So-so-so, I see everything

    8 years ago I wrote on Habré a publication “ My experience in restoring eyesight, ” in which I told about my experience of non-surgical sight restoration — by instillation of droplets and various exercises. Then on Habré there was not yet a counter of views of posts, so those 75 thousand views are a long-term search traffic, once again proving the obvious - the question of sight worries not only me. Today I will talk about the second experience of restoring vision, but this time more radical and with some kind of incredible result. Namely - on laser correction technology ReLEx SMILE.

    (I am even afraid to imagine how pseudoscientific that my post looks compared to other publications in this blog of a professional ophthalmologic clinic, but if you are suddenly interested, you can read).

    What has changed since then? Since you are reading this post, then the situation has not become better. Namely - the result then, although it was, but not the way I would like. And it was not very long - soon after scoring on the exercises, I returned to the “broken trough” - all the same not very comfortable vision. Admit it, you also probably started doing something regular and unusual (exercise for the eyes or back, breaks in work) and scored after a couple of weeks? Well, or am I the only one.

    The minus is stable, not very big: right eye -1.25 myopia and astigmatism -0.5, left eye myopia -1.0 and astigmatism -0.75. But this is enough for life to be filled with discomfort, and in all areas of life. You go to work in the morning - you can see the road, cars and pedestrians, but you can barely see the numbers, signs and signs. You come to work, the projector displays the task manager on the wall of the conversation - you sit down closest to see anything. You go to dinner - there is a football broadcast, but you don’t see who is playing with whom, what time and score - they just run overseas colored sticks and kick a white dot. Not to see someone from a distance of 10 meters or to say hello to a stranger, but “in a similar way” is a nice thing. In the evening you play with a child in Fortnite - not a damn thing is seen at all, because the eyes are already tired for the day. I think

    Lenses? I tried many different, expensive and cheap, one-day and long wearing - whatever one may say, I still feel a foreign body in the eye, and in the evening I want to comb my eyes with a furuminator. Points? Excellent invention, but I will not wear it, of course.

    I preferred to squint imperceptibly :) Although it is not so imperceptible, and in most cases it does not help at all (especially if we are talking about a long period of time, for example, watching a movie with subtitles). I want to see something, but with all desire you can not. It's like a broken earpiece - one plays and everything seems to be heard, but I want to hear it fully, so you press the wiring. And so and that, but he still does not play. And freaking out.


    I had previously thought about laser correction, but “somehow my hands did not reach.” After all, first you want to read about it, but this is a great topic - laser correction technology is no longer counted on the fingers of two hands, and each has its own pros, cons and pitfalls, which are often kept back.

    In this regard, the blog of Dr. Shilova’s ophthalmologic clinic (you read this article in it), which appeared on Habré in 2016, turned out to be salutary. Surely many of you still remember the terrible picture of the eye, which stood before the kata in the first publication :) Since then, I read the blog of this company from cover to cover, while in the background dreaming about good vision. And it was the blog that helped me decide on the correction method.

    Tatyana Y. Shilova- ophthalmologist of the highest category, microsurgeon, professor, on her account - more than 20 years of practice, more than 30,000 operations performed and a whole infinity of certificates / diplomas / awards on the way to the reception of the clinic.

    By the way, among the awards is our modest HABR AWARDS 2018 for the best blog on health topics. And I think that it is a great honor for the whole Habr that Tatiana keeps a blog with us, which she personally prepares all publications for.

    It is easy to guess where, to whom and why I turned :)

    A few words about laser correction ReLEx SMILE

    In general, the name of the technology smacks of dentistry more, but SMILE stands for REfractive Lenticula EXtraction / SMall Incision Lenticule Extraction in this case. The method of vision correction by removing the lenticles (optical lens) through a small incision of the cornea, which is formed (cut) by the VisuMax femtosecond laser.

    This technology was developed in 2006 by German scientists headed by Professor Walter Sekundo - one of the world's coolest ophthalmologists, who also conducts operations in Russia (just in the clinic of Dr. Shilova).

    Let me steal two paragraphs from Wikipedia:

    The key difference of the SMILE method from other methods of laser vision correction is the possibility of vision correction both without the need for flap formation, performed when performing Lasik / FemtoLasik vision correction, and without corneal epithelial surface displacement, performed when PRK vision correction is performed. .

