’s often related to how much they have to correct, but not completely.

I have a friend who had to go back for a touch-up at the 1 year mark (it wasn’t the full procedure, didn’t require the 5 days of healing). During the year she had adequate vision, but not great, she wore light prescription glasses for that period. The worst part for her was the perpetual frustration of not knowing whether or not it was going to get there, when, and if it would take a touch up. She was at about -9 in both eyes before the surgery, and even without the perfect vision she was very glad to have had the correction (-.75 to -1 is a lot better than -9). As of a few months past her touch-up procedure, she said she was just about perfect, quite happy. She did spend an awful lot of time going back and forth for after-care checkups and of course the follow-up procedure, all of which was of course with the docs who did her surgery (and that different touch-up procedure). All for no additional cost of course.

So, part of your potential outcome is down to your prescription, but I also tried my very hardest to make sure that I picked the right surgery, by the right doctor, with the right equipment, with the right follow-up, and sticking to the pre- and post-op regime that gave me the best opportunity to heal. I tried to do everything I could to maximize my healing process. I ate well, and drank lots. I took vitamins. I slept as much as I could. I avoided the use of an eye-shield for the light, as I always got sweaty and that just seemed like an invitation for bacteria. I also avoided the use of the pain-drops in the eye, as I was told that can affect the healing process. Of course, I was told that feeling pain stresses the body which affects the healing process quite a bit as well. For me, the T3s were enough to handle the worst of the pain, and I avoided use of the pain-drops all together. Overall, I tried to maximize my self care.

I am certain that luck played a factor in my results, but I’m also certain that some amount of my over-preparation contributed to the great results.

Anyway, this is a magnum-opus, but hopefully it gives you an idea of what you’re in for. Let me know if you have specific questions, and I’ll get you a (shorter!) reply.

Good luck, and keep me posted on your journey!

PS: No guarantees on a shorter reply.

Continued Reading

Here are my posts on PRK and laser eye surgery, continue reading or, feel free to join the discussion in the comments below!

Laser Eye Surgery Primer: Lasik vs PRK
Lasik vs PRK: What the Lasik Doctor Doesn’t Tell You
My Laser Eye Surgery, Part I: PRK Pre-Op Preparation
My Laser Eye Surgery, Part II: The PRK Operation
My Laser Eye Surgery, Part III: PRK Post-Op Recovery (You are Here)
Halos: A Likely Complication of PRK or Lasik    

The post My Laser Eye Surgery, Part III: PRK Post-Op Recovery appeared first on is this your homework?.

Laser eye surgery is a very popular procedure for correcting near- and far-sightedness as well as astigmatism. Since the first techniques were developed in the early 1980s, many millions of people have gone under the laser hoping to eliminate the need for contacts and glasses. I myself underwent PRK in July, 2011. As is my nature, before I leapt, I looked very closely at the available information on laser eye surgery. What I found was surprising, even disturbing.

It wasn’t until I spent a great many hours investigating the procedure in detail, that I realized how stunningly little information is available to those who are performing their own casual investigation into laser eye surgery. I am dismayed at the lack of information or the outright misinformation provided by practitioners of the surgeries, no doubt in order to prevent scaring off their potential clientele.

The truth is that there are a huge variety of laser eye surgeries, all masquerading under one or two common names. If you think there is only one type (or ten types) of laser eye surgery commonly performed, you are seriously under-informed about the entire procedure. For example, two people, each having had the Lasik variety of surgery performed, could have had completely different surgeries, using completely different procedures, and with completely different risks, side-effects, and expected outcomes.

I hope the following article will provide prospective patients a strong base-level of necessary understanding of the currently available methods of laser eye surgery. Rather than trusting what I provide here as gospel, I prefer that the reader take this article as a jumping-off point for their own education.

For reasons that will become readily apparent after reading this article, I strongly recommend against the corneal flap-based Lasik procedures. Ultimately though, you must find your own answers. Before undergoing surgery, you should educate yourself on the risks involved, you should know what questions to ask of a potential surgeon, and most importantly, it is absolutely critical to know exactly why you would choose PRK, Lasek, Epi-Lasik, or especially Lasik.

While I will discuss some important areas of risk, especially the risk differences between the various procedures, this won’t be an exhaustive risk analysis of laser eye surgery. Each prospective patient should find their own answers to these questions through self-guided research and through conversations with their (hopefully independent) ophthalmologist and their potential eye surgeons. It is my hope however that, after reading this article, those looking into the surgery will have a better idea of just what questions they will need to find answers to.

A Brief Look at Eye Anatomy

Before we begin with the details of laser eye surgery, we need to establish the relevant structure of the eye, specifically the cornea, the transparent part of the eye which covers the iris, pupil, and interior parts of the eye.

The cornea is comprised primarily of the Stroma, with a layer of transparent skin, the Epithelium, covering it. The average corneal thickness in a Caucasian is about 540 µm (about 0.5 mm); it is less in Blacks (520 µm) and even less in Asians (490-510 µm). These are average values, and each individual’s corneal thickness can vary by a significant amount. As I’ll discuss further down, these variances can have very large effects on the risks of the various laser procedures.

