Surgery day, hour by hour

If you wear soft contact lenses, you remove them 48 hours before the procedure and go back to your glasses in the meantime. A contact lens slightly changes the surface of the cornea, and the measurements on surgery day must be taken on your cornea as it really is.

For rigid lenses, it is decided case by case. We generally check with repeated topographies to make sure the curvature of the cornea is no longer changing. I tell you the timeframe during the consultation; it depends on how long you have worn them.

The surgical file

You leave the consultation with your file: the appointment notice with the date, time and place, the pre-operative and post-operative prescription, the consent form to bring back signed on the day, and the quote to send to your complementary health insurance.

Two things to do before leaving home: sign the consent form, and pick up the eye drops at the pharmacy. We take care of the rest on site.

The day before

Do as you usually do. There are no particular restrictions, neither on food nor on drinks.

If you know that stress will keep you from sleeping, you can take an anti-anxiety tablet the evening before, in addition to the morning one. It is not mandatory. Set an alarm, as you may sleep heavily.

The morning

You eat and drink normally. Have a good breakfast. Anesthesia is done with drops; there is no injection and no general anesthesia, and therefore no fasting.

The anti-anxiety tablet is taken about one hour before your appointment time, so that it has time to work. Its purpose is for you to arrive relaxed and let things happen during surgery, without being tempted to move. You will feel a little slowed down, which is the intended effect, and it has no long-term consequences for your health. It will also help you take a good nap when you get home. It is not mandatory: if you are confident you can come in relaxed, you can do without it; just tell me when you arrive.

What to wear

Come as you are, in comfortable clothes. You keep them on throughout the procedure. We add a sterile gown over them, a surgical cap and shoe covers. There is no undressing and no hospital gown.

Before surgery, scrunchies, buns and ponytails come out. You will be lying on your back, with your head on a headrest, and the surgical cap needs to fit properly.

As for eye makeup: even with thorough makeup removal, it is best not to wear any the day before, because some may remain at the time of surgery.

What to bring

Your signed documents, your means of payment, your prescription glasses and a pair of sunglasses, which will keep the light from bothering you when you leave. Travel light; your belongings will be kept in a locked locker while you are in the operating room.

You have already had a complete assessment in consultation. On the morning of the procedure, an orthoptist repeats two or three tests, which are used to program the laser.

Aberrometry. It measures how your eye processes light, beyond the simple correction in diopters.

Reference imaging of the iris. A photograph of your iris is taken while you are sitting up. It is used first for iris recognition: before each laser pass, the machine recognizes your iris and confirms that it is treating the right eye with the right profile. It is also used to correct cyclotorsion, the slight rotation of the eye that occurs when you go from sitting to lying down. This is what makes it possible to apply an astigmatism treatment on the right axis.

Pupillometry. The diameter of your pupil is measured in different lighting conditions. This value determines the size of the optical zone I will treat.

These tests are painless and take a few minutes. You rest your chin on a chin rest and look at a small light.

You lie on your back, with your head resting in a headrest. We adjust the position so that you are comfortable and well centered.

The skin around the eyes is cleaned with an antiseptic, then an adhesive sterile drape is applied that leaves the eye to be treated exposed and keeps the eyelashes out of the way. A small eyelid speculum is put in place to hold the eye open. It is what keeps you from blinking during the procedure. It does not injure the eyelids. The eye that is not being treated is protected.

What you feel

You feel my hands touching your face and your eyelids. That is the main sensation during the procedure.

At times you feel pressure on the eye, especially during the few seconds when the eye is docked to the femtosecond laser. Some describe it as a finger pressing on the closed eyelid.

You feel water running, because the surface of the eye is rinsed regularly. It is cool, and it is surprising the first time.

You see lights and blurry shapes. Your vision sometimes darkens to almost black for a few seconds at the moment of docking, then it comes back. I warn you just before. You will not see an instrument coming clearly toward your eye, rather shadows floating in your field of vision.

You hear a sharp, regular crackling while the excimer laser is working. And you notice a somewhat unusual smell, which comes from the reaction of the air to the laser.

What you don’t feel is pain. At most a tingling here and there.

Throughout all this, I talk to you. I tell you what I am doing, how much time is left, and what is going to happen.

With LASIK

The sequence is the same for each eye. The Visumax 800 cuts the corneal flap, which takes 8 to 10 seconds. This is the docking phase, with the pressure and the darkening of vision. I then lift the flap, like turning the page of a book, and you then see a diffuse light. The Schwind Amaris 750S sculpts the cornea for a few seconds, tracking your eye continuously. I reposition the flap, rinse, check that it is properly in place, and we move on to the second eye.

With SMILE

Everything is done on the Visumax 800, with no change of machine. The laser cuts a lenticule inside the thickness of the cornea, as well as a 2 to 3 millimeter micro-incision. The cutting takes about 14 seconds per eye. I then separate the lenticule and remove it through the micro-incision, then rinse.

With TransPRK

There is no flap and no docking. Everything is done with the Schwind Amaris 750S, without contact with the eye. The laser removes the epithelium, the surface layer of the cornea, then sculpts the stroma in the same pass. There is no strong pressure and no complete darkening of vision. At the end of the procedure, I place a bandage contact lens on each eye, which protects the healing area during the first few days.

How long it takes

About ten minutes in the room for both eyes, including setup, for a pure operating time of about one and a half minutes per eye. The rest is the time between each step, getting in and getting out.

You will not be able to drive after the procedure. The morning tablet makes you drowsy, and your vision is not yet good enough.

You go home with someone accompanying you, or alone by taxi or ride-hailing car, which is what most of my patients do. On foot if you live in the neighborhood. Public transportation is not forbidden; it is simply less pleasant with the light and the watery eyes. When a car is possible, it is more comfortable.

After TransPRK, the first few hours are more uncomfortable, and it is preferable to have someone take you home.

If you are coming from far away

Some patients come from elsewhere in France or from abroad and go back to their hotel. That is entirely possible. Plan to be in town for the check-up that follows, and keep my number handy.

The person accompanying you stays with you during the waiting and preparation time. They go with you as far as the entrance to the preparation room, and do not enter the operating room, for reasons of asepsis. They then meet you at the exit.

There is some flexibility on this. If you have a particular need, a disability, a language barrier, talk to me about it beforehand; we adapt case by case.

Coming with someone is not mandatory. It is nicer to have someone with you, but many of my patients come and leave alone, by taxi or ride-hailing car. If you are having TransPRK, I advise you to arrange for someone to be with you.

Allow one hour to one and a half hours in total on site. If the person accompanying you cannot stay the whole time, arrange to meet them one hour after your appointment time.