This post is a response to two questions: What do you do? and Why aren’t you wearing your glasses?
I’m a sociologist of science and technology. I’m interested in how scientists know what they know. I look at how successful technologies move from magical to mundane while failed ones are written out of history. I try to teach my students to think critically about new science and technology: to ask who wins, who loses and who should decide. As well as the scientific data, I want to know what it means for people to live with difficult, uncertain knowledge and disruptive technologies.
Partly following a distinguished tradition of self-experimentation, but mostly in an effort to steal a march on my mid-life crisis, I recently became intimate with a technology of mind-boggling, eye-watering (of which more later) awesomeness. For the person undergoing it, laser eye surgery feels for a short time like the oddest thing in the world. But, if the social mainstream is mapped by The Simpsons (as good a guide as any, I reckon) then the procedure has become exceedingly normal. Over the last twenty years, during which more than a million people in the UK have had the treatment, it has featured in two Simpsons episodes. In the first, Homer is envisioning a future in which Bart encounters a blind Ned Flanders. Flanders explains: ‘I never should’ve had that trendy laser surgery. It was great at first but, you know, at the ten-year mark your eyes fall out.’
Three episodes later, in a moment of classic Simpsons amnesia, Homer is trying to avoid having to choose glasses. The optometrist suggests surgery, adding. ‘I must warn you it’s an experimental procedure and we still don’t know the long-term effe…’ at which point Homer interrupts her: ‘Less yapping, more zapping!’
I share the excitement as well as the fear. It’s an ambivalence that is common in public attitudes to technology. We yearn for technological solutions to our problems and yet we know that they can disappoint. We worry that we will become dependent on things that we never knew we needed. Technologies normally don’t change our lives in the ways we are promised and, if they do, we take their benefits for granted. The risks, meanwhile, are impossible to fully foresee. Critics of technology are right to call it a social experiment.
My motivation for taking part in this experiment is hypocritical. I couldn’t get on with contact lenses. I used to tell people that I was, like John Hegley (see his poem ‘glasses good, contact lenses bad’), a militant spectacle-wearer. But I don’t believe any person with glasses can completely lose the image of Piggy, the boy from Camberley who loses first his glasses and then his life in Lord of The Flies. Clearly vanity is a part of it, but I am under no illusion that glasses have been the thing holding me back. I don’t know if or how my life will be different without glasses, but the idea of a machine – not just any machine; a laser, that most futuristic of machines – being able to melt my eyeball into a more perfect shape excites me in a very shallow way. For all our ambivalence and in full recognition of its power to change our lives, we embrace technology without much critique. Innovators are the masters of our universe. We adopt their products not just because we are being utilitarian but also because we find them fascinating. Being modern is about embracing novelty, even if it is for novelty’s sake.
Like 2.5 billion other people in the world, I am naturally short-sighted. This ‘epidemic of myopia’ would, in the absence of any solution, be considered part of the normal variation of human beings. But, with technological enhancements, it becomes a defect that can be corrected. My ametropic eyes (whose lenses focus incoming light so that it misses my retina) yearn to be emmetropic ones. For the last twenty years, my glasses have done the job of refocusing the light. Take them away, and the eye itself needs to be given a new lens (like a contact lens) or reshaped.
Laser eye surgery, properly known as LASIK (Laser-Assisted in Situ Keratomileusis), began in the 1980s. The idea of fiddling around inside people’s eyes in order to correct their vision was not new, but a new technology had made precise eye engineering possible. Excimer lasers had been around for a few years. The idea was that, if such a laser could be precisely tuned, it could melt away bits of the tissue on the surface of eye, changing its curve. A scientist at IBM, Rangaswamy Srinivasan, had revealed the possibility of ‘ablative photodecomposition’, the precise etching of living tissue using lasers. The question was how to demonstrate that it could work on people’s eyes. Opthalmologists like Stephen Trokel at Columbia had used lasers on the eyes of dead animals, then human cadavers, then live animals, but animals are notoriously bad at reading eye charts.
Human tests began with blind volunteers. In 1989, Marguerite McDonald published the results of one such study in which a blind young woman had agreed to have experimental laser surgery. Weeks after the surgery, much to the surprise of the researchers, the woman regained her sight. It appeared that her blindness was more psychological than physiological. The study became the accidental first success story of laser eye surgery.
In 1988, a volunteer name Alberta Cassady became the first officially sighted person to have an eye lasered. Cassady needed her eye removed because of a tumour on her eye socket and asked if it would be useful for any tests. McDonald recounts how ‘we got permission to rush her out past all the apes… and do a treatment’, which, in her case, turned her perfect eye into a longsighted one. When Cassady’s eye was removed, the opthamologists could see that the lasers had done the job, removing tiny bits of the cornea without scarring the eyeball.
A later innovation led to what became known as the ‘flap and zap’. Rather than just blasting the eye and letting its fragile surface slowly heal, surgeons began slicing into the cornea, peeling back a layer, using the laser and then replacing the flap to act as a bandage. This procedure, despite its grotesque beginnings, has now become the norm. It is reliable and easily replicated. With machines that can precisely map an individual’s eyeball and target a laser to remould it, laser surgery has become largely automated and extremely lucrative for eye doctors.
I turn up for a consultation, with the Simpsons echoing in my mind, ready to ask about the dangers. To calm my Ned Flanders worry, a leaflet reassures me that ‘becoming blind from laser eye surgery is an extremely improbable consequence’. I tell my students that there is no such thing as ‘safe’, only ‘safe enough’, but I can’t quite shake the ‘extremely improbable’. The UK’s health regulator NICE says that it’s safe and effective ‘in appropriately selected patients’. But the Daily Mail aren’t the only ones to dig up cautionary anecdotes. In the US, former Food and Drug Administration official Morris Waxler has waged a campaign against the treatment, claiming that it causes unacknowledged side effects and is unregulated. Such controversies attract the attention of sociologists because they force the various people involved to make their arguments explicit. But, weighing them against the millions of other data points, I am willing to set aside my professional scepticism.
