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#136877 - 24/01/2003 11:56 lasik eye surgery
image
old hand

Registered: 28/04/2002
Posts: 770
Loc: Los Angeles, CA
i'm about to undergo this so i can get rid of contacts/glasses. anyone go thru it already an d warn me of things NOT to do?

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#136878 - 24/01/2003 12:04 Re: lasik eye surgery [Re: image]
Biscuitsjam
enthusiast

Registered: 22/01/2002
Posts: 355
Don't rub your eyes right after the surgery... That's all I can think of, since I didn't have it.

A whole lot of people that I know have had it and have been VERY happy with it though. It is affordable and comes out with excellent results almost every time. I would recommend you go to a good doctor (check his credentials, any papers he's written, etc.). Also, there are a few things you probably ought to be aware of:

There are a few issues with Lasik:
1. There is a very rare chance of reducing your eyesight permamently. This almost never happens, but it is possible. Similarly, you could get an infection, but these are also rare, especially so with Lasik (as opposed to some of the other eye surgeries).
2. The Lasik surgery is permament. It is possible to have minor corrections, but if it is seriously messed up the first time, or the shape of your eye later changes (both rather rare, but there still isn't much long-term empirical evidence), then you are stuck with the results.
3. There is a real chance that you could get Lasik and not have perfect vision. Some people still need corrective lenses even after the surgery. This is a possibility you should probably consider.
4. Lasik surgery cuts some of the nerves that tell your eye when it is dry. As a result, you may have dry eyes, possibly even needing eye drops, especially late at night or when you wake up in the morning.
5. Lasik reduces night vision in a significant portion of the people that undergo it. In addition, many people have a "halo effect" around any bright lights at night.

I hope that helps. As I said earlier, most people who have the surgery are very happy with the results.

-Biscuits

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#136879 - 24/01/2003 12:20 Re: lasik eye surgery [Re: image]
matthew_k
pooh-bah

Registered: 12/02/2002
Posts: 2298
Loc: Berkeley, California
I at one point was talking to the son of an optometrist about this, and his mother had one argument that convinced me I wouldn't try it if I needed glasses. She claims that all of the people presenting papers at optometry conferences still wear glasses. If they're not convinced, I'm not convinced.

That being said, with every passing year they're learning more about the long term effects, so perhaps the experts have changed their minds.

Matthew

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#136880 - 24/01/2003 12:28 Re: lasik eye surgery [Re: Biscuitsjam]
jimhogan
carpal tunnel

Registered: 06/10/1999
Posts: 2591
Loc: Seattle, WA, U.S.A.
There are a few issues with Lasik:

This seems like a pretty fair list. I have Lasiked friends and coworkers. Some are pretty happy while others are not as happy as they wanted to be.

iMaGe, I expect by now that you've browsed Lasik story sites like this one. Allowing for the fact that some of the horror stories may be amplified by a certain "ambulance chaser" effect, the fact of possible complications remains. I'm pretty conservative when it comes to surgical procedures. All I'd say is that if you have any doubts about what you are getting into, there's not much of a downside to delaying. Kind of like tatoos!
_________________________
Jim


'Tis the exceptional fellow who lies awake at night thinking of his successes.

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#136881 - 24/01/2003 12:31 Re: lasik eye surgery [Re: image]
Cybjorg
addict

Registered: 23/12/2002
Posts: 652
Loc: Winston Salem, NC
I know several people who have had it, all who ended up very pleased with the results.

One of my friends was hating it directly after the procedure because it was uncomfortable and her vision was blurry. She swore that if she had to make the choice again, she would choose against it. After a week or so of her eyes adjusting themselves, she ended up with 20/20 and loved it. It was worth it in the end, she decided.

Probably similar to breast implants, for those who choose to have that done.

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#136882 - 24/01/2003 12:32 Re: lasik eye surgery [Re: image]
tfabris
carpal tunnel

Registered: 20/12/1999
Posts: 31600
Loc: Seattle, WA
I remember reading a Newsweek article about this surgery, a couple years ago, when it was particularly popular.

The main things that I came away with from reading the article were:

- Some doctors were using that surgery system like an assembly line, buying into it and generating the revenue without necessarily making sure that it was the right solution for their patients. And some were practicing it on patients after little more training than a weekend seminar. So it's important to find a doctor who is experienced in the procedure, as well as one who's truly interested in helping *you* rather than making a fast buck on a popular procedure.