In addition to performing about two-thirds of the focusing power of the eye (with the adaptive lens performing the remainder), a very important role of the cornea is to provide structural integrity of the eye. When intraocular pressure is too great, or the cornea is otherwise unable to resist against the pressures within the eye, serious conditions such as ectasia or keratoconus (bulging of the cornea, requiring transplant) can result.

Because all methods of laser eye surgery involve some level of cutting or reshaping of the cornea, the cornea’s structural integrity is always compromised; how much depends greatly on which type of laser surgery is chosen. The difference of just how much cornea is cut between the different methods may surprise you, and should be the paramount consideration when choosing a laser eye surgery method.

The Many Flavours of Laser Eye Surgery

The first step in understanding laser eye surgery is to examine the various procedures that fall under the broad umbrella of the term. The variations between different surgeries can be grouped as follows:

1. Where the correction is made and how the site is accessed.
   • Mid-Cornea – Cornea Flap: Lasik
   • Cornea-Surface
     • No Flap: PRK
     • Skin-Only Flap: Lasek and Epi-Lasik
2. How the correction ‘prescription’ or ‘map’ is developed.
   • General Prescription Map
   • Semi-Custom Preset Map
   • Fully Custom Map
3. How the eye is tracked and the laser is aimed.
   • Outside vs Inside Iris Tracking
     • 3D vs 2D Tracking
   • Tracking Speed
4. How the correction is applied to the eye and the size of treatment zone.
   • Correction Zone Only vs Correction Zone with Tapered Edge
     • Correction/Tapered Zone Larger/Smaller than Dilated Pupil

As you can see, each of the major category groups contains a number of choices (and sub-choices) which can drastically affect the surgery performed. This makes for a dizzying variety of possible procedures falling under the Laser Eye Surgery umbrella. While some discussions on laser eye surgery focus on comparing Lasik, Lasek, PRK, etc, even this level of detail covers only a subset of the important differentiators, and decision points, that make up just the first grouping above. In order to truly understand the procedure, prospective patients need to look at each of these areas in detail.

In this article, I will focus on just the first major question: where the correction is made. This is the major differentiator between Lasik, PRK, Lasek, etc. For more information about the subsequent (important!) questions, see my article: My Laser Eye Surgery, Part I: PRK Pre-Op Preparation.

Critical Decision: Correction Site and Access: Lasik vs PRK

The most critical decision in choosing a laser eye surgery procedure is selecting where the correction is made and how that correction site is accessed. The four primary types of laser eye surgery, PRK, Lasik, Lasek, and Epi-Lasik fall within two main categories of where the correction is made: mid-cornea corrections (Lasik) and cornea-surface corrections (PRK, Lasek, and Epi-Lasik). Each procedure (and their sub-types) are refinements on how that correction site is accessed.

While each of the differences between the various procedures warrants careful consideration, this factor alone, where the correction is made, has by far the greatest impact on overall short-term and long-term risk of the surgery.

Mid-Cornea Correction: Lasik

The Lasik family of eye surgeries, including the various ‘all laser lasik’ procedures (but not epi-lasik, see below) all involve cutting a flap into the cornea (some with a blade, others with a laser), folding that flap back, performing the correction mid-cornea by burning or more accurately vaporizing a lens shape in your cornea, and then finally re-seating the corneal flap. These mid-cornea procedures are relatively new compared to the much older cornea-surface procedures.

As illustrated above, the flap-based correction method involves cutting a significant way through the structure of the cornea, before any corrective shaping is performed. As a result of this, Lasik mid-cornea procedures are always more invasive, significantly compromising the biomechanical integrity of the eye.

This graphic illustrates an average 150µm cornea-flap cut (see the section below on the variability of Lasik cornea flaps), with 1-10 diopter mid-cornea corrections. Note that, since the creation of this graphic, among some practitioners, the 250µm ‘safe’ residual thickness is being revised to 300-350µm.

Cornea-Surface Correction: PRK, Lasek, & Epi-Lasik

The cornea surface procedures, PRK, Lasek, and Epi-Lasik, all involve removing only the epithelium, the skin layer which covers the cornea, and then performing the correction by reshaping the surface of the cornea. With PRK (pictured below), the skin layer is loosened by an alcohol bath, removed completely via a blade, and then allowed to grow back over the cornea after surgery. With Lasek and Epi-Lasik, the skin layer is loosened by an alcohol bath (all Lasek and some Epi-Lasik), a skin-only flap is created via a blade, and then re-seated overtop the cornea after surgery.

As illustrated above, the cornea-surface correction method involves lifting off the epithelium, the skin layer, then correcting the surface of the cornea. As a result, the cornea-surface procedures are the least invasive, retaining the highest degree of biomechanical integrity of the eye.

Each of the surface-ablation methods are quite similar, with the only differences being how the skin is removed and whether or not it is reseated after surgery. Check out the Pros and Cons section below for a more detailed breakdown of each.

This graphic illustrates 1-10 diopter cornea-surface corrections. Note that, since the creation of this graphic, among some practitioners, the 250µm ‘safe’ residual thickness is being revised to 300-350µm.

Serious Concerns with Lasik

If you haven’t already realized the serious concerns with Lasik, concerns arising over the significant difference between Lasik vs PRK (and the other cornea-surface procedures), I urge you to think intuitively about the procedures.

