The worst risk I ever took

Winter 2010.

“There’s no way I can do LASIK on you. I’m sorry, you’re not a candidate,” the ophthalmologist says.

“Are you sure?” I ask, even though I know the answer. I’m just processing the verdict. I’m bummed. I hate wearing glasses, and my eyes don’t tolerate contact lenses.

“Your prescription is too strong and your corneas are too thin.”

Now I have two options. I can accept the answer and move on with my life. Or I can go into a deep research rabbit hole to prove the doctor wrong.

As a finance person, this feels strangely close to the kind of trade offs we manage at work. People in money management tend to be an odd mix of nerd and risk taker: we love research and math, but we also rely on intuition and accept that the future is, for the most part, unpredictable.

So obviously, I go the deep research route.

I read everything I can find online. FDA reports, medical papers, analyses of success probabilities by machine and prescription range. I dig, then I dig further. I learn that PRK, an older and painful surface procedure, is technically available to me. But the probability of complications is high given my strong prescription. Without my glasses, I’m close to blind.

I’m a risk-taker, but that’s not a gamble I want to take.

I also learn that bladeless, all-laser LASIK might eventually make me a better candidate. LASIK is good and getting better. There’s even a rumor that LASIK has become so precise that some baseball players with 20/20 vision are getting surgery to chase 20/15 or better.

Waiting for all-laser would be the smart decision.

But I really. Hate. Wearing. Glasses.

I don’t want to wait. And I don’t know if I’ll be a candidate even with an all-laser procedure. For now, surgeons still cut a flap on the surface of the cornea with a blade, let the laser do the rest, then put the flap back in place.

I keep scrolling through online research, but I’m about to give up. At this point, I think I know the risks as well as any expert in this domain. The eye doctor was right. I’m a terrible candidate.

Then I come across something interesting. I sit up in my chair.

There’s a Harvard ophthalmologist who specializes in high risk LASIK. He has written a book on how to handle complications. I keep reading about him, convincing myself this is different.

And that’s when I’m about to make a bad decision.

I contact him.

After the examination, I sit in his office. He says “Look, if you really want to get this done, I think I can do it. But you must understand: I will cut the thinnest flap possible. There’s a risk that I make a hole in it, and that would be a very bad outcome.”

“Sign me up,” I say.

The day of the surgery, I’m nervous, but I know the risks and I accept them. The room is cold. I’m lying on my back. They put numbing drops in my eye, tape the area around the lids, and insert a speculum to keep me from blinking. Then comes the suction ring. The pressure in my eye rises fast, and my vision goes dark for a moment.

The surgery seems to be going well.

Until he says, “I need to abort.”

He’s made a hole in the flap. He carefully puts it back in place.

I’m back at home. Wearing my glasses. My left eye is a wall of blur. It takes about six months to recover.

Why did I take this risk?

Most people, even experts, are bad at understanding probabilities. This can lead to bad decisions.

In one experiment, researchers asked people to choose between bowls of jelly beans. Respondents could win money by drawing a red bean. One bowl contained 1 red bean out of 10. Another contained 7 red beans out of 100.

The better probability is obvious: 1 out of 10 beats 7 out of 100.

Yet many people chose the larger bowl. They saw seven winning beans and felt better about their chances, even though the odds were worse. Some participants even admitted they knew the probabilities were against them. We calculate probabilities with the brain, but we experience them with the gut.

In another classic experiment on framing, physicians were asked to choose between two treatments for lung cancer: surgery and radiation. One group was told that the one month survival rate after surgery was 90%. Another group was told that there was 10% mortality in the first month after surgery. This, obviously, is the same surgery, with the same odds, presented through two different frames. (Do you prefer 90% lean beef, or 10% fat beef?)

When the outcome was framed as 90% survival, 84% of physicians chose surgery. When the same outcome was framed as 10% mortality, only 50% chose surgery.

These were trained physicians. They understood the math. It’s worrisome to think that life-and-death decisions can depend on framing.

On the positive side, understanding probabilities, uncertainty, and the difference between them can give you a decision-making edge. I’ve built my career in money management around this idea.

But let’s get back to my myopia. After my eye recovers, I’m in the process of moving to Southern California. Over there, it’s sunny every day. I badly want to wear regular sunglasses. I want to run outside and swim without glasses. Every so often, bitterness wins and I’m still doing online research on eye surgery.

Something grabs my attention.

Dr. Feinerman in Newport Beach is one of the world’s leading experts in a niche, relatively unknown procedure called phakic IOL. A phakic intraocular lens is a small artificial lens implanted inside the eye, in front of the natural lens, to correct severe myopia without removing corneal tissue.

We meet in his office. This being Newport Beach, everyone there is good-looking, cool, young, and hip. Feinerman himself looks like the Hollywood version of an ophthalmologist. There’s a rumor he has a publicist. In any case, I can tell he’s switched on and highly qualified.

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The day of the surgery, he’s playing dance music in the operating room as I’m being prepped. I know this is not riskless. The data on long-term outcomes is poor because it’s a newer procedure, and there’s some evidence that cataract risk increases. But I’ve done the research and I’ve done the math, and I like my odds.

Besides, again, I’m a risk-taker.

During the surgery, the propofol wears off a little early. I wake up while he’s still working on my eye. To this day, as I write this, I still relive the discomfort and panic. But it’s only a few seconds. He quickly finishes, and everything is fine.

As I’m waking up, Anne is there. I’ve had propofol for minor surgeries a few times. It makes me unbelievably happy and chatty. I’m yapping away.

In the car, I start opening my eyes.

I can see.

Without glasses.

It worked.

The outcome is almost perfect. I still have some astigmatism, and one eye is 20/40 instead of 20/20. That turns out to help: it means I may not need reading glasses for a very long time.

Summer 2025.

Fifteen years later, I need to renew my driver’s license, and there’s a vision test.

“Stand there, look at the white board, and tell me the letters.”

I struggle a little.

I pass.

I suppose my standards for victory have dropped: I’m now proud of passing a government eye chart.

I walk out licensed, humbled, and still not wearing glasses.

(You can buy my book here: The Psychology of Leadership)

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Endnotes

Denes-Raj, V., & Epstein, S. (1994). “Conflict Between Intuitive and Rational Processing: When People Behave Against Their Better Judgment.” Journal of Personality and Social Psychology, 66(5), 819–829. People sometimes choose worse odds when a larger absolute number of winning outcomes feels compelling, as in the jelly-bean experiment where participants often preferred 7 red beans out of 100 over 1 red bean out of 10.

McNeil, B. J., Pauker, S. G., Sox, H. C., Jr., & Tversky, A. (1982). “On the Elicitation of Preferences for Alternative Therapies.” The New England Journal of Medicine, 306(21), 1259–1262. Physicians made different lung-cancer treatment choices when identical surgical risks were framed as survival versus mortality. In the physician version of the study, 84% chose surgery when the one-month outcome was framed as a 90% survival rate, compared with 50% when the same outcome was framed as 10% mortality.