- Some patients, those who have very dry eyes, won't heal up properly after the surgery and will be much worse off than they were before it. So the doctor really needs to check you out and make sure that your eyes really can tolerate the procedure.
_________________________
Tony Fabris

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#136883 - 24/01/2003 12:47 Re: lasik eye surgery [Re: image]
Dignan
carpal tunnel

Registered: 08/03/2000
Posts: 12341
Loc: Sterling, VA
I had it done.

Before: severe far-sightedness with a bad astigmatism

After: 20/20
_________________________
Matt

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#136884 - 24/01/2003 13:03 Re: lasik eye surgery [Re: image]
wfaulk
carpal tunnel

Registered: 25/12/2000
Posts: 16706
Loc: Raleigh, NC US
I'm also of the opinion that surgery should be avoided unless necessary. To that extent, you might want to try the Bates method of improving eyesight. (I'm sure that's not the best link, but it's the first one I saw.)

It assumes that sight irregularities are a result not of lens problems, but eyeball problems, and that they are caused by muscle stress on the eyeball itself. I'm not going to say that it will cure your eyesight problems, or even that it will help, but I can't imagine that anything in it could possibly hurt, so I'd definitely try that for a while before letting anyone cut on your eye, which, while probably unlikely, does have the potential for damage.
_________________________
Bitt Faulk

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#136885 - 24/01/2003 13:35 Re: lasik eye surgery [Re: image]
blitz
addict

Registered: 20/11/2001
Posts: 455
Loc: Texas
Make certain you are willing to live with the RESULTS of failure and not the RISKS of failure. I know a doctor who had a collegue that lost his vision in one eye from lasik surgery. The doctor I know said there was no way he would have it done.

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#136886 - 24/01/2003 13:38 Re: lasik eye surgery [Re: wfaulk]
DWallach
carpal tunnel

Registered: 30/04/2000
Posts: 3810
Also, one of the things they don't talk about too much is visual acuity. You may have 20/20 vision, but your ability to resolve fine details (like the pixels on your mondo 1600x1200 monitor) might not be as good after the procedure as it was beforehand.

Last I checked, the "complication" rate was hovering around 5%. That's a very huge number. I would not go for an elective surgery until they got the complication rate under 0.5%, at the most.

Finally, if you're not in a hurry, there is much cooler technology around the corner. Check out what Brian Barsky, at U.C. Berkeley, is doing.

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#136887 - 24/01/2003 14:21 Re: lasik eye surgery [Re: image]
Dignan
carpal tunnel

Registered: 08/03/2000
Posts: 12341
Loc: Sterling, VA
Okay, now that I'm not incredibly late for a class, I can go into more depth, as it appears that I am the only one here who has had first hand experience with the process. Trust me, I am well aware of the pros and cons. I'm willing to bet I'm one of the better people to give an opinion on it, as I think you'll see.

To start, I am a little over the 2.5 year mark with 20/20 vision, or what I would call perfect.

My mother had the operation before I did, and her results were not good. She had a lot of problems and had to go in for a total of 5 operations, 2 on one eye and 5 on the other. However, we finally got it right and she now has very good eyesight, if not 20/20.

Despite this process, I went ahead with the operation. In fact, I was so eager to have it done, I wasn't concerned with these facts:
-my mother's problems with her operations
-I was a test participant on a new type of laser
-at the time, the operation was not as successfull for far-sighted people as near-sighted, and I was very far-sighted
-the new laser I was a test subject for broke just before I was supposed to go in, and I had to come back another day while a repairman from the company was flown in to fix it

Despite all this, I went through with it, came out of it, and was seeing without glasses that very night.

My dad, who just started wearing glasses in his late 40's, decided he didn't now want to be the only one in the family wearing them, and he had it done recently on one eye. His results were also poor, as he was over corrected. They can fix it, however, and think they will, based on previous experience.


Here are the tips of advice I'd give:
-first, how old are you? if you are under 40, I think you'll have a much better shot
-the operation does not improve some things. When you get older your reading vision will not be as good. This is not an eye issue, but a muscular one from what I understand.
-you may be nervous, but don't take any sedatives if they offer them
-after the surgery, as someone said, don't touch your eyes. they will probably ask you to sit somewhere for 5 or 10 minutes with your eyes shut the entire time. After that, your coneas are effectively healed, but they will take time to heal completely.
-when you get home, SLEEP. This is why you shouldn't take the sedatives, because you will find it harder to sleep afterwards. the period within the first 4 or 5 hours is the most uncomfortable one, and I slept through it.