    When performing vision correction according to the ReLEx SMILE method, in one step, using a single femtosecond laser, a lenticule (a precisely calculated optical lens) and a small corneal incision through which the lenticular is removed is formed in the inner layers of the cornea.

    If you wish, you can read more about this technology in the blog: introductory part and continuation with the description of the whole process with telemetry. In this article I will not describe in detail what and how, so as not to repeat, but I will go straight to the practical part.

    Diagnostics. SB , MNK and imbsh

    Diagnosis is an integral part of the vision restoration process and in my case lasted for several hours. For laser correction, it is necessary to pass an obstacle course of about 10 different devices, after which the doctor selects the optimal technique. You can go through everything in 5 minutes, but I asked a lot of questions and constantly distracted in the photo, because I immediately sensed that I would write something about it all. By the way, the diagnostics was conducted by Dr.Zhukov, an ophthalmologist, Zhukov Konstantin Petrovich, who willingly answered all questions.

    Several devices from the obstacle course, which I managed to take a picture:

    Auto Refractometer - shows an approximate refraction, that is, approximate dioptries that need to be put in glasses to improve vision. Such devices are in every clinic and in most optics stores - if you have ever done an eye test, you have seen this house in the field or a balloon.

    The pneumotonometer is also a familiar device for measuring eye pressure (ophthalmotonus). Contactless measurement - a trickle of air is briefly applied to the eye, and at the same time changes and deformations of the eye shell are recorded.  

    IOL-master - a device for contactless measurement of eye length, corneal curvature and diameter, anterior chamber depth. For me, the surprise was that the length of the eye averaged 24 mm (I have a right one - 24.92, and a left one - 24.74), I thought about 4 centimeters :)

    Aberrometer is a device for conducting a more accurate (than with an autorefractometer) measurement of the quality of vision, as well as for determining the optical distortions (aberrations) present in the human vision system. From this piece of iron you can transfer data directly to the laser setup, with which the laser correction is performed.

    In another room, there was a continuation:

    Keratotopograf - a piece of iron that scans the cornea, that is, the structure on which the operation will be performed. The degree of sphericity and relief of the outer shell of the eye, its thickness (a very important indicator that will be repelled when choosing the type of correction) and other possible pathologies are investigated.  

    Then, if I'm not mistaken, there was another keratotopograph that scans the anterior and posterior surface of the cornea. My cornea was not a bit, not beautiful (as evidenced by the green color in the pictures) - spherical, smooth, unchanged, almost 540 microns thick (the cornea thickness is measured in microns and averages 520-550 microns).

    That's not all :) The next device - phoropter. It automatically changes lenses with different diopters, which were previously manually changed. Here's how it was before:

    But this is how it looks now - with a slight movement of the hand, the doctor can put on any glass. On the side, the phoropter has a built-in projector that projects the desired image onto the wall, be it standard symbols or some patterns, contrasting images.  

    SB. OLS. Imbsh. BYNKM. INShMK - on this line I was already beginning to squint.

    As the cherry on the cake is the Schirmer test, which tests the tears of the eyes. When we blink, the eye is wetted with a tear fluid that has a certain composition. If there is something wrong with this composition or if the tear glands work poorly, then we have an unpleasant bug - SSG, it’s also dry eye syndrome (I was diagnosed this thing for a long time, not a very pleasant artifact), which after a series of operations (like lacy) even more pronounced. In the case of SMILE there is no such thing, so it was another weighty argument in his favor - I didn’t want to run constantly with drops.

    The test is not very pleasant - under the lower eyelid of each eye, special strips of filter paper are inserted, from which the eyes begin to pinch and they tear. On pieces of paper there are divisions, according to which after a few minutes, they are measured by how much they get wet: normally there should be 10-15 mm, I have 5 mm on one eye and 7 mm on the other.

    On this tearful note, the diagnosis ends, all the results are transmitted to Tatiana and she personally studies them in order to determine the algorithm for further actions.  


    The whole text below will be specially written in as non-medical language as possible, since, firstly, I don’t speak it and would have confused something, and, secondly, Tatyana has already written about everything in detail . So first of all I will tell you about the sensations, and you can dig deeper if you wish.

