LASIK recovery and climbing

I just got LASIK (eye surgery) done a week ago, and am wondering if anyone knows much about recovery specifics, particularly with climbing. Perhaps someone on here is an eye doc or has gotten thorough answers from a climber doc.

The surgery went great, no complaints, I'm psyched. Thing is, all the O.D.s, assistants, the handouts they gave me, and most info on the web says to take a week off from strenuous exercise, and then you can basically go for it (but wear eye protection; I guess falling debris and such is a big concern). Sounded fine to me, but I also wondered what they define as "strenuous exercise." Also, none of them are climbers, and so my eye surgeon was (naturally) a bit more conservative in his recovery advice than the "go for it after a week" guidelines... So, I'm a bit confused and chomping at the bit, but of course I realize this is important stuff and I don't want to screw it up. My surgeon seems great and we're going to speak more about this, but I'd welcome any other informed advice.

Is there something about changes in blood pressure with strenuous exercise that can mess up the healing, even after the first week? I tend to push myself fairly hard in training, am very devoted to it (and climbing), perhaps moreso than what's considered "strenuous exercise" in the general population. Lots of high-intensity intervals, hill runs, lifting, blah blah, where my heart rate often gets between 90-100% of max. I'll often incorporate some of this into solo climbing circuits, and I regularly do full days of climbing with a partner.

Then there's the actual climbing, which is probably less of an issue (probably high blood pressure with hard bouldering moves and such, but I rarely do that type of climbing) except for, perhaps, leader falls, like if there's something about the gravitational changes, acceleration/deceleration, etc. Maybe I should just top-rope and solo for awhile (how long?) before risking leader falls, but I'm unsure.

Thanks for any advice.

Kelly, hey good to hear from you. I had LASIK done a few years back. Much better than getting sand under the contacts and corneal abrasions multiple pitches up. A few other doc/climber types I know had it done, too. While I'm no ophthalmologist, I did check it out a bit. As with any healing, there is a curve to it, probably closer to logarithmic. Healing actually continues up to a year from mitosis studies in wounds. Funny thing is that ophthalmologists who do reLASIK touchups find that the cornea definitely lifts more easily along the microtome incision line than intact cornea, even years later. A decent amount of healing is done by 2 weeks. You do need to let things heal before having any significant stress applied to any wound. The challenge is that if you knock off that thin corneal layer & lose it, you could set yourself up for needing corneal transplants (bad). The main things you don't want to have happen in the early part of healing here is to apply a shearing force which could lift/rip off that thin corneal layer. So, no rubbing your eyes for like 6 months, especially for the first few weeks. You don't want to expose your eyes to falling objects for the first month or so. Be careful with bushwhacking. Use protective eyewear, especially on ice or in backcountry situations. That's part of why I use that ice visor you've seen me use. Sleep with the protective eyewear they give you for the prescribed time. Hope that helps.

Thanks tons, Leo!

Hey Kelly and Leo,

I remember reading somewhere that corneal surgeries can affect how well you see at high altitudes - like above 25K. Anybody confirm this?

Lee

I don't know much about it, but I've heard that was only true for the old style surgeries that they don't do any more.

Disclaimer: I'm not an ophthalmologist, but I've been running a laser center for 11 years and have worked with almost nothing but eye doctors for the last 26 yrs.

Kelly, strenuous exercise won't be an issue after a week. I'm more concerned about infection in the first several days with sweat and foreign objects (hair, hats, hands, birdcrap, etc.) That's not much of a risk since you're on antibiotics for the first week. Trauma is always the biggest risk. (I'm talking rubbing, gravel, twigs, etc.)Taking a whipper isn't going to generate exotic forces on the flap unless you hit something with your eye; obviously you want to be careful. Raising your blood pressure is a risk for intraocular [inside the globe] surgeries. Most docs warn patients off skiing for 2+ weeks to "be safe" in the event of a faceplant. All docs encourage eye protection; good sunglasses are required in Colorado as UV/IR is a risk factor for eyes.

Leo, for the fun of knowing, we've sometimes lifted 10 year old LASIK flaps for retreatments. It's not common, but it is possible if you have the instruments to do it.