That's it. It's a very painless surgery. If you'd like me to describe it to you, I'd be happy to. I've seen plenty of them.

Another issue, as was mentioned, is who to get it done by. In that area I was fortunate. My eyes were done by the best person in the world possible. There's a DC area doctor named Mark Whitten (spelling?). He has, I believe, performed the surgery more times than anyone on the planet. He did Tiger Woods eyes, to which he attributed the following 7 championships that he one. He also did Matt Lauer on the Today Show in their segment on the subject. This is not one of those weekend seminar guys.

Lastly, there's the issue of cost. Yes, my whole family has had the operation. In my case, we got a break for the test thing. In my mom's case, the company was doing a toys for tots promotion where if you brought a toy, you'd get $1000 off. Not too bad. In my dad's case, he had too much in his FSA at the end of the year, and decided he might as well. None of these cases were, by the way, cosmetic decisions. The inconvenience of glasses was too much for us, and it gets expensive in it's own right. I tried contacts, but could only wear the gas permeable ones that were very painfull. My mom, as my dad says,"needed her glasses to find her glasses."

So there is my experience on the subject. Glad you asked?? Again, if you'd like me to describe the actual surgery, the procedures, or the after-visits, I can. Or at least what my doctor did.

Anyway, whatever happens, just remember, it's better than having to do this.
_________________________
Matt

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#136888 - 24/01/2003 14:42 Re: lasik eye surgery [Re: Dignan]
Cybjorg
addict

Registered: 23/12/2002
Posts: 652
Loc: Winston Salem, NC
In reply to:

Anyway, whatever happens, just remember, it's better than having to do this.




No kidding. My mom had RK done back in the 80's. One eye ended up over corrected and the other ended up worse than it originally was. She still wears powerful contacts.

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#136889 - 24/01/2003 14:58 Re: lasik eye surgery [Re: wfaulk]
Anonymous
Unregistered


In reply to:

But his real brillance was in discovering that vision was extremely susceptible to mental strain. So, it does change a lot during the course of a day, even for people with normal sight, depending on the stress the person is under.




That is so true. I've noticed that when I'm stressed out and don't wanna do anything but just go home and relax, my vision gets very blurry, to the point where I have trouble reading billboards on the highway or reading a license plate 20 feet away. But when I'm well rested, very relaxed, and I can very easily concentrate, then my vision is perfect.

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#136890 - 24/01/2003 15:02 Re: lasik eye surgery [Re: ]
wfaulk
carpal tunnel

Registered: 25/12/2000
Posts: 16706
Loc: Raleigh, NC US
And have you noticed that when your eyes feel tired and you press on them with the balls or heels of your hands, you see better for a few seconds or minutes afterwards?
_________________________
Bitt Faulk

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#136891 - 24/01/2003 15:25 Re: lasik eye surgery [Re: image]
image
old hand

Registered: 28/04/2002
Posts: 770
Loc: Los Angeles, CA
thanks for all the input. i've been struggling today because i did my exam in the morning. using the computer after getting my eyes dilated (so they can see if i'm healthy and viable for the surgery) proved to be a daunting task.

now, the doctor that i went to is Dr. Moosa of Los Angeles. he has quite a record (98% success rate, the OFFICIAL lasik surgeon for LAPD and LAFD officers who want it). Now price was pretty steep, but i'm paying for the name, imo.

i'm 22, and i agree with you that the younger you get it, the more beneficial it becomes. I figured that i was spending around 250$ a year on glasses/disposablecontacts/contactsolution, so lasik is more economical.

anyways, i have a week to chicken out (my appt is next saturday)... so hopefully i get thru reading those horror stories without changing my mind.

