emerging.org

Props to both Berkeley Secret Garden and Berkeley Indoor Garden - great hydroponics stores, and not head shops. (Also really easy to get to!)

Sure, there’s that understanding that some of the people going in are growing a little more than tomatoes, but at least they know what they’re doing, the staff are really helpful, and the place is organized.

That’s a lot more than I can say for the other places visited in the last week. It’s one thing to play reggae in the store (as these two did) but the other shops? Wow - I was surprised that they could operate the cash register.

Yah Rastafari

Supposedly this is a really wet season for the bay area. It must be - we’ve got mold growing on what’s left outside on the porch. The porch swing is moldy (and torn after the windstorm picked it up and knocked it over to the neighbor’s porch, and the bench has this general dark tone that is growing darker by the week.

Who knew we moved to a rainforest?

Normally I wouldn’t bother writing about something like this, but it’s been raining for days, and I’m waiting for a clear window to show on the radar pattern so I can go for a run.

Good thing we didn’t move to Vancouver after all…

If you are how phasing out your DVD collection in favor of rereleased content on Blu-ray, you’ve got problems. I can’t quite go far enough to call someone an idiot without firsthand knowledge, but this is pretty close.

DVD CONTENT IS GOOD ENOUGH, PEOPLE. C’mon. If you really can’t watch movies without complaining of their lack of realism, grow an imagination. It’s a movie. When you get your Blu-ray movies, you’ll probably complain about how overly realistic it is - actors will look like real people, blemishes and all. (Actually, this may be one case of the porn industry _not_ driving technology forward: The rumor is that this coming content is _too_ good - to the point that you can see too much detail. They’re happy with DVDs.)

Besides, for those who really aren’t paying attention, this is likely the last physical format war, the future is software. Hell, Netflix is offering unlimited downloads _now_. By the time you get around to bankrupting yourself buying Superman III for the fourth time, the rest of us will be watching movies from our penny-per-gig hard drives, or who knows, 20 cents-per-gig solid state devices?

Ooof. I don’t know the details of the bill, but if the article is correct and a large portion of the bill’s payout is to people who can’t afford their houses as a result of the subprime mess, Clinton is demonstrating some bad judgement.

Bailing out idiots who didn’t read the terms of their mortgage or didn’t add up their expenses versus income over time isn’t a way to reintroduce confidence in the economy, it’s government-sponsored rewarding of ignorance. Clue - if you’re looking to buy a house, and can barely afford the payments, so when the ARM resets according to the terms you’re signing then don’t buy a house. Don’t understand the terms? Don’t sign.

If housing is too expensive where you live, rent. (We rent.) If you want to buy as an investment but it’s too expensive, move. This isn’t hard. Your job doesn’t pay enough? Then go to where it balances out better. If you can’t do that, do something else or find another employer. I know I’m oversimplifying, but all the presidential candidates are talking up how great of a country we are, and if we really are that great, we should be able to figure out this complex ’spend less money than we bring in’ idea.

Oh wait, that’s the same problem we have at the government level. Hmm. Maybe we are just screwed.

I’ve signed up for the San Francisco Marathon (www.runsfm.com), providing more proof that I’m an idiot. I do believe it’s a lot more fun to promise, then figure out how to get there, rather than planning out in detail and promising what you already know how to do.

Plus, I had to pay $85 to sign up and I’m too cheap to not actually run, now that I’ve paid for it.

I shouldn’t have taken Percocet after the surgery - as it is, I really can’t say how painful it was right afterwards. By the time I got home, I was functional, but if I didn’t put effort into moving, my head dropped and I’d just fall asleep. The sunglasses were on, the windows were (mostly) closed, and once I took the dogs out, I just laid down and went to sleep.

Jen got home some time later and I got up briefly, but from what she says, I wasn’t really that coherent. Got me. I did notice some sensitivity to light, but there still wasn’t any pain. By about 6pm, the Percocet was worn off, but I was still in a hangover state. The eyes were the least of my issues, and keeping them closed wasn’t hard at all.

