A Crisis of Face

Prologue, Errata, Apology

I have been trying to write this essay for over a year now, which is completely and utterly ridiculous (to give you some idea, the file name I’m working from right now is “laser eyes crisis of face redux part eleventy the return of the revenge electric boogaloo.docx”).

It’s way too embarrassingly personal for this blog (so I thought; it probably still is), but it is also too pedantic and research-y for my personal blog. Here is where I default to my crappy academic first-paragraph structure in which I namedrop Montaigne, don’t end clauses with prepositions, and remind you of the etymological origin of the word “essay.” It means to TRY. You TRY to read it, I’ll TRY to write something that makes sense: it’s totally a social contract. Take your expectations and lower them to the floor. Done? Good.

Once upon a time, this was going to be the story of how two days after my 28th birthday, I took a bunch of Valium and let this guy I had never even met before shoot lasers into my eyes and now everything is clear, yay rainbow puppies unicorns ironically-chosen pop songs about rain and clarity!

The thing is – the things are – as follows:

1) The lasers shot into my eyes are really only the start of the story;

2) there’s no point in writing that particular narrative, as others have before and with prettier charts and graphs;

3) It wasn’t really what I wanted to write.

But before I begin, let me answer the questions you really want to know about my eye surgery, the ones I always get asked: nah, just a little bit of Vicodin; yes, I was awake; they gave me a bunch of Valium first, which was probably the most expensive Valium I’ll ever buy, and it didn’t relax me, just made me even less filtered than usual, (ask me sometime how I corrected the surgeon’s grammar); it was about 4 months before I had 20/20 vision all the time; I paid for it with crowdfunding, working an extra job, and a 0% loan because all I really have going for me is my awesome credit score; yeah, probably; no, I couldn’t smell my eyeballs burning and late at night thinking about this, I try to tell myself that the soldering smell was the chemicals evaporating from the laser and I need to believe that, also, why are you asking me about the smell of my burning eyeballs? …Freak.

Then there’s the rambling pre-emptive apology: Why did I do this? How could I, when after a lifetime of derision, suddenly it’s like totally hot to be a girl with extremely thick glasses?

As a feminist and a socialist, I feel that it seems very bourgeois and vain to have corrective surgery or any kind of elective procedure. So why did I do it? When I tell people that by late 2010, without my glasses, I was close to being legally blind in my left eye (yet the state of New Jersey kept giving me a driver’s license), it always turns into some dick-measuring contest where people whip out glasses and contact lens prescriptions. Damn, people are so competitive.

This is what you need to know about my specific choice to do the procedure, and these are my disclosures: by late 2010, I hadn’t gotten a new pair of glasses in more than 2 years; my vision correction was about a -8 in each eye; I also had myopic astigmatism (I forget the exact degree, and it wasn’t as serious as the regular myopia, but it was fairly significant); I couldn’t see well enough to put contacts in; I was getting daily headaches from eye fatigue because my lenses were scratched up so badly.

There were numerous things I simply refused to do, or did not do, or told myself I could not do because the prospect of not being able to see or of potentially damaging my glasses was too terrifying; this included swimming and most other active activities.

By late 2010, these avoidances had become restrictive enough that they came to include leaving the house at night, even to walk around in my dark, blurry, sidewalk-less neighborhood. If the cats knocked my glasses off the nightstand, I was completely helpless. I was in an awkward donut hole of ability: I was not blind enough to fluently navigate sightlessly, but so impaired without corrective lenses that my quality of life was impacted.

I needed new glasses, but the cost would have been close to $1,000 for new lenses and frames, which was frustrating, especially when compounded by my living on a grad student salary ($13k a year!) and the fact that they needed to be replaced every other year or so.  Based on this, I concluded it would be an investment if I pursued laser surgery as it cost approximately the same as 3 pairs of glasses, and the expenditure would pay for itself in about 5 years when I factored in the increasing cost of glasses. Since corrective surgery can’t prevent presbyopia, even if I made it to 40 without needing glasses again, I’d save money (and who’s to say I’d make it to 40, full stop? Quetzalcoatl is coming back this year, right?).

