Living in a city like San Francisco is a nigh-constant assault of people in pain that want so much. Like most people, I learned to screen it out. I walk through the streets as if they were empty, clenched, haunted by a vague anxiety and fear.
While this is by no means healthy, this makes it less energetically expensive to leave the house. It still was hard, so for years, my goal was to get better at two things:
Avoidance. Noise cancelling headphones and poor vision meant I actually don’t see or notice people around me. Just pretending doesn’t work, since subconscious movements and eye patterns will give you away. I also walk very quickly, so no one has much chance to engage with me.
Boundaries. Getting better at refusals, saying “Sorry, no.” Having a policy not give money to people makes this easier. I break it sometimes when I feel like it or want to encourage things I like (like a cat on their head, great musical talent, raw charisma, or something that makes me feel genuinely good)
A few weeks ago, a friend of mine dropped off a box of delicious sandwich leftovers from their company office, more than I could eat. It seemed like a good idea to hand them out to people on the street, so I did. There were a couple immediate differences when I did this.
Seeking. I was on the lookout for people who might want these sandwiches. When I came across someone and they asked me for spare change, I was pleased! I could offer them a delicious sandwich! It was a positive, not a negative, that they were requesting my attention. I was a lot less afraid. I was also surprised that it took so long to give out the sandwiches. When I’m avoiding, I feel as if there are people on every block. But when I was seeking them out, I realized that some people I thought were omnipresent were only there some days of the week.
No, But. I had something of value I wanted to offer. Interactions were positive sum, relieving me of unwanted sandwiches and reducing waste, plus the people who got the sandwiches were quite happy about them. I was worried they’d be offended and prefer money, but this didn’t happen. I didn’t feel any guilt or awkwardness.
This made me wonder: If I had something concrete I could offer people that they would be happy to get over spare change, this would reduce a lot of my anxiety of living in a city. Ideally, this would be relatively cheap for me to provide and easy to carry everywhere. A pleasing social experience is probably the best thing, though I don’t know how to comfortably provide those on the fly.
Luckily, I got another box of sandwiches a few weeks later. Much of the same thing happened. I felt a lot less fear of engagement with the people around me. When my favorite camp had disappeared, I was surprised to find that I was disappointed.
This is the opposite of dissociation. Instead of assuming all of the sensations around me would be negative, I paid attention. I realized that actually, yes, I did like the feeling of being around some of these people and camps more than others.
I haven’t gotten any free boxes of sandwiches lately. But even now, when I recognize someone or spot my “favorite” tents, I tend to feel more interest and calm acknowledgement (or even curiosity) than avoidance and anxiety.
There’s still a ways to go. My next step is to have actual conversations with the people I’m curious about. I’ve only dared to with sandwiches in tow.
I got Lasik eye surgery a month ago, early May 2019. Since then, my vision has been between 20/20 and 20/15. It is somewhat baffling to me that my vision never stops being good. Contacts get dry and the world clouds up as the day goes on. Glasses get dirty. My imagination was underprepared for the reality where my vision is excellent from when I wake up to when I go to bed, full stop.
Making the decision
Making the decision took several months. I knew for years that I wanted Lasik when I was old enough, and at age 23 I was taking the decision seriously. I had stable -1.50 vision in both eyes, bad enough that I couldn’t drive but not bad enough that I needed to wear contacts or glasses all the time.
The main questions were:
Would it be worth it if my vision isn’t that bad to begin with?
PRK or Lasik?
Are negative side effects likely? (Dry eyes, poorer night vision)
Is my age an issue?
Which surgeon should I go with?
The people who tend to say that Lasik is worth it start with terrible vision. Mine was only mediocre, so it was less clear up front.
“Going from -1.5 to 0 means you lose about an inch of sharpness at maximum closeness (2 inches from your eyeball) and you gain the entire world from 2 feet to infinity.”
Mars Van Voorden
The consensus I found from talking to friends who had gotten Lasik was that I had more to gain, especially with modern techniques and a good surgeon.
PRK vs Lasik: I considered PRK as an alternative to Lasik. The benefit of PRK is that it does not create a flap in the cornea, so the flap can’t be dislodged. In my first consultation, I found out that there is a lot more pain and risk of infection from PRK. Also, surgeons are less experienced at doing PRK. In hindsight, the pain of Lasik was enough for me. PRK sounds miserable.
If I did a lot of martial arts or contact sports or thought I would in the future, that may have tipped the balance. But even then, the corneal flap heals to around 90% of original strength within a few months (according to one consultation). One reason the flap is less of an issue is that a blade is no longer used to cut the corneal flap. A laser is used instead, which promotes healing better than the smooth knife cut.
Age: I’m in my early 20s. My optometrist was concerned about my age, since my prescription might still change in the future. Both consultations that seemed to think this was a non-issue. I knew for myself that my vision had been consistent for the past 10 years, so I judged that it was okay. If it does change within the next few years, I can get a corrective Lasik surgery. I hope I don’t have to. One thing that reassured me is that my mother and grandmother both got Lasik to great success.
Dry Eyes and Night vision: Most friends I knew with Lasik didn’t have problem, and the ones who did still felt it was worth it. I felt confident about the machines and skill of the surgeon I went with, and feel like this reduced my risk of side effects.
I was concerned about halos and worse night vision, but at the second consultation they explained that the new state of the art in Lasik could actually improve night vision.
One of my very trusted friends said this about night vision: “It got more like I was on acid all of the time. Lights are just brighter and more dominant than they used to be and finding things in true darkness is harder. I was also one of the last to get hand cut eye flaps, night vision is supposed to be improved in current generation all laser Lasik.”
