Laser Surgery & Observing.

Having long suffered from astigmatism, after being driven absolutely bonkers by changing glasses a multitude of times and a lot of soul searching, I finally went ahead and had laser surgery over 8 years ago.

Have you ever wanted to know what effect laser surgery might have on your observing?

Here’s my account of what my experience was like and how my observing and astronomy will never look back. (Pun entirely intended).

Deteriorating Eyesight.
After enjoying over 40 years of observing, I love nothing more than peering down the telescope
looking at faint objects and trying to see the tiniest detail on planets or the Moon. As the years have
passed I have found that my observing has suffered due to inadequacies in my Mark I eyeballs. I have
suffered from astigmatism for many years which has given me many issues over time. This has been
extremely noticeable at the telescope and using a camera, as adjusting the focus on either of these
cannot cure my prescription. This meant that I always needed to wear my glasses when observing or
taking photographs. This often resulted in holding my head at funny angles to try and reduce the
reflections on my glasses that always seemed to interfere. I had considered laser surgery a few years
ago, but considering the extreme nature of the treatment, I always considered it far too radical as my
eyesight was far too precious to be tampered with. I tried contact lenses about 10 years ago, but my
eyes seemed to resent having anything plonked in them and soon became very sore. As I approach
middle age, another problem has now reared its ugly head. Presbyopia! This is caused by age stiffening
up the lens so it cannot accommodate close vision so easily. This means I now needed two pairs of
glasses, one for everyday use and another for reading and on the computer, greatly adding to the
inconvenience. I put up with swapping between two sets of glasses for four years but it was, to put it
mildly, extremely frustrating. I did try vari-focals for a short time, which were a vast improvement day
to day, but it always seemed that what I wanted to look at was frequently in the wrong part of the lens
and often had to move my head into such awkward angles to see through the part of the lens that
enabled me to see what I was looking at clearly. DIY was a nightmare when doing close-up work. Plus
there were still those awful reflections and positioning of the head to put up with while observing as

Growing Frustration and Investigations.
With growing frustration, my mind turned to investigating having laser surgery again. I did a lot of
research on the Internet, and, as you can imagine, found very many horror stories. The thought of
anything going wrong (and it can) was quite off-putting. This is really what has prevented me from
seriously considering having it done previously. Added to this, a work colleague had it done about
three years previously. This resulted in awful eye infections and other on-going problems, which the
last I heard were still trying to be resolved.
In the end, the frustration of observing was just too much. I really did need to do something drastic to
try and enjoy my observing again. I searched around the Internet to see what benefits as an observer I
could expect from having such a procedure? There isn’t that much previously published, but I did find
two short articles. One published in Sky & Telescope in August 2003 and another in Astronomy
Magazine in November 2007. Their conclusions were just as I expected. Some people have fantastic
improvement in night time seeing, others end up with permanent flares and spikes around stars after the
surgery. So it did seem a real mixed bag. But since publication of those articles, laser surgery technique
has been further developed and much improved, with many more patients having gone through the
procedure. So after much consideration I decided to have the tests done to see if my prescription and
eyes were suitable. After having all the tests, surprise, surprise, I was a suitable candidate. So now
came a very difficult decision. After much deliberation and soul-searching, making that decision to
have the surgery was probably one of the hardest I have made. Knowing how important I regard my
eyesight, and how much I love my hobby, did I really want someone messing about with my eyes?
What if it did go wrong? But, despite all my reservations, I did make that decision, paid my deposit and
booked my treatment.

Available Treatments.
As I understand it, there are a number of different procedures you can have.
The main treatments on offer are:
LAZEK – An alcohol solution is used to separate the epithelial layer from the cornea. The surgeon uses
a blade to cut a flap. The laser reshapes the cornea and the epithelial layer is replaced.
LAZIK – The surface epithelium of the cornea is removed. This can either be done by blade or by laser.
The laser procedure is more expensive and has a shorter healing time. This is more expensive than
LAZEK procedure, but has quicker healing.
There is also an option of having Wavefront Technology with both procedures. This takes into account
small imperfections in the focus achieved by your eyes. By mapping these in much greater detail a
much higher accuracy laser correction is applied to the shaping across the cornea. This option of course
comes at a premium.
The amount of correction that can be achieved is dictated by two things: Your prescription and the
thickness and condition of your cornea. A stronger correction will result in the laser removing more of
your cornea, so will require a thicker cornea to work on. This will also be more expensive. You often
see adverts advertising cheap laser from a few hundred pounds per eye, then this price is based on them
carrying out the minimal correction. At that cost your eyesight probably has minimal problems, so the
benefit from having the surgery would be minimal. You can bet your life that if your prescription is
particularly strong, it will cost much more than that advertised price.
Quite important for night vision, I was really pleased to find out that they measure the diameter of your
dilated pupil in the dark. They then make sure that they treat right across that diameter of your cornea
to maximise your sight correction at night. Had they not done this, there would have been distortions in
the vision when the iris was at its widest and the untreated cornea exposed to the incoming light path.