Use your instincts when assessing the wisdom of severing a significant portion of the cornea. Ask yourself what purpose the cornea serves (See: ‘A Brief Look at Eye Anatomy’ above) and what potential consequences can arise from compromising it so significantly. Bear those thoughts in mind as you read the following areas of concern with the Lasik procedure.

1. The Lasik Cornea Flap Never Heals

First, and most importantly, the ugly truth about Lasik is that the cornea flap never actually heals. The cut is permanent. The cornea is forever compromised. You may hear Lasik surgeons repeating a familiar talking-point that: “Within two years, the lasik flap will be strong enough that any force significant enough to dislodge it, would injure an untreated eye.” This is a lie. It’s a lie told over and over again by countless lasik doctors. They sleep at night by telling themselves that the wound does ‘heal’ in that the skin heals and it creates a bond, however the cornea itself never actually heals, never rebinds together, the flap is permanent.

The cornea flap never heals, only the skin layer overtop of it. There are numerous reports of quite mild trauma, even actions as light as finger rubbing, that have dislodged the flap even up to 14 years after surgery.

As you’ll see in the following section, the potential consequences of that permanently thinned cornea are incredibly serious.

2. Higher Risk of Permanent Vision Loss Due to Ectasia with Lasik

Ectasia is a stretching and bulging of the cornea, resulting in rapid vision loss, often requiring corneal transplant to treat. The causes of ectasia are manifold, but a significant rise in post-Lasik ectasia has been seen.

The Lasik community has taken the issue very, very seriously. The most frequent topic being discussed by Lasik surgeons in journals and at conferences is the development of methods of pre-screening patients to reduce the rate of post-lasik ectasia.

The true rate of post-Lasik ectasia may never be known, but estimates have peaked at the 0.6-0.9% rate and with newer screening techniques in place, the current rate is estimated to be about 1 in 2,500.

With millions of lasik surgeries being performed, even a 1 in 2,500 chance of debilitating vision loss is far too high for my taste. And that’s only if Lasik doctors turn away as many patients as possible. The risk factors leading to ectasia are still being studied, but the residual thickness of the cornea, coupled with the amount of correction are universally cited as the prime factors. The rates of ectasia are significantly reduced after PRK and other cornea-surface procedures, where less of the cornea is compromised.

Again, the fundamental problem with Lasik rears its head, the cornea is critically important for maintaining the structural integrity of the eye, yet as the two graphics above illustrate, significantly more cornea is compromised by Lasik than by the cornea-surface procedures such as PRK. Yesterday’s wisdom was that 250µm was a ‘safe’ residual thickness, but today’s best practices suggest 300-350µm. What will tomorrow’s ‘safe’ be? Obviously the Lasik industry is coming around to what should be intuitive to everybody, that the more of the cornea that is compromised (both by the flap cut and by the correction itself), the less it is capable to maintain the proper shape of the eye.

Prospective patients of any medical procedure understand that there are risks. They understand that there is a trade-off between the potential upside of the outcome versus the potential pitfalls of side-effects. However, many prospective Lasik patients aren’t ever aware that there are alternatives that provide those same upsides, without the serious pitfalls. Lasik doctors will tell you that incident rates of ectasia are low, but they don’t tell you that they are many, many times higher with Lasik than with PRK.

I strongly recommend that anybody considering Lasik, do some serious digging into the phenomenon of post-lasik ectasia. It’s an incredibly serious condition that simple common sense (as well as serious scientific study) reveals is more likely to occur with mid-cornea Lasik procedures, than with cornea-surface PRK procedures.

3. The High Variability of Lasik Flap Thickness

With Lasik, before the correction is even applied, a significant amount of the cornea is sliced into. This is done either via a kind scalpel called a “microkeratome”, or via a specialized laser used only to make the flap, an “IntraLase” laser. However, the thickness of this flap is never consistent from patient to patient, indeed it can vary greatly depending upon both the skill of the surgeon and upon which Lasik variant, microkeratome or IntraLase is chosen (with the latter being somewhat more precise).

Even with the best surgeon using the latest flap-cutting technique, there is still quite a bit of chance involved in just how much of the patient’s cornea is going to be cut into to make the flap. For a somewhat frightening exhibit of this, refer to the abstract from the paper below, which describes differences in the ‘reproducibility’ of Lasik flap thickness between mechanical blade and IntraLase laser flap-cutting methods.

What frightens me about that report is that, while IntraLase flaps are off by more than I’m comfortable with, the flaps cut by surgeons using mechanical blades were sometimes off by huge amounts from what was being aimed for; both types of blade had a range of actual cut thicknesses wider than 115µm. Even if you are a ‘good candidate for lasik’, the high variability of the flap thickness could leave you with a much too thin cornea. When aiming to cut only 130μm into the cornea, sometimes cutting over 70µm too deep is an absolutely staggering error. Indeed using one type of mechanical blade, the incidence rate of “thick flaps”, flaps greater than 170μm, which means cutting significantly deeper into the cornea than intended, was over 10%. Scary stuff.

Indeed, due to the unpredictable flap thickness, the Lasik journals recommend surgeons measure the thickness of the patient’s cornea flap mid-surgery (a procedure called pachymetry), aborting the procedure if the flap thickness will result in a too-thin cornea. Makes sense right?

Well most Lasik surgeons don’t do this.