By 9pm, they did start to hurt. It wasn’t that bad, all told - I’ve felt far worse. But it’s made worse by the fact that nothing can be done about the pain - no touching the wound, or applying pressure. (I was told not to rub my eyes for 2 months, which is really a tough mental task for someone who stares at a screen all day and fights software.)

Jen started administering drops, which were 4 times a day - morning, noon, evening, night. One drop of an antiseptic (Vigamox) and a anti-inflammatory (Econopred+) in each eye. At this point, we did the night drops, and she also added a ‘comfort drop’ which was some kind of local anesthetic. My worry was that if it did get worse, I wouldn’t be able to open my eye properly. The drops did help, though. (There are some neat docs online at the FDA regarding Econopred+ if you search for them. Looks like some internal docuementation that wasn’t supposed to get online, complete with NDA references.)

I also took another Perc, simply because I had slept most of the day and didn’t think I’d sleep all night. It put me right out, even with the stupid eye goggles I had to wear at night for 10 days. At 3AM, right on schedule, it wore off, and Jen gave me another set of comfort drops and another Perc pill. I slept right through to morning. That was the last time I’ll ever take Percocet, unless I’m really in a lot of pain. This was also the end of the comfort drops.

At this point, my vision was still fuzzy, maybe 20/500, so I could get around, but only inside. Lights were tolerable, but computer screens were a bit much, and I spent most of the day with my eyes closed again, even with sunglasses on. Saturday consisted of a lot of laying around and sleeping, while listening to TV or music. Sunday was more of the same.

Monday I ventured outside, with a hat and sunglasses, but it was pretty painful. An attempt at a walk was aborted early, and while in the car I had my jacket pulled over my head. I was almost functioning, though.

Tuesday I went to work and did some odds and ends - it was slow, being a holiday (I only figured this out afterwards), and I could putz along, with extremely large fonts for everything. By leaving early, before the sun was really up, I avoided any bright lights.

Most of the week went by normally, with only minor disruptions and slowdowns. My eyes didn’t mind light, but seemed to want change - a half hour of looking at the screen would feel tiresome, but putting the sunglasses on helped. After a half hour of that, taking them off helped. Weird. The eyedrop regimen continued, and at this point, while really bright lights were a distraction, they weren’t painful. No dry eyes, either.

Thursday I went in for my first checkup, when the temporary contact lenses would come out. At this point, I could navigate the busses and BART without any trouble, but I wouldn’t have been comfortable driving - everything was still too blurry to do more than 25MPH. Everything looked fine, and my contacts came out.

A side effect of losing the contacts is that my vision degraded for a day or so. This must be because the wound is exposed and gets a bit roughed up, but I don’t know this for sure. The drops continued, but only Econopred+, with a ‘Tears Again’ ointment at night, which appears to have the same makeup as sty medication - it’s oily, and gives me really blurry vision.

Clear sailing so far - I still can’t see that well, but I can get around, and things are improving. The hardest thing at this point is avoiding impacts and rubbing of the eye. After years of having automatic shields up, I’m used to letting things (like dogs) hit me in the face, and it’s hard to get used to not doing that for now.

There hasn’t been an a-ha moment like with normal LASIK, where suddenly everything’s 20/20 and pain-free. It’s been fuzzy, and not the nicest recovery period, but at least it’s getting better!

OK. Now for the details of the actual LASIK/PRK procedure itself. I’m still recovering, so more details may follow later.

First - the procedure itself. I showed up at 9:15 with an expectation of being around for about 2 hours of prep/surgery/paperwork. At 10:40, I was done. The actual time spent in the chair was probably 5 minutes of active work. (And 5 minutes of the poor doctor and assistants trying to get me to suppress my blink reflex.)

When I got in, I first went through the same barrage of tests as the first day, to make sure the maps are up to date, that my prescription was correct, etc. I spent a lot of time staring at the corneal topographer - I’m sure it was to make sure the map is correct, but the number of trials made me wonder if I was doing it wrong.

A mild anesthetic was used on my eyes, and was told to wait for a bit with my eyes closed. I suspect this is to make sure the last measurements were correct (Regarding the area lased - as I understand it, halos are more common when the area operated on is smaller than the area covered by a fully dilated pupil. This is a bit of a guess, but it makes sense.)