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#136892 - 24/01/2003 15:40 Ophthalmic surgery [Re: image]
morrisdl
enthusiast

Registered: 21/08/2000
Posts: 346
Loc: Rochester, NY USA
Not sure where you live, but the company I work for (B&L) makes the lasers for this type of surgery. the latest form of this is called zyoptics. It not US - FDA approved yet, but I know its being tested. I think its available in Europe and Canada right now.

the difference in the procedure is upfront diagnosis of your eye. The Ophthalmologist maps the various lenes of your eye, to precisely determine where the inaccuracy is. A computer takes this data and plots the best possible cornea shape to correct the total eye geometry. I am probably doing a poor job of explaining, but I am just a computer geek not and eye doc. Here is the first link i found :

http://www.laserfocus.com.au/equipment.htm

I know that with this procedure the risks are minimized, and the outcomes have been substantially better. I think most outcomes are 20/20 or better (BTW - 20/20 is average, 20/10 is considered perfect vision).
_________________________
Cheers, -Doug Morrison Mk2-32G Back light buttons, Neon red screen

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#136893 - 24/01/2003 15:41 Re: lasik eye surgery [Re: Dignan]
genixia
Carpal Tunnel

Registered: 08/02/2002
Posts: 3411

The inconvenience of glasses was too much for us, and it gets expensive in it's own right


Too true. I've just had my eyesight checked again, no real change (again), but I observed to the doctor that I'm getting worse computer-related eyestrain than I used to. He suggested that one of 2 things could be done. Firstly, the lenses could be marginally weakened to reduce the strain whilst hacking, but that would affect distance vision, or secondly, having 2 pairs of glasses, depending on use (I'm far-sighted BTW). Well, the first 'solution' didn't make me happy when we did a quick distence test, so he wrote up a prescription for 2 pairs.

I then went to the shop and looked at frames. In the past couple of years I've started having skin reactions to Nickel, so I need either plastic (yuck), or Stainless Steel, or Titanium frames. Needless to say, I haven't found a nice looking pair of frames for less than $200. Of course, my insurance will cover $130... of the first pair. So that's $270.

Being far-sighted, the lens is thicker at the outside edge than in the middle. That makes far-sighted lenses significantly heavier than near-sighted lenses of the same strength. So I'd need to have polycarbonate lenses - most lightweight frames will not accommodate my lenses in glass. That's going to cost me another $35 on the first pair. (And I don't know what for the second.)

And of course, my insurance won't cover the second pair of 'basic' lenses either (AFAIK). I don't know how much that is.

And that's before we've even got into anything like scratch resistance or anti-glare coatings.

I'm potentially looking at the wrong side of $400, not counting the insurance premiums that I'm already paying and the $10 copay for the visit itself.
_________________________
Mk2a 60GB Blue. Serial 030102962 sig.mp3: File Format not Valid.

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#136894 - 24/01/2003 16:07 Re: lasik eye surgery [Re: matthew_k]
g_attrill
old hand

Registered: 14/04/2002
Posts: 1172
Loc: Hants, UK
I at one point was talking to the son of an optometrist about this, and his mother had one argument that convinced me I wouldn't try it if I needed glasses. She claims that all of the people presenting papers at optometry conferences still wear glasses. If they're not convinced, I'm not convinced.

Is an optometrist really going to advise you to have a procedure which could me you will never buy a pair of glasses from him again?

Gareth

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#136895 - 24/01/2003 16:26 Re: lasik eye surgery [Re: DWallach]
cushman
veteran

Registered: 21/01/2002
Posts: 1380
Loc: Erie, CO
Wow, thank you for posting that link (the one here about creating contact lenses for abnormally shaped corneas). I may need this in the future, and I hope they can get something going soon.

I had an accident before Christmas where a nail from a nailgun ricocheted twice, then punctured my left eye, hitting my retina before popping back out again. I had surgery and now have 20 stiches in my cornea in a diagonal line that may interfere with my field of vision when it finally heals up. A corneal transplant was suggested as a possible solution if I need it, but that has a 12 month recovery period, and I'm going nuts after only one month with one eye. I would pay any amount of money to avoid that.
_________________________
Mark Cushman

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#136896 - 24/01/2003 16:30 Re: lasik eye surgery [Re: genixia]
DWallach
carpal tunnel

Registered: 30/04/2000
Posts: 3810
FWIW, you shouldn't treat the cost of glasses as a medical expense. The lenses, maybe, but the frames are effectively jewelry. Glasses effect how you look every bit as much as the clothes you wear.

That helped me justify the pricey titanium frame that I've been wearing the past few years. The other helpful justification is that they're so amazingly light. My old glasses would gouge my nose. My current frames are very comfortable.