It is easy to fixate on technological risks. But we should also cast a critical eye on the benefits of a technology and how they are shared. Laser eye surgery, although it promises to return people to normality, can be considered a human enhancement. As with other enhancements, from blood doping to modafinil, it introduces ethical questions – will it exacerbate social inequality? Is there a line between therapy and enhancement? Should we be searching for perfection anyway?
On entering the eye clinic, I am sold a vision of a life free from glasses. I am told that I will be ‘free to run’, whatever that means. The literature on the tables is full of stories from rock climbers and actors, once encumbered by glasses, now fulfilling their true potential. The guarantee is that my eyesight will be 20/20 or my money back. 20/20, it turns out, is nothing special. It is a gloriously vague metric of mediocrity. If you have 20/20 vision, you can see at 20 feet what a normal human being sees at 20 feet (the distance you sit away from the letters at the optician’s), begging the question of what counts as normal during an ‘epidemic of myopia’. The magazines hint at going beyond this workable imperfection. They talk about ‘life with HD vision’. Some birds of prey apparently have 20/2 vision. I’ll aim for that.
I’m played a video in which the company’s chief scientist – let’s call him Chuck – tells me what an exciting day it is and how passionate he is about eyes. He tells stories of life-saving eye surgery and schemes to deliver glasses to people in poor countries. Chuck says that the technology they use was originally developed for the Hubble Space Telescope. He is on a video, so I can’t interrupt him (Didn’t Hubble have blurred vision and need glasses as soon as it was launched?) Chuck tells me, without acknowledging the contradiction, that the technology is bleeding-edge new but also reassuringly old and therefore safe as houses.
New eye machines on offer in the clinic promise more perfect perfection. ‘Wavefront-guided LASIK’ will map the miniscule contours of my dysfunctional eyeballs so that the laser can smooth out every crease. According to its web site, the STAR S4 IR machine algorithmically ‘Calculates the ablation torsional angle from multiple matching reference points’ as it steers its robotic laser. But first, I must get my eyes mapped. A Pentacam machine measures my cornea while I concentrate on a spinning bar. The next machine involves staring into something like an X-Wing targeting computer. Then I look at a picture of a hot air balloon above a desert highway. A tiny puff of air is bounced off my eyeball to measure the pressure inside my eye. All of these machines are in standard-issue desktop grey-cream. I’m then given a very old-fashioned eye test – guessing letters and trying to draw out tiny differences between patterns of dots. Congratulations, I’m told, I can have eye surgery.
Then Chuck is back on screen, only this time he’s less excited. He tells me that my eyes will take some time to recover and they will be dry for a few weeks. And they will still age. In a decade or so, my new superpowers will fade and I will need reading glasses. Chuck then reassures me that he has lasered his own wife and daughter.
Before I go, I’m told the price. Apparently the offer in the window was only for people who had pretty good eyes to begin with. Mine are a tougher challenge. Given that computers and lasers will be doing the hard work and the whole thing will take two minutes, I am unsure why this justifies the price bump. Whatever. Less yapping, more zapping.
On the day of the operation, I meet the surgeon. His job title seems rather grand considering he will be playing magician’s assistant alongside an automated laser, whose instructions have been provided by another machine. Nevertheless he is eminently qualified and maintains an old-school paternalism as he tells me that my stupid eyeballs are poorly suited to the flap-and-zap. Instead, he recommends a similar, more painful operation with a longer recovery time. He tells me that it’s my choice but, reading the subtext, I have no option. Translating his expertise in relative risks into something meaningful would require me to do a degree in opthamology, and I need to get on.
I am whisked into the operating theatre, where I am underwhelmed by the performance: no gown, no scrubbing up, no sense of occasion. There is a period of five minutes where it all gets a bit Clockwork Orange. My eyeballs are numbed and the lids forced open with tiny clamps while a drop of solvent dissolves the top layer of the cornea. Then the lasers, making a noise like a Geiger counter, do their thing, the surgeon puts on a contact lens as a sort of bandage, and it’s done. The laser has taken tissue away from the middle of my cornea, making it flatter, refocussing the light onto my retina. But, because of my astigmatism – a non-spherical eyeball – the laser also corrected for this, as well as ironing out all of the ‘microprescription’ lumps and bumps.
I am given a minibar of eye drops to administer once the anaesthetic wears off. Just before putting on my sunglasses to stumble home, I catch a hint of crystal clear vision. Then things blur. But this an iatrogenic blur rather than one of deformity, and I am told that it will pass as my eyes heal over the next few days. On my eyes’ journey back to normality, they feel as though they are being dragged through a pool of chlorinated onions. I close my eyes while my corneas mend and realise that my ethical concerns have evaporated. I don’t worry that others are missing out on this rather pointless procedure. I don’t feel enhanced, nor did I feel that my glasses had disabled me before. If anything, I feel a bit less special, a bit boring. I harbour a lingering question as to whether the surgeon who stood by while the laser did its thing might have had other dreams in mind when he qualified, but I console myself that he probably does more worthy things too.
As the fog breaks and clarity returns, I am still in search of justification. I am not the people in the magazines who are desperate to escape their glasses because they are professionally extreme - rock climbers – or professionally vain – actors, TV presenters. The one benefit I hit upon is that I can now tuck a pencil behind my ear like my Grandpa used to. Maybe I should stop being a sociologist of science and take up some activity that would be impossible in glasses, like cycling in the rain, diving for pearls or running for leader of the Labour party?