Lee&Zach: "Old" RK surgery is notorious for its fluctuations at altitiude. (That's why pilots were not allowed to have RK surgery.) The FAA does allow pilots to have modern excimer surgery (LASIK or PRK) because it doesn't significantly decrease the structual integrity of the eye or induce visual changes w air pressure.

Hope this helps. Rob.

Thanks for the links, Mike, and to Leo and Rob for the great info.

Lee, I'm certain that the altitude problems are from radial keratotomy (RK), the "old" style of eye surgery. I guess some people get vision problems at super high altitudes anyway, but the "new" style (LASIK) doesn't seem to be an independent factor with altitude problems. I looked into this a fair bit before getting my eyes done, and I have some friends who've climbed really high post-LASIK without problems.

I talked with my surgeon today, he was great in explaining everything and answering my barrage of questions. FYI, in case you're thinking of LASIK and the questions I asked are of interest to you (edit: I now see that lots of this is redundant to what Rob wrote, sorry!):

It sounds like, indeed, the healing of the flap (the cut they make along the cornea before the laser reshapes things) is the big concern. For one, the more active you are, the greater the risk of getting hit in the eye -- like Leo mentioned, think bushwhacking, falling pebbles, dust, gear/rope smacking you, etc. Flap-damaging risk from a rise in blood pressure isn't a big issue, but when people perform the "valsalva maneuver" (holding your breath upon super hard muscular exertion; weightlifters do this all the time, and it probably happens on hard climbing moves, too) that can, in fairly rare cases, disrupt the flap. Such intense, static contractions while breath-holding increases thoracic pressure and all these other things up through the head and eyes, just like like those cartoons--and real-life characters--with the bulging neck veins and eye sockets... Apparently it's important to not overdo that too soon, but it rarely causes a problem.

My surgeon didn't think the g-force risk (I don't understand g-forces, or what they could be in a leader fall -- anyone?) is much of an issue. He said they don't operate on F-16 and F-18(?) pilots due to the g-forces, but suspected that a leader fall only generates a couple of g's, which wouldn't cause a problem. Of course, however, you aren't in control when whipping off something, as Leo reminded me in an email.

My surgeon also said that the flap heals rapidly, at least most of the healing does. It's a logarithmic deal, as Leo suspected, with something like 80% of the sealing happening the first day, then 86-88% by 3 weeks, and like 95% (or maybe it's 98) after about a year. So, in these first couple of weeks Dr. Christianson (my surgeon) just cautioned me to work back up to my baseline in case I was one of the rare instances where too sharp a rise in bp from exertion could cause a problem with healing of the flap. Things like more moderate-intensity outings, even if prolonged, sound like they'd be better than the shorter super-high-intensity things. And overall, the main thing with LASIK recovery definitely seems to avoid direct pressure on the eye from contact, like Rob wrote--no rubbing the eyes, don't do those super hard squeezing eye blinks, wear eye protection when exercising for the first several weeks to a month. I suspect we normally get more crap in our eyes than we realize, and this sounds like a big concern in the initial phases of LASIK recovery. Hopefully I didn't misrepresent any of my doc's words here; I think this is pretty accurate.

I'm too lazy to go back and edit my above babbles, which are now fairly redundant to Rob and Leo's info -- but hopefully all this helps folks in the future.

Excellent points Rob & Kelly. To address the issue of RK (radial keratotomy), that cut quite significantly into the cornea (50-80% of the thickness - as I was told). That weakened the integrity of the cornea, which allowed it to bulge at low atmospheric pressures (recall Dr. Weathers). LASIK cuts much less of a percentage of the cornea, which theoretically diminishes the potentially for eye/corneal bulging at low pressures. RK also has the potential to permit disruption of the globe/eye with direct blows. Hence, LASIK is an improvement in structural strength regard. However, RK has the benefit of lack of a flap (eliminating the catastrophic potential of losing the corneal flap). Hence, RK has the benefit of negating the potential for abrupt need for corneal transplant. Contact lenses obviate the above risks, but do have the potential for temporary loss of acuity with loss of lens or corneal abrasions from trapped particles (like Windgate) between lens & cornea.

FWIW, my wife & I elected to undergo LASIK some years back.

