Laser Tag

I arrive a few minutes early for the procedure. The doctor’s assistant calls me in for a preliminary vision test—the usual kind where you are shown progressively smaller characters until you stop seeing and start guessing. She has me look toward the ceiling and puts a series of drops in my left eye to numb and dilate it.

“Just the one eye?’ I say.

“For today, yes.”

She leads me to an adjacent room, turns out the light, and leaves me alone. I listen in the dark to the symphonic hum of machines — an air purifier, a computer, and the reason for today’s visit, a water-cooled laser machine.

Nearly all people with diabetes eventually develop some degree of damage to their retinas—the thin photosensitive film that lines the back wall of your eyes. In its early stages, diabetic retinopathy, as it’s known, is relatively symptom-free and can even go undetected by an ophthalmologist. I didn’t notice anything wrong with my own eyes for years, but I was eventually sent to a specialist as a precaution.

Trouble first appears as small bulges in the delicate retinal blood vessels. Then more significant abnormalities like hemorrhages start to develop. As the vessels continue to deteriorate, new ones start to grow. But they are weak and cause even more problems. Left untreated, these changes can lead to retinal swelling, detachment, and blindness.

By my first visit with a retinologist, I already had a few areas that needed treatment. Panretinal photocoagulation is the official term, but most call it “laser.” It involves firing an argon laser through your pupil to cauterize the swollen or leaking areas of your retina. It’s done to prevent further damage, but it isn’t a cure. In fact, it’s purposefully destructive, like blowing up a bridge to avoid enemy advancement.

After twenty minutes of sitting in the dark, the retinologist enters the room. “Are you dilated yet? Let’s see.”

I open my eyes so he can check.

“Wow, look at you. Good, let’s get to work.”

He and his assistant—his wife—look over my chart, call up images of my retina taken with a specialized camera during a previous visit, and quietly discuss their game plan. Once they are ready, the doctor sits across from me and rolls the laser contraption between us. It doesn’t look much different from anything else you might see at an eye appointment, and if you didn’t know there was a laser attached, you might think you were getting a new pair of glasses.

He cleans a plastic focusing lens and squirts it with a sterile coupling solution before attaching the lens directly to my numbed eyeball. Then he has me rest my chin in a stirrup and stabilizes my head to the unit with a velcro strap. I try to relax and take a series of deep breaths.

“What is that?” the doctor says. “Some kind of Yoga? Relax, you’re making me nervous. We’re doing some very delicate stuff today. Don’t move.”

“Got it,” I say.

“And don’t talk.”

There is a small snake light attached to the side of the laser machine. “Follow this light with your eyes,” he says. He moves it up and down and side to side. “Don’t move your head.” The light is pale green and hard to see. But he tells me to stay focused on it and to ignore the red, pin-sized dot meandering across the rear wall of my left eye like a sniper’s sight.

“Okay, lock and load,” he finally says, then laughs. “Just like back in’ Nam.”

“Uh oh,” his wife says. “You’ve got him back in Vietnam, that’s not good.”

They both laugh. I do too. A little.

“Don’t move,” he says.

The last thing you want to do is look directly at the red dot because, when he’s ready, the doctor hits a foot pedal, and — ZAP — your eye is suddenly dazzled with an intense burst of light. The duration of the blast is no longer than a tenth of a second, but if you happen to be looking directly at it, well, you can imagine. After the first laser blast, it becomes nearly impossible to see anything, including the green snake light you’re supposed to stay focused on. You look where you remember it being. “No, over here,” the doctor says, wiggling the light so you can find it. He hits the pedal about a dozen times before stopping to prepare a different lens. His wife unstraps my head so I can sit back and relax. She hands me a tissue to mop the tear running down my cheek.

“How ya doing?” the doctor says.

“Okay,” I say and let out a long sigh. Despite the laser burning tiny holes in the back wall of my eye, it isn’t painful. Not really. But it is stressful.

“Don’t worry,” he says. “I’m not drunk.”

But it wasn’t him I was worried about. When someone has a fear of heights, often what they’re terrified of is the urge to jump. This feels like that. Being told not to look at something mere microns away from where you are supposed to look takes a lot of self-control.

“You want a Valium?” he says. “Honey, get him a Valium.”

His wife hands me a white pill and tells me to chew it. “It’ll work faster that way,” she says.

But I barely have a chance to swallow before we’re back at it. Zap, zap, zap, like a welder.

Twenty minutes later, we’re done. The doctor’s wife unstraps my head, and I sit back in the chair with relief.

“Be sure to wear sunglasses when you go outside,” the doctor says. “Do you have a pair? Honey, get him sunglasses.” The doctor’s wife hands me a pair of cheap oversized sunglasses, so dorky they’re almost cool. Like DEVO might wear. “We’ll see you in six weeks for the other eye.”

My left eye is temporarily blinded, and the doctor’s wife leads me to a couch in the waiting room. “Sit here for a while,” she says.

First, it’s as if I’m looking at the world through a thick red filter. Then gradually, more colors arrive. Yellows, blues. Eventually, a donut-shaped array of lights dots my vision—the afterimage of laser strikes. The vision in these tiny burn holes is unlikely to return, but their bright and distracting afterimage will gradually fade over the following weeks. For now, however, it’s as if I’ve been staring at the center hole of an insanely bright Christmas wreath.

As I enter the sunlight of a cloudless afternoon, my eye aches. It feels dry. So dry, I could pop it out of its socket and draw pictures on the sidewalk.

The Valium finally kicks in.

I stumble home.