Also, at the end of 2010, some terrible things completely shattered my personal life. Details are unimportant here, but some wonderful people reached out to me and asked what they could do to help. I already said this above, but gifts from good friends both online and off made the financial aspect of the surgery possible, and I emphasize that only because I really cannot ever thank them enough. Anyway, I was able to afford it due to a small discount through my grad student elective coverage, these gifts, some savings I had from launching my business, and a loan from CareCredit, which I repaid in 6 months without paying any interest.

I was, unsurprisingly, not a candidate for LASIK because my eyes were too bad, but I was cleared for photorefractive keratectomy (PRK), which is an older, more intense procedure with a much longer recovery time. That’s what I chose, and that’s what I did, and it’s worked out phenomenally well.

But that’s, frustratingly, STILL not the point. You can look up all kinds of PRK recovery diaries (I found this one very helpful) if you are curious as to how it works in terms of the recovery.

It’s also vital that I emphasize that despite what I am going to write about here, I am and remain extremely happy with the surgery and I have fewer than 0 complaints about the surgeon, the eye doctor, or anyone else at the center, all of whom were just wonderful to me. There is not one single thing I wish they would have done differently and the only clear regret I have is not having found a way to do it earlier.

It’s the unintended outcomes of the surgery and what it did to me mentally that I want to write about. I don’t know how many patients there are like me, who had had very strong prescriptions for most of their lives, and hence had no real idea what their own adult faces looked like.  I don’t know how many people suffered an almost shattering sense of disequilibrium in their self-concept, but that definitely happened to me.

After the prescriptions were done and I no longer needed the assistive features on my computer to read me through my day, I had no idea who was looking back at me in the mirror (and after the surgery, I realized I only had one tiny mirror in my house). Something was missing, but things were also better. I wasn’t who I had been or who I had understood myself to be. I didn’t know who this person was, but I seemed to be stuck with her. After a lifetime of dismissing Looks (“I can barely see; why bother? I hate superficiality! I won’t even buy a mirror SO THERE, system! Fuck makeup damn the man!”), I became acutely aware of every negative feature that anyone could possibly see in me, as well as plenty they probably couldn’t.

I was a conventionally unattractive and overeducated woman living in middle America and teaching 18-22 year old pre-business students, who frequently used teaching evaluations as opportunities to address perceived deficits in my physical appearance. Therefore, I probably had numerous self-image issues anyway, but not having my glasses was strange and redefining, so much more than I had anticipated or imagined. I had thought, prior to the procedure, that in absent moments I might try to push my glasses up on my face and I would wonder what was missing (happens all the time, even now, especially when tired). I had assumed there would be some moments of mild terror, but the amplitude of how terrifying it was to not know who was looking back at me in the mirror was at times indescribable. The cinematic metaphor to which I returned over and over was Eyes Without a Face. This is really embarrassing to admit here, even swaddled in my thick walls of protective text, but I started to really believe  / feel like I was incredibly hideous, almost monstrous. It was like being a teenager again, except it sucked more, because it’s annihilatingly embarrassing to admit I felt like that when I was approaching 30. I began to feel like my glasses had been a mask or protector, and now I was facing the world, alone, and without the barrier the glasses created.

Worst of all was when people implied that I had somehow betrayed an important identity claim or let down some marginalized group: “Oh,” a creepy guy I met via an even creepier online dating site told me, “You didn’t say you got rid of your glasses. That’s a real shame because women with glasses are soooo sexayyyy.” I wanted to punch him in the face (for a lot of reasons, actually), but I started thinking about embodiment when he said that (which I will discuss below). The smaller, less direct comments from other people stung more: “What’s wrong with glasses?” “You just don’t like people thinking you’re a geek?”