    A few days after the diagnosis, I arrived at the surgery already, brought the results of blood tests - everything is ok. Dr. Zhukov once again does an eye examination (but not so detailed), measures pressure in the treatment room and, if necessary, can add a couple of non-alcoholic drops for calm.

    Then I go to the waiting room, which is called the "aquarium" (because of the glass walls) - they give out a disposable robe, cap and slippers. In front of me in the queue was only one guy-sniper, who came to correct one eye. The waiting time was 30 minutes, but during this time you manage to screw yourself up decently :) The

    operating room is quite large, but it feels small because of the enormous size of the VisuMax laser machine, behind which several people work at once: Tatiana Shilova herself and engineer who is responsible for the technical part of the operation.

    All body movements in the operating room take place under the strict control of another assistant girl, who has everything in the army: a step forward, sat down, lay down, hands on her stomach, bent her legs, closed her eyes, opened, do not twist her head :) She "pours" eye anesthesia - three sets with an interval of seconds at 40. At first, a little tingling, but after a minute you feel nothing, although you can see everything.

    At this time, the surgeon with a voice that instills confidence in the success of the operation, gives instructions on how to behave and what will happen - this is done before each operation individually for each patient.

    Then the “bed” drives under the laser installation, where the preparatory work continues: Tatiana secures the upper and lower eyelids with a special film, and then sets a clever cliprazzhim, which maximally opens the eye and eliminates the possibility of blinking By the way, no blinking reflex occurs; You can crawl the eye, but do not want to.

    Further, as they say, “everything is simple” :) The patient drives under the laser machine, and the professor tells what will happen now. I listened to this moment, because there were thoughts of a slightly different order in my head. An “eye” with a green dot approaches the open eye, approaching ... The

    laser works for 25 seconds (or, more precisely, from 20 to 24 seconds). The first 15 seconds it can be seen, the remaining 10, then before my eyes a white screen. Milk. The surgeon, while the laser is operating, talks and warns about the moment before which the “milk” appears.

    Actually, this is the most psychologically difficult moment - to be conscious and to see with your own eye how you stop seeing :) In childhood we were told “ do not shine with a laser pointer in your eyes, ruin your eyesight ” - we shone and nothing happened. And then they shine with a laser in just 15 seconds, you stop seeing anything. As if the T-800 terminator, in which the T-1000 sticks in a crowbar, the picture rushes to a point and disappears into the void. And the very understanding that you routinely stopped seeing like this, hmm, a little scary. A little - because you are conscious and unwittingly reassure yourself that everything is under control, that it should be so and that you are not somewhere in the subway.

    And in a minute everything is corrected. The laser leaves, and the doctor makes a small (2-2.5 mm) incision and with a special spatula separates the laser-formed film - the lenticule. Sorry, if someone reads the post for dinner :)

    Then it is taken out of this tiny entrance with tweezers and, ahem, disposed of. But no, I for some reason asked to keep it as a keepsake - if I don’t like it, I can always shove it back :) Then a couple of drops of saline and light stroking of the cornea, “pain in a cat, pain in a dog”. This is done to smooth out the upper "cap" in the cornea for uniform straightening.

    Then the first eye is closed, the second one is opened and the sequence of actions described above is repeated.

    Painfully? Absolutely not. From “theirs” and “chuchut” it is much more painful :) As soon as the second eye is operated on, the assistant commands the “rise” - you get up and see the smiling faces of people who, after such an invasion, seem like relatives.

    Then give 10 minutes of respite in the rest room, where you have to lie down with your eyes closed. I haven't been on vacation for 5 years, so I appreciated it. And then everything, you can go.

    My mistake was that I arrived by car and was full of hopes to leave on it (it was not recommended to do this verbally and in writing, but I took it not as a ban, but as a recommendation). Quest is quite doable, but there will be little pleasant. Abnormally small. The fact is that anesthesia passes after 30 minutes (10 of which lay in the rest room), and then the eyes begin to hell watering. I was warned about this, but I thought "let them water as much as they like, wipe them with napkins . ” In this case, having missed the moment that they will water from the fact that they will be tweaked. To pinch, again, hellishly) If you call them by their proper names, it is not “a grain of sand in the eye,” about which everyone writes, but the onion rings of her mother’s son’s girlfriend, who are right in front of her eyes. And with such special effects I had to go sneaking 40 km, as luck would have turned out to be an inclementingly sunny day :) I was riding in two sunglasses, as I could have hung the windows with clothes and still sobbed like a beluga. It is like a toothache, from which one cannot escape anywhere - even if you close your eyes, the light from somewhere is “felt”. But in general it is all individually: someone has more watery eyes, someone less.