Once I went into the operating room, a couple more minor checks were done (sorry, I don’t know the names of all the machines). Then there were the drops. Lots of them, pouring over the sides of my eyes. Pads were fit into my head covering to soak them up as they ran down the side of my face.

I think there were multiple types of drops, but I’m not sure.

Then I got laid back on the table. This is the surprising part - I was expecting that at some point I’d get a mild sedative like Vicodin. Nothing strong, but something that would allow me to respond to commands while not caring that my eye was being scraped. Nothing of the sort was given to me, and I started to realize that I wasn’t getting it. Oh well.

Once Dr. Hyver came in, the restraints were put in to hold my eye open. This sounds bad, but it really wasn’t - it was hard to suppress my blinking, but eventually, they were able to hook the restraint below both eyelids, and crank it open. (There was some crank mechanism on the side, I didn’t get to see. One eye was done at a time.

Then the chair rotated under the laser, and I could see the red blinking light I was going to have to focus on. Around it was a thin white ring of light. The laser was mounted off to the right. More drops were used.

Here’s the creepy part. First the epithelium has to be removed, so Dr. Hyver said he’d be ‘blocking the light for a few seconds’. Granted, I don’t have good vision (or didn’t) but I swear I saw what looked like a rotating dentist brush come in. Similar, but not the same.

The rotating brush comes down, and fills the field of vision for about 10 seconds or so. This happened a couple times, I suppose while the proper region was covered. Once it’s done, everything’s really blurry.

Now I was warned that the light would get distorted. There was a tool that came across the eye, I suppose to remove the epithelium mess. My vision cleared a bit, but it really did distort in the process. Almost like controlled waves of light, as the tool wiped the mess away. This was kind of neat, actually. I don’t know if I really liked the effect or just knew that the weirdest bit was over.

The laser is the next step. It’d been programmed with my map, and was ready to fire away. I was told to watch the blinking light as well as I could. Once it started, it just pulsed away (at about 2 or 3Hz) as it ablated the cornea surface. The actual time with the laser was about 30 seconds per eye.

During this process, the light seemed to move around, and I was supposed to track it. At the same time, everything was becoming progressively brighter and blurrier. I didn’t know how bad this would get, and it got a bit uncomfortable, but it eventually stopped, at about the point where I could mainly just see a white blur through most of my vision with a little bit of red.

I don’t know if the light was really moving around or if that was a trick of the eye, but it did jump a bit. Following it was a decent task, but the machine is sampling input at 4kHz, so really, if you aren’t keeping up or move to the wrong location, it’s going to know long before you can intentionally go out of tolerance. (Really, how far can you move your eye and/or head in 250 microseconds?)

Once this was done, I had to open the other eye and look at a Q-tip held about 3 inches up, while the final procedures were done. I don’t know what these were, because something blocked my vision in the other eye. I would have asked, but the other eye still had to be done, and I didn’t want to know quite yet.

After whatever that procedure was completed, a contact lens was dropped in, since i really had an open wound on my eye, and the ocular restraint was removed so I could blink.

Those poor people then had to try to get the restraint in my eye, and repeat the procedure. It was largely identical to the first run.

Once both contacts were in and I was out from under the machine, I sat up and was led to an adjoining room, to sit in a chair with my eyes closed for a bit while some last minute items were done. (Paperwork, maybe? I don’t know.) A quick inspection was done, and I passed.

I received some sunglasses, and was all ready to go. At this point, my vision was fuzzy, but better than it would have been without glasses before. I was light sensitive, but not that much. Since I was going to take the BART home, I was advised to take a Percocet pill now, so it would take effect by the time I got there.

This may or may not have been the best idea, but I made it home. I’ll cover the drugs in the next installment. I took a taxi to the BART station (it would have been a 10 minute walk), because I was supposed to keep my eyes closed for 4-6 hours.