That to me is frightening. There is a huge random variation in flap-thickness, but most doctors don’t even measure the flap. This means most Lasik surgeons have no idea how much corneal thickness their patients have left after surgery.

4. Retreatment is Far More Complicated After Lasik

Because a significant part of the cornea is compromised when cutting the lasik flap, there is obviously significantly less cornea thickness after Lasik. Additionally, because of the high variability of that flap thickness, it is difficult to determine in advance how much flap thickness will remain. This means that, not only is the structural integrity of the eye lessened, and unpredictably so, but the options for retreatment are also severely limited. There is only so much cornea that can be safely burned away, and since Lasik already starts much deeper into the cornea than the cornea-surface options, immediate retreatment to correct errors in the procedure or future retreatment to re-correct changing vision are far more risky, sometimes not even possible.

Even a single Lasik treatment is simply not an option for people with thinner than average corneas or significant vision prescriptions. For these people, the much less risky cornea-surface treatments (PRK, Lasek, epi-Lasik, etc) are still a safe and recommended option. For those with thin, but supposedly ‘safe enough’ corneal thicknesses, they’re rolling the dice as to whether their post treatment eye will still be ‘safe enough’ for retreatment or whether they might be stuck with uncorrectable vision forever.

Not only that, but there can be serious issues with epithelial ingrowth under the flap when a retreatment is attempted. Epithelial ingrowth after Lasik is not exactly unheard of without retreatment, but it is significantly more likely when performing a Lasik retreatment.

Of course, nobody wants a retreatment to correct the first procedure, but it can be necessary. “The re- treatment rate after primary LASIK varies in different studies and is approximately 6% to 20%.” And, because you’re working with a much more compromised cornea after Lasik, the options for retreatment are significantly more complicated.

5. Severe Eye Dryness is Far More Common with Lasik

Many people who have never had laser surgery have dry eyes. It is annoying, sometimes painful. Few of them have found eye dryness severe enough to undergo a surgical procedure to implant plugs to help hydrate their eyes. This is the “dry eye” that is meant in laser eye surgery journals. It is not trivial.

Immediately after my surgery, I got a feel for this sort of severe dry eye. It lasted a few days while my epithelial layer re-grew after PRK. It was not something I would have wanted to live with for the rest of my life. Unfortunately, many Lasik patients have to endure this, or have additional surgical procedures to help mitigate it.

Lasik cuts much deeper into the cornea. It severs a lot more nerves than PRK/Lasek/Epi-Lasik. And of course, the deeper you cut (which is unpredictable due to randomness of corneal flap cuts), the greater chance you have of cutting so many nerves that your eyes no longer produce enough tears. A staggering 1.3% of Lasik patients had to have plugs surgically embedded in their eyes to help offset severe and painful eye dryness.

No PRK patients had to have this done. PRK leaves a more intact, more healthy cornea.

If Lasik is so dangerous, why is it so popular?

This is a question worth asking. If Lasik has higher rates of very serious short- and long-term side-effects, why is it so popular.

Lasik is an easier sell. Lasik patients feel ‘good as new’ just a day or two after surgery. With little discomfort in recovery, Lasik patients tell other prospective patients how easy it was. How great they see the next day. These patients have no idea how much riskier their procedure is over PRK/Lasek/Epi-Lasik, they just know they’re fine now. Lasik is the very definition of a ‘quick-fix’, often it appears easier, but serious problems can occur in the long run.

With PRK, the skin layer of the cornea is removed. Like removing any top-layer of skin, that area is going to be raw until it regrows. PRK has a five-day recovery while your cornea regrows a fresh, seam-free layer of skin under a protective bandage contact lens. These five days are uncomfortable, and painful without medication. Additionally, the skin that grows back is a little swollen for a week or two, this causes slight vision artifacts (ghosting, faint double-images) until the new skin over the cornea completely heals. I describe the preparation and healing process in detail in my series documenting my experience My Laser Eye Surgery, Part I: PRK Pre-Op Preparation.

With the newer Lasek and Epi-Lasik procedures the recovery time and experience matches that of Lasik. In these procedures the epithelial skin layer is not completely removed. Instead the skin layer is folded back in a flap (similar to Lasik, but it’s a skin-only flap, not a corneal flap), and then after the correction is made to the cornea, the skin flap is laid back. This is less traumatic to the cornea’s skin, but has its own minor complications with that flap. These complications are significantly less serious than corneal-flap complications. Often, the worst that happens is the Lasek skin-flap simply has to be removed, effectively turning the procedure into a PRK procedure.

I chose to stick with PRK over Lasek/Epi-Lasik (but never Lasik!) mostly because it was the oldest and most studied procedure and the surgeons were more experienced with it. If I was looking at the procedure today instead of in 2011, I may well have chosen an epithelial-flap procedure like Lasek. I would never contemplate the Lasik corneal-flap procedure.

So, in the past there was a significant difference in recovery between Lasik with its corneal-flap, and the safer PRK, with its epithelial regrowth. Now however, there is little difference in recovery between the corneal-compromising Lasik and the corneal-conserving Lasek/Epi-Lasik.

Of course, doctors are still performing Lasik, when in my opinion there is absolutely zero benefit (even over the short term) to the patient compared the alternatives.

So why is Lasik still performed?