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#136897 - 24/01/2003 16:37 Re: lasik eye surgery [Re: DWallach]
DWallach
carpal tunnel

Registered: 30/04/2000
Posts: 3810
Wow, on a bizzare side-note, I found the web site for the firm that made my glasses (www.lindberg.com). It took over my whole screen to show me its marketing material (most likely a Flash thing). I guess they want to make it visible to users with uncorrected vision!

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#136898 - 24/01/2003 16:48 Re: lasik eye surgery [Re: genixia]
Terminator
old hand

Registered: 12/01/2000
Posts: 1079
Loc: Dallas, TX
Hi,

What is your rx exactly? I can tell you what material to ask for. I dont know a lot about the prices of frames, but they sound a little steep. Poly has to have a anti scratch coating applied or it will scratch as soon as you try to clean them. Its a very soft material. Plastic (CR 39) is more scratch resistant but comes out thicker. Another alternative that is better optically is hi index plastic (tradenames like spectralite, trivex) It is 15-20% thinner than CR39. Try to find a frame that has smaller and more rounded lenses and your lenses will end up looking thinner. I can help you more when I have your rx info. Glass is the best optically but is a pain to produce since most you have to harden it, drop ball test it, etc. Its also very heavy.

Sean

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#136899 - 24/01/2003 16:59 Re: lasik eye surgery [Re: wfaulk]
Anonymous
Unregistered


Definitely. That guy hit it on the head. My vision is controllable - it's just a matter of learning how to control it.

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#136900 - 24/01/2003 17:22 Re: lasik eye surgery [Re: DWallach]
genixia
Carpal Tunnel

Registered: 08/02/2002
Posts: 3411

FWIW, you shouldn't treat the cost of glasses as a medical expense. The lenses, maybe, but the frames are effectively jewelry. Glasses effect how you look every bit as much as the clothes you wear.


I couldn't agree more with the last sentence. I have been wearing glasses since I was 2, and know only too well the taunting and bullying that can arise in schools from wearing the 'wrong' type of frame. (Anyone in the UK remember the NHS dark plastic frames?? Ugh.) Given the choice then, I would have never worn glasses, and the reason that I have continued to do so is purely medical.

That being said, all that taunting and bullying goes away eventually. It's possible now that it doesn't really happen much in schools today, since a significantly larger percentage of kids wear glasses, and advances in materials have resulted in stronger and lighter glasses that are less ugly.

But still, the fact remains, I wear glasses for a medical reason, not to look good. It's only in the past few years that soft contacts have even been an option for me (astigmatism), and since most people that I know with contacts still have glasses too, that'd only be additional cost.

I agree that glasses can also have a cosmetic effect, although I'd observe that it is diminished somewhat for far-sighted people such as myself - The nicest frames in the World aren't going to overwhelm the 'Bottle-bottom, huge-freaky-eyes' effect that far-sighted lenses have. I'd also observe that a lot of the more 'cosmetic' frames seem too restrictive in their styling for general purpose use. The stylish small squarish frames that would look great on me when I'm in a suit with my hair in a ponytail just aren't going to cut the biscuit when I'm in jeans and t-shirt at a rock gig. So that'd result in multiple pairs being necessary.

I see where you're coming from...it's just I've never really considered glasses as a 'luxury' item, and to buy multiple pairs for purely cosmetic reasons. Too long in the saddle I guess. And better toys to spend the cash on

<Rant Mode>
Why are all the manufacturers sheep, and insist on following each other along the fashion road? I don't have a problem with them introducing new styles, or keeping an eye on fashion. But they just seem to choose a new fashion, and produce 90%+ of their frames to fit that fashion, hence severely limiting choices for those whose faces don't fit it..If I have to see just one more pair of ridiculously small lensed frames that will never suit me (not in a million years), then I swear I'm gonna scream.
_________________________
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#136901 - 24/01/2003 18:17 Re: lasik eye surgery [Re: cushman]
jimhogan
carpal tunnel

Registered: 06/10/1999
Posts: 2591
Loc: Seattle, WA, U.S.A.
I had an accident before Christmas where a nail from a nailgun ricocheted twice

HOLY [censored] [censored]!

Gawd, it hurts to read that. It sounds like they rushed you to the right ER. I'm feeling like something here is a tribute to how far opthalmic surgery has come over the years.