The Surgery Itself.
As the date of the procedure approached I was extremely anxious. In fact I didn’t like talking about it at
all. So much so, that most of my work colleagues didn’t even know I was going to have it done until the
day before. I opted for LAZIK (laser flap construction) treatment with Wavefront technology. Although
much more expensive, it should give me the highest probability of achieving a very good outcome.
This was particularly important for my observing and photography. Why would you scrimp on
something as important as your eyesight? I wanted to ensure that I didn’t regret my decision.
Arriving on the Friday morning, I had a few more preliminary tests and measurements then had a quick
discussion with the surgeon. All was now set for the procedure itself, something I really wasn’t looking
forward to. They lay you down on a swivelling couch between two large pieces of equipment. An eye
shield with some small holes in it is placed on one eye. Anaesthetic drops are put into the other eye to
be treated. A clamp is then placed onto your numb eyeball and seconds later you are swung under the
laser and told to look at a light with your other eye. A few seconds later you hear the machine counting
down to zero and the light goes off. The laser has now separated the epithelial layer from the cornea
and created the flap. You are then quickly swung round to the other side where the flap is lifted off the
cornea and moved to one side. (One side of the flap is always left attached to the cornea). At this stage
you feel quite a bit of pressure on the eyeball and the vision in the eye being treated goes completely
black. This would have been a bit disconcerting had I not been informed of this beforehand. Very
quickly you are swung back under the laser where you are told to look at a light with your other open
eye. The laser takes a few seconds to reshape the cornea and the bulk of the procedure is over after
another countdown. Yes, there was something that smelt like burning while this was being done!
Whether it was my cornea or not, I don’t know. You are then swung away from the equipment. The
clamp is removed and the epithelial flap is carefully replaced back over the cornea by the surgeon.
Blurred vision returns to the treated eye before this point. This procedure is then repeated with the other
eye. The whole process taking less that 5 minutes.

After the treatment I was then taken into a small sitting area with a nurse and given a very welcome hot
cup of tea. I found myself physically shaking due to the adrenaline that had been pumping around since
I arrived which peaked massively due to anxiety during the surgery. From coming into the surgery and
being able to leave took just over 20 minutes. Straight after the procedure the eyes are still numb, so
there is no sensation of pain or discomfort at all. I was amazed to see that already everything was in
reasonable focus, but with a hazy fog in front of everything. I was amazed that I could see quite a bit
of detail in distant objects and I could read number plates very easily as my wife drove me home.
About half an hour after the procedure, the effect of the anaesthetic drops started to wear off. It wasn’t
particularly painful, but felt a little bit like having grit in the eyes. When I got home I did as advised
and went to bed to try and sleep for most of the afternoon. The gritty feeling was still present that
evening but I was able to watch some television easily. That feeling had subdued quite a bit by the time
I went to bed for the night. I also had to wear some sexy protective goggles whilst sleeping to try and
stop me scratching my eyes in the night, causing my wife much hilarity.
The Morning After the Day Before.
When I woke up next morning the day after the operation, both my eyes slightly ached, but the gritty
feeling and the fogginess had gone. Going back for an eye test that morning I was assessed how
effective the treatment was. I still couldn’t drive until I had the eye test, but this confirmed that I had already had a prescription very close to 20:20 vision after less than 24 hours. I regularly applied Anti-inflammatory and antibiotic drops to my eyes regularly and I had to avoid getting water in my eyes for the first week. Returning a week later another eye test showed that my vision was now better then
20:20. I went back to work on the Monday. After the operation my eyesight varied from day to day, but
the majority of days are completely blur-free. The healing can take many months to complete before
the true prescription was properly known.
Already it seemed to be a great outcome to me for day to day, but how did I find it in practice doing my
beloved hobby? Four days after the operation we had a clear night and I nipped out with a pair of
binoculars to have a look. The Moon looked slightly blurred round the edges but the stars being fainter
looked relatively pin-points of light. For a few weeks after the surgery, bright lights and brighter stars
at night started to have long spider web flares around them, so I was a little concerned at this stage.
This effect has gradually reduced as healing progressed and is now almost non-existent.

My Conclusions.
So how has the surgery affected my general observing at the scope? Now almost two and a half years
since my surgery, I have spent many a session out under the night sky with my new found vision.
Views of the Moon and Saturn are the best I have had in many years, possibly since I was a teenager.
Lunar features are clear and crisp with small detail popping into view during short periods of steady
atmospheric seeing. Saturn’s Cassini Division was very clear at the ansae of the rings, despite the angle
to Earth still being fairly shallow in early 2012. Star images look extremely sharp and pinpoint and
there is no excessive flaring around bright objects. I was also pleased to have easily split the star
Porrima using a 10″ Dobsonian and a 5mm eyepiece, easily seeing dark space between the slowly
widening double star in Virgo. Later I also caught a glimpse of The Pup, the diminutive white dwarf
star companion to Sirius. So, for me, the surgery has so far exceeded all my expectations. Using the
telescope and camera has become much easier and less frustrating. Views through the telescope are
now as good as I have ever had. If I get a good 10 years of good eyesight out of the procedure, I feel it
will be money well spent.

Would I recommend laser surgery to anyone else? On the one hand, I have had such a good experience
and outcome, of course I would. But, on the other, I would be loathe to recommend it to anyone else in
case they had a bad experience, like my work colleague. One thing I do know is that you should
definitely NOT have laser surgery if your prescription is still changing. Don’t forget that they cannot
fix everything. My astigmatism and short sightedness may now have been cured, but I still have to use
reading glasses, as laser surgery cannot cure the lens stiffening problem. But this is something I can
definitely put up with considering the huge improvement I have seen in everything else I am now able
to see.

In summary, despite my initial reservations before having the treatment, having this operation has
definitely enabled me to enjoy visual astronomy much more, rediscovering the visual acuity of my
Yes there can be problems and complications resulting from the procedure, but as time goes by these
seem to be a lot less frequent.
My eyes are sometimes feel a little dry, especially just after waking up, but again this feeling has
become less regular as my eyes have healed.
If the improvements I have so far seen last me for just 10 years before my eyes change again, then it
will definitely be money well spent.

Dave Eagle FRAS. August 2013.