Leo and anyone else interested,
I've never heard of anyone actually "losing" a LASIK flap, since it is about 20% attached with full thickness cornea. The biggest statistical group for a dislodged (slipped) flap after a few weeks, used to be from a "fist blow." (Who did they hang out with?) BTW those RK incision are typically 90-95% depth of central cornea and probably way more corneal transplants resulted from RK than have ever resulted from LASIK. I'm not sure I can think of any doctors who would still do them at all in this day with all the other choices.

I had LASIK 8 years ago and have long since stopped counting the number of face plants I make skiing. (3 today, in fact.) They're pretty stable and become more stable over time.

For those who have an aversion to the LASIK concept, I would proudly suggest PRK (the first laser procedure approved by the FDA). No cuts, no flaps, just outstanding results. Almost nothing can go wrong, ever. (The military does almost nothing but PRK, and they probably do more Laser Vision Corrections than anybody. PRK's are stable.) I suggested PRK for my brother, a policeman, for that reason.

Lastly, corneal transplant is not the first line treatment for a slipped flap. Typically the flap is refloated into place and allowed to reheal. Sometimes temporary sutures are required. Sometimes the flap is removed (surgically) and then they heal just like a PRK. Corneal Transplantation is generally reserved for the types of cases that maybe shouldn't have been done in the first place with undiagnosed corneal disease, severe neglect, or trauma afterwards.

An interesting factoid you don't hear much anymore is that the FDA approved PRK initially when it became clear that is was safer than contact lens wear! (You'd be amazed at the number of people who put contacts in their mouth or get an infection going under a lens and have catastrophic loss even today.)

Thanks, Rob, super interesting stuff.

Given those benefits to PRK, why isn't that more common than LASIK? I assume there must be some downsides to it or else it'd be the preferred treatment for everyone. Can't remember, but maybe I read somewhere that the recovery time is much longer?? Or maybe it's more expensive?

Rob, interesting points. The ophthalmologist (Canadian who had done the 2nd most LASIK in N. America at that time ~22K, ~6y ago) who did mine told me about the corneal transplant issue for lost flaps (where it was torn off and no longer salvageable). It got my attention given the things I like to do and where I go. I've seen dislodged flaps professionally. Again, I'm not ophthalmologist. As an aside, it was pretty amazing back in '89 when I visited Russia and saw the conveyor belts at the 2nd Pirogov Moscow Medical Institute with patients getting RK. Also, I had worn contacts ~22 years with plenty of insertions into my mouth for cleaning in the field (not that I recommend it). FWIW, no corneal infections, lucky me.

Kelly Cordes wrote:Thanks, Rob, super interesting stuff. Given those benefits to PRK, why isn't that more common than LASIK? I assume there must be some downsides to it or else it'd be the preferred treatment for everyone. Can't remember, but maybe I read somewhere that the recovery time is much longer?? Or maybe it's more expensive?

Common in the military, where they don't do LASIK on pilots or navy seals (etc, methinks). I had a chance to chat with someone who worked in San Diego as a contractor about eye surgery. They compilled research data and had some interesting opinions on the different surgeries for which they apparently have a ton of data (military folk sometimes = lab rat perhaps). Said, if you're active, that PRK is the better way to go as it was more robust. But, also, that if you tolerate contacts well, to stick with them as the risks were still out there. Anyhoo, was an interesting exchange (and one I can't recall much of...unfortunately). Was thinking about it, as several friends have had their eyes done with good success. But, I do tolerate contacts really well, so, will hold off for now.

Article with interesting info below.

Geez, Kelly, you working on being the bionic man or something? Cheers!

-Brian in SLC

Navy program has been adopted by entire military

San Diego's large military community will continue to benefit from a growing U.S. Department of Defense funded program that provides free refractive surgery to medically eligible active duty servicemen and women.

While most near or farsighted individuals struggle with contacts in front of the bathroom mirror, military personnel deployed to Iraq often battle 120-degree temperatures, gusting winds, sand storms and spartan accommodations. Similarly challenging is the fact that glasses interrupt the seal of protective gas masks, they scratch and they trap dust and dirt.

"Those are just a fraction of the issues that face our active duty forces," said Capt. Steve Schallhorn, ophthalmologist at the Naval Medical Center San Diego. "By reducing dependence on glasses and contact lenses, people who have to go into harm's way are better off."