Best of luck going forward
_________________________
Jim


'Tis the exceptional fellow who lies awake at night thinking of his successes.

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#136902 - 24/01/2003 18:28 Re: lasik eye surgery [Re: wfaulk]
jimhogan
carpal tunnel

Registered: 06/10/1999
Posts: 2591
Loc: Seattle, WA, U.S.A.
It assumes that sight irregularities are a result not of lens problems, but eyeball problems, and that they are caused by muscle stress on the eyeball itself.

Probably only tangentially related....I had had the same (very mild) distance eyeglass prescription since ~1978, but found myself in the mid-90s with typical 40-something problems with nearvision/reading. *Plus* it seemed like my ability to refocus and my distance vision were getting worse.

I finally broke down and got "progressive" bifocals and things have improved a lot -- I can read, refocusing is no longer a problem, and it seems like my distance vision has improved. I can go around without my glasses and have fewer hassles focusing.

As friends considered Lasik, I thought about it, too, but then decided that it would be more hassle to haul reading glasses around (as you all will someday!!) than it would be to just keep wearing the bifocals. The risks, too, I still rate as too high. OK, I'll say it: I'd wait a few years for the "next, best thing" with lower complication rates.
_________________________
Jim


'Tis the exceptional fellow who lies awake at night thinking of his successes.

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#136903 - 24/01/2003 18:30 Re: lasik eye surgery [Re: genixia]
tanstaafl.
carpal tunnel

Registered: 08/07/1999
Posts: 5549
Loc: Ajijic, Mexico
I haven't found a nice looking pair of frames for less than $200.

[rant]
Eyeglass frames are among the biggest ripoffs I have ever seen!

Can someone explain to me why maybe five pieces of wire and a couple of nose pieces should cost that kind of money?

How is it possible that I can go to my local department store and buy non-prescription sunglasses "off the rack" so to speak that have pretty much equivalent frames -- for $10--$15, including the lenses and glasses case?

There has got to be some sort of monopolistic price-fixing conspiracy going on between the optometrists/opthalmologists and the frame manufacturers.
[/rant]

tanstaafl.
_________________________
"There Ain't No Such Thing As A Free Lunch"

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#136904 - 24/01/2003 18:39 Re: lasik eye surgery [Re: tanstaafl.]
genixia
Carpal Tunnel

Registered: 08/02/2002
Posts: 3411

Can someone explain to me why maybe five pieces of wire and a couple of nose pieces should cost that kind of money?


Can someone also explain why the less material there is, the more the frames cost?

My wife looked at a pair of designer 'frames'. They were frameless, with the arms and bridge bonded to the lenses. As far as I can tell, the lens cost isn't a factor in the frame cost.... so why did they cost $320 ??!
_________________________
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#136905 - 24/01/2003 18:43 Re: lasik eye surgery [Re: genixia]
pgrzelak
carpal tunnel

Registered: 15/08/2000
Posts: 4859
Loc: New Jersey, USA
Paging jdandrea... Paging jdandrea...

He is that 1 in xxx number of people who do not heal in 5 seconds after the surgery. It took him about a month or two...
_________________________
Paul Grzelak
200GB with 48MB RAM, Illuminated Buttons and Digital Outputs

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#136906 - 24/01/2003 18:53 Re: lasik eye surgery [Re: jimhogan]
cushman
veteran

Registered: 21/01/2002
Posts: 1380
Loc: Erie, CO
Thanks Jim. I definately was lucky when it came to the right doctor. I was driven to the local ER then they referred me to a large hospital in Nashville where a retinal surgeon performed the surgery. 20 years ago I would have lost my eye but if I'm lucky I will recover nearly 95% of my vision (if the scar does not cross my field of vision).

It has really made me more aware of how precious sight really is. The eye that was injured was my dominant eye and it provided me with 75% of my vision overall. I've had to adjust since to use my other, and with just one eye I can really sympathize with the blind or sight impaired. At the time I was nowhere near the work area and was not doing anything dangerous, but from now on I will be wearing safety glasses for absolutely ANYTHING that could potentially fly up into my face!

Don't take your sight for granted, and I know that I would think very long and hard about having lasik surgery when my sight could be corrected by contacts or glasses. One advantage of glasses over contacts is the additional layer of protection they give!
_________________________
Mark Cushman

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