Methodological statement: Because I have a stunning deficit in my mind where most other people have common sense, I finally started Researching this just a little while ago. Specifically, I was looking for what other people have said about self-concept and PRK. I limited my search to PRK specifically because this procedure has a more involved and much longer recovery timeline than LASIK and because it tends to be used with people who have a stronger degree of correction than LASIK patients.

I wanted to find out if I was just a uniquely unconfident snowflake, or if there was a larger trend in post-PRK patients experiencing significant and significantly negative ways in the ways they saw themselves. I’m well aware of the fact that I am not personally a sample, that the plural of anecdote isn’t data, and there were significant variables in my own life that probably contributed to or exacerbated my own negative feelings. But I can’t be the only one. Right? … don’t answer that.

But I was curious, and I just moved across the country and am kind of  bored, lonely and under-employed right now (hi! hire me! I do a lot of things!), so I conducted a very preliminary literature review to see what has been said about self-concept and PRK. For the patient readers, I will discuss what I found (don’t worry, it’s only a few things), then talk about embodiment a little as if I know what I’m talking about, then I will put in a gratuitous cat picture. Why else do we have eyes and an Internet, right?

Ergo:

I found relatively few high-quality articles on this topic. Most people seem to agree that PRK and other corrective surgeries enhance self-image. Googling “self-esteem PRK procedure” yields 715,000 results, most of which I consider biased because they come from vision center ads.

I think for most people, these procedures DO enhance self-esteem, but overall, there is a lack of robust literature assessing outcomes in self-concept for patients who had a) worn glasses for most of their lives and b) had a very high degree of correction. The studies I found have small sample sizes and problematic / non-descriptive means of assessing self-image.

For example, in a 2001 study in the Journal of Refractive Surgery, most patients were actually found to have a higher self-image after a PRK procedure (see: Jerzy Toczolowski, Piotr Oles and Zbigniew Zagórski). However, the sample size of this study (alliteration! Awesome!) is very small, only 25, and it was conducted in Poland; my impression and hypothesis is that in late-capitalist, voracious, image-obsessed America, findings might be significantly different. So all this really tells me is that if I take 25 people in Poland and the adjectives they would use to describe themselves as the norm, I’m not normal (also, if I had to pick any adjectives to describe myself, not a one of them would be in Polish).

Lest you think I’m actually just severely dissonant in my perception of self, a 1995 article in the same journal – which used a larger sample – found that “The psychological findings suggest that PRK patients cannot be considered more distressed or anxious than other myopic individuals” (Erickson, Ryan and Aquavella). Of course, that study uses Myers-Briggs, of which I’m suspicious (do I talk to people at parties? It depends on the party). All this really tells me is that the sample they chose indicates there is not a greater than average degree of anxiety or distress among the group of people who are candidates for and then elect to have PRK.

This is not directly related, but for the past year I have also held Helen Rose Fuchs Ebaugh’s Becoming an Ex in high regard. While I am not a sociologist, I wonder if there is an aspect of role exit at work here. In the past year, I also left a role in my own life (career / career student / mediocre academic). I understand Ebaugh as saying that the process of announcing the role exit reduces cognitive dissonance, and repetition and easing into another role reduces this dissonance. I wonder if the visibility and then the invisibility created this cognitive dissonance for me. I had a role, which was embedded in my face, of a bookish / geeky / nerdy female, and as long as I had that item on my face, the cultural construct in which I lived seemed slightly forgiving or understanding, as I was immediately and visually ascribed as belonging to a certain group. I wore glasses for about 20 years and I had had poor eyesight for years before I got them. There was very little of my pre-procedure life that I remember clearly (again, with the seeing-words) that didn’t involve corrective lenses. But then one day they were gone. There are many moments of bifurcation in one’s life, I think, but this one was certainly the most cinematic in mine. I walked into a room a person with very limited vision (simple past, completed action) and walked out to begin the process of recovering at 20/20. The division is so absolute and crazy. Usually borders bleed into each other, but this is an absolute division.