Well, it costs money to upgrade a practice from Lasik. New machines, new training, new techniques. What’s the business incentive for a doctor to do this? There is little. Until Lasik is removed as a medically authorized procedure, doctors can tell themselves that incidents of complication are low (which is true, but many times higher than other, equally effective procedures), and continue earning huge amounts of money offering the Lasik quick-fix.

And Lasik is a powerful ‘brand’. When people think laser eye surgery, they think Lasik. Indeed some PRK and Lasek providers are advertising their clinics as Lasik clinics, capitalizing on the brand recognition, while recommending the safer procedures.

What is a prospective patient to do?

The vast majority of prospective patients will never research laser eye surgery. Will never even be aware of the issues described above. That to me is frightening.

I hope the information I’ve provided helps the people who have found this page. Prospective patients should take this information and go do their own research. They should ask their local Lasik/PRK clinics questions about these complications. They should take those answers and try their best to find out how true they are.

Ultimately prospective patients are going to have to make a decision for themselves. Hopefully I’ve helped to make it a well-informed decision.

Good luck, and keep me posted on your journey!

Continued Reading

Here are my posts on PRK and laser eye surgery, continue reading or, feel free to join the discussion in the comments below!

Laser Eye Surgery Primer: Lasik vs PRK
Lasik vs PRK: What the Lasik Doctor Doesn’t Tell You (You are Here)
My Laser Eye Surgery, Part I: PRK Pre-Op Preparation
My Laser Eye Surgery, Part II: The PRK Operation
My Laser Eye Surgery, Part III: PRK Post-Op Recovery
Halos: A Likely Complication of PRK or Lasik    

The post Lasik vs PRK: What the Lasik Doctor Doesn’t Tell You appeared first on is this your homework?.

In July of 2011, I had PRK laser eye surgery done. Shortly before, I wrote up a Primer on PRK vs Lasik that the reader may find interesting (TL;DR: Lasik is a dodgy quick-fix, avoid it, stick with PRK). Since then I expanded on the differences between PRK and Lasik, which hopefully provides the reader with all the questions they should be asking their laser eye surgeon: Lasik vs PRK: What the Lasik Doctor Doesn’t Tell You.

Before I went into the surgery, I did a great deal of research and found a dizzying array of variables that the prospective patient should take into account before choosing whether to have the surgery and where to have it performed. Resulting from this research I detailed the critically important questions that need to be asked before going under the laser: My Laser Eye Surgery, Part I: PRK Pre-Op Preparation. In this article, I describe the PRK procedure itself and the subsequent recovery period. Edit: Here is the third part, detailing my post-op recovery: My Laser Eye Surgery, Part III: PRK Post-Op Recovery.

Summary First

It has been about three years since my PRK surgery, and I still couldn’t be happier. I reached better than 20/20 vision three weeks after surgery, and have had practically no side-effects with my 20/15 vision since around the four-week mark. I have not tested my vision for quite a while, but I don’t feel as if I’ve had much if any fall-off (your eyes will naturally get worse whether you have surgery or not). I still have better vision than I ever had before, and regularly am able to ‘show-off’ when discussing my PRK by reading things at distances others cannot. Before the surgery, I was about -4 in each eye with an astigmatism of around 1.00. I see much better now than I did with glasses or contacts before and my eyes are actually less dry and less red than they were before surgery. I have had zero regrets about the procedure.

While I have been on the ‘best case you can hope for’ end of the bell-curve of results. *knock wood*, I think perhaps that my efforts to assist in my healing provided at least some benefit to that experience. Along with my account of surgery and recovery, this article will also detail the steps I took to give myself the best possible chance to recover optimally, in the hopes that readers may benefit by it.

Day 0: Operation Scorched Orbs

Pre-Op: Peak Anticipation

The procedure was crazy fast. The time between arrival at the clinic and departure for home was about 45 min, and that’s including filling out the necessary paperwork, waiting 5-10 min for the pre-operative anesthetic drops to take effect, post-operative exam, etc. The actual procedure took about 5 to 10 minutes, maximum.

After I was signed in and waivered, I was brought into an examination room for one last look at my eyes, to ensure that nothing had changed and that I was still Go for Surgery. With the green-light, I was led to a bed in a quiet pre-op prep room and given some anesthetic drops for my eyes. I was then left alone for ten minutes, just outside the operating room, so that I could obsess once more over the risks of the coming procedure the anesthetic drops could take effect.

At length I was ready. A nurse fetched me and brought me into a medium-sized room that was dominated by the sight and sound of a large, droning machine. The machine itself was a desk-sized cabinet with a manhole-sized robotic surgery on an arm overhanging an attached bed. The contraption, made for a single purpose, sprouted a host of digital and optical display instrumentation, control knobs, and ventilation tubes. The sound it emitted was somewhat lower on the tonal register and decibel scale than a vacuum cleaner, but above in volume and pitch the buzzing of a wasp nest. It was a blanketing white noise, loud enough to soothe jangled nerves, and loud enough to isolate the room from sounds coming from without (coming from within too, for that matter). The machine would not have looked out of place on a Star Trek sickbay set. Come to think of it, it would not have looked out of place on the set of a Borg Cube assimilation chamber.

The surgeon introduced himself and laid me on the bed. He proceeded to give a quick overview of the procedure, what I would experience, what it would feel like, and what was needed of me. The surgeon’s description of the process had no surprises for me, I knew the procedure fairly well, even having gone so far as to watch videos of the surgery online, and when he asked if I had any questions, I replied that I hadn’t.