Once at the BART, I just took a train to SF, and rode it to the Embarcadero, where I picked up the right east bay train. It was a bit hard to read the station stops and I can never hear the announcer, but it was doable. Once off BART in Oakland, I picked up the 51 bus to Alameda. It was a bit hard to read the signs, but the 51 signs are in blue, and that was easy to trigger on. I did stand there like I was drunk, and could barely open my eyes enough to watch for the bus. This was more Percocet than surgery, I think.

The 51 dropped me off close to home, and after walking a couple blocks, I got in, laid down, and passed out. More later on the recovery - drugs, sleep, and so on.

Just got my eyes fixed at Scott Hyver’s Daly City location south of San Francisco. Figured I’d provide a little bit of detail on the process, since most of the summaries I found while researching were either positive (and very short) or negative (and very long). In the case of the negative reviews, many of the entries provide a lot of whiny details but not a lot of medical background, sometimes even without a date.

Maybe this story will help out a little bit. Here’s my background - I’m 31, and had myopia with about a -7.5 diopter prescription. (Roughly 20/1100) My prescription hadn’t changed in nearly 4 years, although my glasses had started to feel a little bit underpowered. A stable prescription overall.

I’ll give a little background then some terminology. This has been of interest for about 10 years, but I was too cheap to pay for it. In the summer of 2006, I decided to seriously investigate LASIK (with wavefront in particular) at Coleman Vision in Albuquerque. I was approved, but didn’t quite go for it. Then Wind River came in and I ended up in the bay area.

After settling in, I went to Pacific Vision in San Francisco, and got turned down. The rumor is that if you’re not a really ideal candidate, you can be turned down by offices to keep their success rates up. I don’t know if this was the case, but I did get an elitist feel (from a technology perspective) at Pacific Vision.

As an aside, I was told at Pacific Vision that my corneas were thick enough, but too flat, and could result in halos. Instead, they wanted me to go with ICL as a replacement for LASIK.

Next, I went to Scott Hyver’s location in Daly City, on December 27, 2007. They approved me, particularly for PRK. And they could fit me in for surgery December 28. (I had reviewed a lot about Scott before going in, it really wasn’t an uninformed jump.)

Before I go into the details of the surgery, here are some terms:

LASIK (easy one) - the process of using an excimer laser to reshape the cornea to correct vision. A key part of normal LASIK is that a ‘knife’ is used to slice the cornea so it can be hinged back for the laser to do the work.

LASIK/PRK - (photorefractive keratectomy) this is the same as above, but instead of cutting a flap, the epithelium (special layer on the surface of the cornea) is scraped off, and the laser works from there.

ICL - This is a relatively new procedure (and currently twice as expensive) that is similar to cataract surgery. A slice is cut in the eye and pressure is maintained while a new (rolled up) lens is inserted. It unrolls in place and acts as a new lens, correcting vision internally.

Wavefront - A variation on the normal correction procedure. Rather than just taking off X microns of the cornea to get back to 20/20, Wavefront analysis takes a high resolution map of the cornea and accounts for the specific shape of the cornea. This lets the surgery correct for any local aberrations, correcting for minor irregularities in the cornea.

I have a slight abnormality in my cornea shape that made me a little better fit for PRK, according to Scott. All 3 locations indicated my cornea was thick enough to account for my prescription. (The higher the prescription, the more that has to come off to bring vision back to 20/20.)

I was comfortable with PRK - it has some significant differences from normal LASIK:

• A longer recovery time. Normal LASIK gives almost 20/20 vision immediately, once the flap is back. PRK leaves you with an open wound that has to heal, and for my prescription, takes months to heal.
• A longer track history. PRK is actually one of the older procedures (oldest?) still in use. It’s got almost 30 years of history, and the technology is well known with a low failure rate.
• PRK does not leave a flap that has to heal - instead, the epithelium grows back naturally (but slowly). Flaps always have a risk of being ripped open, and while rare, still a possibility.
• PRK actually _can_ provide better results, in theory. Since the wavefront corrections are at the surface, the epithelium grows in properly around them, whereas with a flap, the flap may not fit back as naturally as it would have without the corrections.

That’s the overview - next I’ll cover the actual procedure.