Leaving grad school was a process, unlike the surgery. People were generally extremely positive about the surgery, and generally very sympathetic about the situations that led me to choose to leave grad school. The difference is that of verb tense, of the simple past vs. the past progressive. I did, I was doing; I became, I was becoming. I was becoming an ex-(Failed!) grad student; day by day I was less and less what I had been and more and more whatever I am now (and it’s way better). But one day I was a person with glasses. I had a procedure and then I wasn’t. I underwent a process letting go of one role; the other happened suddenly. How to reconcile that? It is only now when I understand these two fundamental changes side by side that I think I can understand why it was so shattering and that the real recovery, the mental recovery, went on for so long. I have not had time to look it up, but the rhetoric used to refer to sight, and the English verb tenses used – in all their wonderful specificity – are something somebody (else) should really look into.

I don’t know if everyone who wears glasses had similar experiences to me. As an ex-grad student, I feel compelled to mention the Cyborg Manifesto. I was a cyborg; I went through every waking second of every day with a device that allowed me to see, a device on my body and in some sense part of my body. My physical engagement with the world depended to a great degree on the correct functioning of this device. “From another perspective, a cyborg world might be about lived social and bodily realities in which people are not afraid of their joint kinship with animals and machines, not afraid of permanently partial identities and contradictory standpoints. The political struggle is to see from both perspectives at once because each reveals both dominations and possibilities unimaginable from the other vantage point” (Carraway). I no longer know on which side of the dichotomy I fall. All I can read in this quote, now, is the imaginary emphasis on the word “see.”

This change in my embodiment and interacting with the world was not as profound as the ones others undergo. I know that. But this experience really has given me a great deal of interest in embodiment, though I know virtually nothing of the theory surrounding it (recommendations?). Of all the changes in identity claims one has in a lifetime, it is virtually certain that at one point one will change how they physically interact with the world. Yet we seldom talk about it. Why?

SO WHAT? As I said before, every single thing about the staff and surgeons was wonderful. But it might be good if the corrective eye surgery field provided some psychological preparation for the profound change in self-concept that is likely to occur. Maybe we should stop fetishizing sexy glasses or understanding them as an intertwined aspect of a subcultural identity. Maybe we should normalize physical difference. Maybe we should just fund preventive measures to address the pandemic of eye issues (did you know almost 80% of urban Chinese children are myopic? [link is in Chinese, sorry]). I don’t really know what any of this does. I don’t even know if anyone is going to read all of this (if it took me a year to write it, I estimate people will read to the end by about 2015 or so). I’m sure my conclusions and interpretations are invalid and intellectually feeble, poorly informed by a useful framework. I live in the real world now, so I can’t do the usual grad-school cop-out and say “there’s just something there, you know?” More research is needed.

What do you think? Have you had corrective surgery? If so, how did you reconcile your former self with the present one? What issues did you encounter during that process? How can we understand embodiment in a world where physical difference can be erased and experiences normalized?

Epilogue

Every time I went for a post-op appointment, I walked by the Lion’s Club donation bin for glasses, which was helpfully situated by the front door of the clinic (great marketing move, there).

And just so you know – every single time, I told myself I was going to do it. I reached in and I opened my bag and touched my glasses and I suddenly could not fucking make my hand put them in the box. I just froze and pretended to be looking for my keys, and walked out the door, still getting fingerprints all over the lenses. I did this four consecutive times. But I still have them. Sometimes I look through them to try and see things the way I used to; I can’t now. It’s all a confusing blur, almost like a metaphor or something.

I just can’t let go, not of that, not of what I was.

I still can’t.

PS: I promised a cat picture:

OMG IT IS EATING SPAGHETTI

Works Cited

Carraway, Donna. “Cyborg Manifesto, Part I.” 1985. Donna Carraway’s Cyborg Manifesto. September 2012 <http://people.emich.edu/acoykenda/cyborg1.htm&gt;.