Schallhorn pioneered and currently directs the Navy Refractive Surgery Program and continues to free patients from the burdens associated with poor eyesight at no cost. Active duty from all branches and coast guard are eligible. Once a candidate is approved for the surgery by their eye doctor, the individual's commanding officer submits a request to the program and designates a priority. The applicant's need and job duties determine whether the wait time is weeks or years.

The program has treated 100,000 service members to date, while Navy facilities perform roughly 15,000 procedures annually. The number keeps rising as the benefits eclipse the risks and the technology improves.

"As we treat more and more people, more and more people want it," Schallhorn said. "The fleet, the line, the operational forces have come to appreciate what it can do for them."

Maj. Michael Rohlfs underwent PRK at the Naval Training Center's Primary Care Center in Point Loma during April 2005 after returning from a five-month stint in Iraq. Rohlfs, a Marine stationed out of Marine Corps Air Station Miramar, took advantage of a clinical trial two weeks after his first inquiry. He no longer wears glasses and looks forward to the luxury his new eyesight will afford during his second tour of duty in Iraq this coming August.

"It's made a difference in this portion of my life, but especially when I come down here to the field," Rohlfs said while training in Yuma, Ariz. "It's just so much easier out here not worrying about fooling around with glasses."

The actual application of the laser to the eye lasts between 10 seconds and one minute, depending on the patient's vision. The time consuming work is prepping each patient beforehand. Side effects range from minor eye irritation, such as dry eyes to serious visual impairment.

"There are risks," Schallhorn said. "We have learned how to manage the risks, mitigate against the risks, know what patients may be at greater risks and try to maximize the safety of the surgery in that context."

Recovery time varies with the type of surgery from days to months. Photorefractive keratectomy (PRK) is a surface procedure that requires true convalescence afterwards and a longer visual recovery than Laser-Assisted In Situ Keratomileusis (LASIK) eye surgery. Rohlfs was unable to drive and had difficulty with bright lights for five days following his PRK procedure.

"After the five days, my eyes were healed and I had no more pain and no need for glasses," he said. "Over the next couple of months my eyesight continued to improve. Today I see better than 20/20."

In the early 1990s, the head of Navy special forces catalyzed the program and secured funding after identifying problems with contacts experienced by SEALs (Sea, Air, Land), a highly skilled and mobile unit trained to operate strategically and tactically.

In 1993, the Naval Medical Center San Diego stepped forward as the first facility to offer clinical trials evaluating the safety of refractive surgery among military members. Letters and calls poured in to Schallhorn detailing the difficulty of performing military duties while wearing glasses or contacts. At that time, the procedure was not commercially practiced, as the lasers used had yet to receive Federal Drug Administration (FDA) approval. Following the FDA's endorsement of two excimer lasers in October of 1995, the military program expanded and patients were able to receive the surgery without having to participate in a study.

The Navy's initiative caught on and the Army and Air Force subsequently started their own programs. There are now more than 20 military laser vision correction centers nationwide, seven of which are Navy-operated. The San Diego facility accepts patients from as far as El Centro and Yuma, in addition to servicing greater San Diego County. Recently, a clinic opened at Camp Pendleton for Marines, shortening the local wait time for San Diegans.

Schallhorn argues that there is more to gain from refractive surgery than improved eyesight.

"Enhanced quality of life and moral, while secondary … shouldn't be overlooked in the overall context of the benefit we provide," he said.

For more information, contact the Naval Medical Center San Diego by visiting nmcsd.med.navy.mil or calling (619) 532-6400.

Hi Kelly ~ In regards to "foreign objects, bushwhacking, and general eye protection" I thought I would pass this along.

I wear 'Oakley HalfJackets', when climbing. They're rated ANSI Z87.1 test for high-velocity impact protection. Also cool are the fact that the lenses can pop-out to change color. I use "Persimmon" for climbing ice and a more neutral ones for high-reflective granite. Frame-less around lower bottom area eliminates blind-spots.

oakley.com/brochures/eyewea…
oakley.com/technology/impac…

Best of luck on your recovery ~ Did you find a home for the "Pillar of Spantik" poster yet..?