Which surgeon: Two friends of mine had gotten Lasik from the same surgeon. A benefit was that it was cheaper than average in the area, which to me implied that the surgeon did more surgeries and thus had more practice. The machines they used in that office seemed to be the state of the art, the same ones used at the Lasik center at Stanford. The two friends also had no meaningful side effects.
Other considerations: With a low prescription like mine, there was a higher chance of having better than 20/20 vision.
I asked a lot of friends about this to see if I was missing anything big. Someone explained diopters, and how I would lose some ability to focus close up and need reading glasses sooner than otherwise. There were some stories of knowing someone where things went wrong, but many more personal anecdotes of Lasik being worth it.
Something I didn’t take into account was safety. I am much less likely to get hit by a car now, and feel a lot safer walking around city streets.
There are some downsides that might show up later on, but so far, Lasik seems very worth it.
Timeline of Subjective Experiences
The first four hours were incredibly uncomfortable. The eye numbing drops wore off around 20 minutes after the surgery. Opening my eyes was too bright. Even with my eyes closed, everything was too bright. This pain lasted for around 4 hours. During that time, all I could do was sit with my eyes closed while my body focused on healing.
The rest of day one, I was zoned out from Valium but was able to keep my eyes open enough to barely participate in my weekly Dungeons and Dragons game. After I could get my eye open, I could see things clearly, including screens and things up close. I did have to blow my nose every 15 minutes from the constant tearing.
On day two, it shouldn’t have been a surprise then that I got a cold. The valium, stress, and the constant tearing of my eyes at first led to a week-long feeling of clogged sinuses. I was pretty relaxed about it. Valium lasts a while.
Day three, I bought a pair of sunglasses. I found the darkest ones I could that would also block out UVA. Even then, the world was too damn bright. I was worried that I would be overwhelmed by people on the street and making eye contact with them, but this is entirely solved by wearing sunglasses. Also, I can see people from further off and avoid them more effectively. This isn’t an ideal strategy, but it’s how I cope with living in a city right now.
My eyes were no longer tearing. They were dry sometimes and uncomfortable, but not what I would call pain.
Later that day, I got bitten by a small dog. It was a small bite that didn’t break the skin but left a bruise. I broke down completely, barely able to speak and still hold back my tears. This was confusing! I knew that I didn’t care that much about minor pain. It wasn’t about the dog. I retreated somewhere private and sobbed for around 10 minutes before being able to interact with people again.
Something about that minor physical pain triggered a release of all of the numbed discomfort from the surgery. I had felt grief or loss about my old eyes since the surgery. My eyes had been trying very hard, and they weren’t good enough for me? That feeling of grief went away after crying.
This was also around when the Valium wore off. A thing I had to keep in mind was that Valium would interact with alcohol, making each drink dangerously more potent.
A week later, my eyes no longer felt like I had left contacts in them for several days. I thought “dry eyes” would feel dry, but really, it means itchy. I feel strong urges to rub my eyes every other day or so, and when I do, I put in eye drops.
One strange thing I noticed was that my hearing seemed to be better. The spatial cues in my environment or subtle lip-reading made some sounds feel louder. This could also be from freeing up processing power in my brain, now that interpreting my visual environment is so much easier than the interpolation and guessing from before.
Three weeks in, I’m still slightly sensitive to light but not in discomfort in the same way. Up until 2.5 weeks, I was wearing sunglasses outside every day, rain or shine. I no longer feel the need to when it’s overcast, but I think that sunglasses will be a larger part of my life now.
One nice thing about sunglasses I bought is that my vision is so clear that I can use the sides of my sunglasses as rear-view mirrors, and get a sense of what’s behind me without turning my head. This gives me a huge amount of extra spatial awareness I’m still learning to integrate, and when I don’t wear sunglasses I sometimes miss it!
I used to get headaches often. Getting Lasik reduced the amount of headaches I get. I now can pinpoint headaches down to more specific things, like reading in low light or looking at my phone in a car.
I also think this is helping my social skills significantly. I’m picking up and responding to a lot more cues from people. I have had less social anxiety since, and I hope it stays that way.
My depth perception and spatial awareness is a lot better, and this makes me feel less anxiety in general.
I feel freer in a way that is hard to pinpoint. If I were sent back in time, I wouldn’t have to worry about my vision. In the zombie apocalypse, I’d be able to spot them coming from afar. If I wanted to be a dirtbag traveling the world, I could do that all while seeing clearly. At festivals, I no longer will have to choose between seeing clearly and experiencing the pain of dust and sunblock that came from putting on contacts in a camping environment.
I’m a little disappointed that at no point did I get a feeling of euphoria from seeing clearly. No joyous “you’re free now,” or “this is so beautiful.” Instead, I get a few pings a day like “That’s convenient. You can see that person’s expression,” or “I guess it is kind of cool that you can see all of those nice rocks and trees right now.” I’m holding out some hope that my neurochemistry will change and that I’ll get a moment of euphoria when I look out at clear stars in a wide night sky.
Six months later, I’ve jumped in Barton Springs without a worry about my eyes, blinking water out them, and could see my friends smiling from a distance. But Lasik hasn’t been without drawbacks. If I am dehydrated, in a plane, or near a chlorine pool, my eyes get dry. Reading on my computer for 4+ hours will do this. It’s uncomfortable until I put in eyedrops, and if I don’t have eyedrops immediately on hand it’s stressful.
This seems to be getting better over time. We in our chronic screen dependent lives all have dry eyes to some extent, and long-term contact wearers deal with this too. It’s changing my relationship to screens in a way that I hope is for the better.
Many parts of the world are not beautiful. Still, I am not looking away. I feel safer, and brave in choosing to experience the world more fully.