Prior to this, I had been prepped by both technicians and ophthalmologists, they had given me the necessary information on the procedure, it’s risks, and it’s post-operative care, but this was the first time I’d been told the ‘nuts and bolts’ of using a high-powered laser to burn a new shape into my cornea. Based on my prior research, I was likely more informed than the vast majority who had laid on the bed before me. As I’ve mentioned previously, my one criticism of all the laser eye surgery providers is that they are not overly forthcoming with details on risk, complication, and actual procedure. They were all quite helpful when I asked for greater detail, or had specific questions (if they’re not, run the other way!), but none were forthcoming with more than the minimum required. I suppose this is necessary, as most truly don’t want to know more than the very high-level picture of risk and reward. The reader would be forewarned to do their own research before going under the laser, though I suppose that message is preaching to the choir in this account.

After the run-down of the surgery, and after one last chance to ask questions or back out, we began the assimilation surgery.

PRK Surgery: Blink and You’ll Miss It

A nurse inserted Clockwork Orange eye-priers, and dabbed a few drops of lubricant drops. Then, the bed I was on was swung under and into the machine. From above, the large, round robotic surgeon looked mostly benign, but from beneath, the beast’s many-eyed, many-fanged face felt uncomfortably close. That said, as a lover of all things novel, technological, and physiological, the dozen different lights and probes and nozzles of this technological terror were at once intimidating and fascinating. My heart-rate was at its highest at this point of Peak Anticipation.

As the procedure commenced, I was a little surprised when the very first part of the purportedly “no-touch” procedure was the doctor placing a ring-like device on my eye (to be filled with an alcohol solution for effectively ‘delaminating’ my epithelial from the cornea), then using a scalpel to score the epithelial around it. I’d known that some procedures use laser, others scalpel for removal of the skin-layer. This isn’t a critical part of the procedure (unlike the cutting of the Lasik cornea-flap, in which the laser is much safer than the scalpel, but you shouldn’t even consider Lasik and its cornea-flap anyway, so never mind). I wasn’t overly concerned about this, but I did have a brief, wry thought involving “no-touch” and “my ass”.

I wasn’t too nervous once things got started. I’d imagine it’s like bungie-jumping or sky-diving, the nerves peak, then fall away when you step into oblivion. I suppose there’s no evolutionary advantage in nervousness past the point of no return, instead the body goes into a “let’s do this” mode, though the message is probably less verbal and more atavistic.

The surgery was quick, and fascinating. I had an unparalleled view of the operation, best seats in the house. While fully manageable sober (I declined the happy-pill), the procedure was a bit unpleasant for a few different reasons. Readers will have to decide for themselves whether they’d rather have the sedative.

The first unpleasantness was that, despite the knowledge that they had milisecond 3D tracking of the outside of my iris (the best available at the time, see Part I), I was more than a little nervous that I’d screw myself up by losing track of the orange target light that I had to stare at. In practice, this isn’t really an issue, the laser is supposed to detect any movement off-axis and halt the procedure within a millisecond or so. Even armed with that knowledge, I was still apprehensive before starting. And this worry raised itself during the procedure itself, as I kept wondering, “Hey did I just move my eye?” It was difficult to tell with all the activity, water, implements, and flashing lights going on in your eye, and it left room for groundless doubt to creep in. In the end, there were no issues of course.

The second less-than-pleasant aspect of the surgery was the smell. Awful. Ever had your tooth drilled at the dentist? That’s the smell. Worse for me, I have a beard. And because you can’t wash your face for a while (don’t want to risk bacteria getting flushed into your eyes), for three days, every time I disturbed my beard I’d get a fresh waft of Charnel No. 5.

The third, and most unpleasant aspect of the surgery is the fact that there is an awful lot going on to your poor eye. While the eye itself is completely numbed, three parts of the procedure were uncomfortable: the Clockwork Orange eyelid clamp; the epithelial removal ring, which had to press fairly hard onto your eye (stick your knuckle into your eye pretty good for an idea); and the ice-cold water bath immediately after the laser had done its work (instant, terrible ice-cream headache, centred in your eye, thankfully lasting only a few moments).

Once it was all over (I’d say in a blink of an eye, it was so quick, but of course blinking was prevented by surgical clamp), I took a breath, gave a brave thumbs-up to the surgery team, and we started all over again on eye two. The second go-round was easier, as I knew what was coming, but I found myself dreading the ice-water bath more than all the other ocular indignities. It wasn’t that bad, but like licking a nine-volt, your body remembers its first time jangling raw nerves and is naturally hesitant the subsequent times.

Recovery: Into the Heart of Darkness

Immediately post-op, I could see fairly well. But hazy. 100x better than not wearing contacts. I could tell my vision was corrected significantly, but it was like looking through dense fog. Within about 10 minutes, on the way home, the light sensitivity kicked in. Even with eyes shut tightly, sunglasses on, my head down low in the car, and a hat pulled low over, it still felt super bright. And I mean painfully bright. I just wanted to go home and get in the darkness, fast.