Ebaugh, Helen Rose Fuchs. Becoming An Ex: The Process of Role Exit. Chicago: The University of Chicago Press, 1988.

Erickson, D.B., R.A. Ryan and J.V. Aquavella. “Cognitive styles and personality characteristics strongly influence the decision to have photorefractive keratectomy.” Journal of Refractive Surgery 11.4 (1995): 267-74.

Jerzy Toczolowski, MD, et al. “The Sense of Self-concept Change in Patients After Radial Keratotomy .” Journal of Refractive Surgery 17 (2001): 134-137.

 

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4 Responses to A Crisis of Face

  1. jill says:

    fascinating discussion of the side effects of your surgery. I thought about LASIK and was a good candidate. They had me go without contacts for three months while I considered it. In the meantime, discovered breast cancer and started surgeries and treatment for that.

    I kept researching the outcomes of LASIK. Everyone I talked to loved their results. But, most had reduced near vision and many had the ‘halo’ night lights. I decided those weren’t a trade I wanted to make and I’ve stuck with my glasses. (and the cancer is all gone.)

    • mirandate says:

      thanks Jill. :-D That means a lot to me because this was very hard for me to write. I know, ridiculous. Luckily I don’t think (m)any people will read all the way through and see the true depths of my neurosis.

      Incidentally, my doctor told me multiple times that PRK is becoming more popular among surgeons again: it works better long-term ( lower incidence of recidivism, halo, near vision reduction, no need for a flap). It’s just very inconvenient for most people. Maybe if you ever reconsider it you might want to think about PRK. I healed a lot faster than most people do, and it was doable because I was barely employed and hardly ever had to leave the house. I spent about 3 days knocking myself out with sleeping pills and didn’t / couldn’t drive, watch TV, use the computer without it reading to me, read, etc.

      I’m glad you’re better now!

  2. Kevin says:

    Miranda –

    I tried to post a massive response last night, but my Kindle ate it. Sorry ’bout that.

    First off, thank you very much for posting this. I appreciate how hard it was and it means a lot that you would come to so public a place to do so.

    I agree with you wholeheartedly that eye surgeons and psychologists should do more research into the psychological effects of eye surgery; whether the patient realizes it or not, in many cases, some part of their self-perception is going to be transforming at the end of the process. It might be positive, negative, or neutral, but there needs to be more knowledge created and shared with patients. An anecdote may not be data, but it can still be a powerful, exceptionally thoughtful starting point.

    For me, I’ve worn glasses since I was in fourth grade. I’m now 31, and I can’t really imagine my face without them. I’ve grown a beard in the last few years, and tinker with it, but the glasses are sacrosanct at this point. When LASIK first started gaining traction when we were kids, I thought I might want to do that some day since I had always been the dorky, slightly ignored dude, and I blamed my glasses for that. Now I realize that’s just who I am, and while I don’t think that I fetishize the glasses over-much, I just have no idea what I look like without them and don’t really know why I should try. However, I have been lucky enough to have stable eyesight when corrected that isn’t causing problems for me, so I’m lucky in that regard. It sounds like you made the right choice for you, and it’s certainly possible I might change my mind some day. I certainly have a better understanding of the process now.

    Thanks again for the great post. I read every word.

    –Kevin

    • mirandate says:

      Kevin,
      Thanks so much for the kind words. It means *A LOT* to me! And I’m sorry your Kindle ate your original response (makes me glad I only use mine to read). I love my eye doctor and the surgeon who did this (possibly because I usually visited them while taking lots of exciting drugs), but the entire rhetoric around the process is that lasers basically infuse your entire face with self-love or maybe botox or something. But I really suspect that particularly for high-correction patients like me, who had a long, long history of poor vision, some meaningful preparation would have smoothed the process a little.

      Thanks again for reading this.

      -Miranda

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