    I arrived at the parking lot and closed in the garage, where it was perfectly dark and cool :) And when I woke up, everything was already ok. It was just bright, until the evening was like sunglasses. A small shroud is due to the bubbles left over from the laser. In the evening you pay attention to the unusually large halo effect around the light sources. The very next day, no shroud, the special effects subsided, and before our eyes - a new life.

    Within a few weeks, you need to drip drops into your eyes (given out at the clinic), accelerating the process of restoring the eyes. According to the treatment plan, three types of drops alternate: Dex-Gentamicin (broad-spectrum antibiotic + anti-inflammatory component), OKVIS (eye tissue protector) and Dexamethasone (anti-inflammatory) - from the second week. 1 drop several times a day.

    The full term of rehabilitation is 3 months, but this is already talking about something at the molecular level - after three days I did not experience any discomfort. And now I understand that everything I probably even liked.


    To the best of my knowledge of Photoshop, I tried to visually show what was and how it was:

    As I saw it before: from the house opposite you can see cars and their outlines, but most of the models are indistinguishable, the numbers are even more so. If someone waves from the balcony opposite - then I immediately wave back and only then try to count on the floors who it was. On the playground, it is clear that someone is running, but who exactly is hardly distinguishable.

    As you can see in the first hours after the operation: you see clearly, but in the eyes of the veil - because of the gas bubbles that form during the operation.

    As you can see the next day. Everything is cool, no artifacts.

    What the light sources look like on the first day after the operation:

    A week later, the glow effect around the sources became noticeably less.

    According to the results of the last check in the clinic, the vision is 120-150%. Someone will ask, “ what the hell, what's another 120-150% ?! “, But what arithmetic turns out to be: the tenth row of the standard table for eye examination corresponds to 100%, but in some cases the resolution of the retina allows you to distinguish smaller objects - I have from 2 to 5 additional lines. I do not believe it myself, but the doctor / device does not make sense to deceive me, and I don’t want you :)

    In the end, we talked with Tatiana, I asked her various questions. For example, how she sees vision correction in 15-20 years - it was interesting to hear the opinion of the professor. Tatiana said that she had just returned from the University of Newcastle, where the planned meeting with her colleagues, who finally managed to print the cornea of ​​the human eye on a 3D printer, was held - perhaps this is the way to develop vision treatment.

    Also suggested several topics for posting to the blog. Believe it or not, but Tatyana writes all the publications on Habré herself - she likes to write, but she has the same problem as all of us - only 24 hours a day. Anyway, Tatyana received the award “The Best Blog on Health of the Geek” as much as possible and I wish her even more creative success.

    Friends, you have no idea what a thrill it is to find something that I already thought to be lost to some degree. I have a professional deformation - lying under the laser, I actually thought that it would be interesting for someone to read about this experience, tried to come up with some metaphors and ideas with photos. But so far, I have not invented anything worthwhile - all the analogies are somehow fresh and faded. Well, for example, a new iPhone comes out - you take it in hand, the wow-effect lasts a week, and a month later a new smartphone comes out and you understand that the positions of the iPhone have been shaken. And the returned sight is not a gadget, not a sports car or anything else that you can touch or share - it is some kind of other matter that no one else sees you. If you have poor eyesight - postpone the purchase of the next iPhone, MacBook,

    I asked Tatyana Yuryevna how I can thank her. She asked if I could record a video review - I never recorded it, but of course I can, what questions! But I began to try to record something on the front camera and very soon realized that my internal censor would not miss such content. Therefore, one day I caught a friend and together with him we recorded a video clip in which there are answers to frequent questions, a fragment from the operation itself and, of course, many thanks to Tatiana and her colleagues from the “ Doctor Shilova Clinic ”:

    Take care of your eyesight!


    - My experience in restoring vision
    - Dr. Shilova’s blog on Habré
    - Telemetry from a laser for correcting vision: a complete operation with comments (not for the faint of heart)
    - A laser that cuts inside the cornea: ReLEх procedure at the physical level
    - Large FAQ about different types of correction view: all questions geeks in one place

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