Once home, my wife commenced Operation Grow Op, by tinfoiling all the windows. I’d heard some found this necessary, and I figured I’d hold off. I regret the decision, especially in eye-scorching sunny mid-July. My advice is to do this in advance, you won’t regret it. It was bad until it got dark inside. Even the tiniest slit in the corner of the window was crazy bright to me, even while wearing sunglasses. Be prepared to be a mushroom for 5 days.

Overall, aside from the light sensitivity, there was almost no pain. My eyes were definitely sensitive, they were abused pretty good, but the pain drops they give you pre-op lasted a while, and I was thinking I’d take a T3 that night, but didn’t have to. I took half of one of the sleeping pills they gave me and slept well all night. I didn’t use an eye-shield at all, just to help avoid bacteria. I’ve slept with one before and my face was a sweaty steamy mess.

Note: My surgery clinic gave me a little green bag that had all my drops (antibiotic, steroid, pain, lubrication) each well labeled with giant numbers on them listing their dosage intervals. Also in the bag were enough sleeping pills to last a week, and a load of T3s. You’ll be dipping into the bag for drops at least every 4h for the next 5 days, so you will grow to love/hate your Little Green Bag.

This is an important one to ask about too, check to make sure how much of the above your clinic will give you on the day, and how much you’ll have to get yourself. If they don’t provide it, I strongly recommend you getting all of your drops and drugs in advance. You literally will not be making any trips to the store for the next few days.

Extra Important Note: Standard eye drops that come in the medium size (30ml) bottle *all* have preservatives in them. The non-preservative ones don’t come in sizes that are greater than 1ml (to avoid infection). You’ll be using a ton of these drops to keep your eyes lubricated, and I realized way too late that using the standard drops that much just dries your eyes more. On Day 2 I started to notice that my eyes felt drier shortly *after* using the drops than they had been before, and on Day 3 I confirmed it. That’s the preservatives. Late on day three I had my wife pick up some of the non-preservative ones (available at your local drug store) and it helped immensely. Check with your doc first, but if I had to do it over again, I’d only have used them. The best ones I found after researching online were Refresh brand, specifically the “Celluvisic” variety (they’re about $0.50 per three dosages). They’re fairly thick and goopy, but they actually have less in them than the standard drops, and they were miraculously more comforting.

Continued Reading

Here are my posts on PRK and laser eye surgery, continue reading or, feel free to join the discussion in the comments below!

Laser Eye Surgery Primer: Lasik vs PRK
Lasik vs PRK: What the Lasik Doctor Doesn’t Tell You
My Laser Eye Surgery, Part I: PRK Pre-Op Preparation
My Laser Eye Surgery, Part II: The PRK Operation (You are Here)
My Laser Eye Surgery, Part III: PRK Post-Op Recovery
Halos: A Likely Complication of PRK or Lasik
    

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This series of whiteboards isn’t intended to offer much help to the player who’s had much or any coaching. Instead, the aim is to teach some of the fundamentals of the game, helping beer-leaguers and the like who took up hockey at a later age. This is the third instalment, see parts one and two here:

Beer League Pro Tip (Part 1): Winger D-Zone Responsibility
Beer League Pro Tip (Part 2): Beat Every Goalie and Have Airtight Defence

In this instalment, I explain how the Centre is really a Centre-Defenceman in the Defensive Zone. Together the three D-Men function as a unit, the key part of the box-plus-one D-zone strategy. They form a defensive triangle with a strong foundation covering both sides of the net and a spearpoint that attacks the puck.

What do you think? Do these whiteboards help explain the Centre and Defencemen roles in their own zone?

Click for larger versions.

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This series of whiteboards isn’t intended to offer much help to the player who’s had much or any coaching. Instead, the aim is to teach some of the fundamentals of the game, helping beer-leaguers and the like who took up hockey at a later age. This is the second instalment, see parts one and three here:

Beer League Pro Tip (Part 1): Winger D-Zone Responsibility
Beer League Pro Tip (Part 3): Centre and D-Men Defensive Unit

Hopefully this series shows relative beginners where the real danger areas are in the attacking/defending zone.
It should also shine a bit of light onto the two types of saves the Goaltender has to make: Reaction and Blocking. Knowing the difference between a Reaction Save and Blocking save (and when you’ll see each) is very valuable on both Offence and Defence.

On Offence, if you can force the goalie to make more Blocking Saves, you’re going to score more. On defence, if you know where the dangerous areas are, you’re better equipped to prioritize your defence and get scored on less.

What do you think? Do these whiteboards make it a little more clear where the most dangerous area on the ice is?

Click for larger versions.

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This series of whiteboards isn’t intended to offer much help to the player who’s had much or any coaching. Instead, the aim is to teach some of the fundamentals of the game, helping beer-leaguers and the like who took up hockey at a later age. This is the first instalment, see parts two and three here:

Beer League Pro Tip (Part 2): Beat Every Goalie and Have Airtight Defence
Beer League Pro Tip (Part 3): Centre and D-Men Defensive Unit

A lot of time the guy who’s never played any organized hockey is thrown on the Wing and has to just figure it out for himself.

As Justin Bourne put it in a Backhand Shelf article:

That said, teams with Wingers that don’t know where to be in the D-Zone spend most of their games in their zone, and get very little chance to generate any offense.

What do you think? Do these whiteboards make it a little more clear what the Winger role is in the defensive zone?

Click for larger versions.

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“I know.” Two words, famously ad-libbed by Harrison Ford after many repeated takes of the scripted “I love you too” line. Two words that evoke love far more powerfully than any hallmarkian sentiment in this or any other galaxy. In all of cinema, in all its rich and romantic history, “I know” is certainly the most romantic ad-lib. And in my estimation, “I know” is high among the most romantic lines, full stop.

It is in one of the darkest moments of The Empire Strikes Back, in all of the Star Wars franchise really, when Han Solo replies with those two little words to Leia’s tearful and frighted admission of “I love you.” And in that moment we witness a breaking of character. Not merely the breaking of the fourth wall by Ford with his ad-lib, but the abandonment of a mask behind which Solo had been hiding for so long.

At first blush, it might sound in-character for Solo. Another in a long line of the snappy repartee that had characterized his and Leia’s relationship. But it was more than that. His was a naked and vulnerable return of her statement of love.

Up to that point their relationship had been adversarial, full of romantic friction. Solo had been pressing his suit with Leia, but in a ‘scruffy’ sort of way, the way a scoundrel would. From Leia’s perspective, Solo’s pursuit had seemed not motivated by love, but perhaps by a mere desire for conquest.

Leia had been rebuffing his passes, uninterested in a shallow relationship. But all the while she obviously has feelings for Solo (see the scene on the Falcon in the worm/cave when they kiss for the first time).

I'm "nice men".

But when the shit hits the fan big-time in Cloud City, when there’s no more time for messing around with unimportant matters, Leia abandons all pretexts. It’s likely to be her last time ever seeing Han, and she’s filled with sadness and regret. She needs to tell him that she does truly love him.

Solo, whose cad-like behaviour was as much a pretext to cover his own true love as Leia’s protests had been, who had been enjoying the ‘game’ of fencing back and forth with Leia, and who is about to be lowered to his almost certain death (whether from the carbonite or from what awaits him on the other side of the hibernation), looks back at Leia after her expression of love, and says, “I know.”

Two little words. And in that moment, he’s not just acknowledging that Leia loves him, but that he has known for some time. He’s acknowledging that he has been in love with her too, and that the game they’ve been playing isn’t necessary any longer.

Solo isn’t being cool as he’s about to meet his fate. Instead he is abandoning those childishly status-consious defense mechanisms, the ‘protections’ that he has always wrapped himself with. Those same ‘protections’ that have prevented him from ever truly connecting with another person on a deep level. In his most desperate hour, Solo at once makes himself completely vulnerable by surrendering himself to love, and also draws upon the immeasurable strength of love in order to face his fate.

Such is the magic of love, it can provide strength beyond imagining, but only to those who open themselves wholly to the vulnerability of unrequited love and to the unbearable pain of true love lost.    

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A whisper of breeze ruffled the airfield’s August-browned grass. The sky overhead was warm and inviting. With unlimited visibility, the bright blue canopy appeared as if it had pulled back from the earth to provide extra airspace beneath. One lone cotton-cloud lazed over the horizon. Two eagles circled effortlessly high overhead. It was a perfect day for flying.

Pilot Rod Rees strode across the lawn. A young man in the Summer of 1963, my Uncle Rod was little older than I was when I first heard the story of his maiden flight. My mother Arlene, only a girl then, saw no trace of fear as her older brother approached the field. His eyes were set, his face was determined, and his aircraft was slung confidently under his arm.

After weeks waiting for the kit to arrive, after a summer holiday spent indoors on painstaking assembly, after his fingers had become calloused from fine tooling and his lungs ravaged by glue fumes, the day had finally come for his dream to take flight.

Aircraft fuelled and pre-flight checklists completed, Rees glanced yet again at the listless pine-bough windsocks overlooking the R-Bar-Eagle farm’s upper horse paddock —newly rechristened the Galiano Island Airfield. He bent low over his aircraft and, with a high whine and a puff of blue smoke, the engine coughed to life. Rees cycled the controls and adjusted the radio’s trim knob one last time. He looked up, taking two half-steps backward.

The plane burst forward.

With shocking acceleration, the little craft jounced over the turf. Far sooner than expected, as if it had been all those weeks itching to break the reins of gravity, the plane bolted into the sky.

Uncle Rod’s labours paid off in that one moment. His creation at last tasted its first breath of sweet summer air. Its wings, nearly as wide as an eagle’s, waggled in excitement before flexing.

As if in triumph, the plane thrust one wingtip skyward. In an almost playful motion, it continued its roll, flipped onto its back, and drove straight into the ground.

It all happened in the space between breaths. The quick takeoff, the brief flight, the sudden return to earth. There was a shocked stillness, the only sound a muffled whine coming from beneath the belly-up aircraft. Rod stood stunned. As if waking with a start, he killed the struggling engine and dashed over to search for survivors.

For a long time Rod examined and prodded at the shattered propeller and crooked wings. My mother watched her brother’s efforts from beneath the shade of the old pine at the end of the drive. She knew from hard-earned experience that the fiery look in his eyes meant not to say anything as he passed on his way to the garage, nor on his way back with the jerrycan of fuel.

Soaring high above, two eagles floated on endless thermals. Aside from a cloud of black pyre-smoke rising from the farm below, it was a perfect day for flying.

–

Prompt: CBC Canada Writes “Bloodlines Challenge”.

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