“It’s a Vision Thing” – Chicago Tribune

This is what he had to tell me:

First, the reason I couldn’t see. The cause of nearsightedness, or myopia, is a cornea that distorts the way light enters the eye.

The cornea, on the surface of the eye, provides 75 percent of the eye’s focus before light hits the lens, which fine-tunes the focus.

Myopic eyes are much too steeply curved, or long, and refract the light in abnormal ways, causing blurriness.

Refractive eye surgery, in which the shape of the cornea is altered, has been around for half a century. The earliest techniques involved cutting off the cornea, freezing it, reshaping it with a lathe, and sewing it back onto the eye.

“It would take a couple of hours for the procedure, and only a few surgeons were trained to do it,” said Dr. Sandra Belmont, director of Laser Vision Center at Cornell Weill Medical Center in New York. Belmont first starting performing refractive surgery in 1983 and was one of the investigators who tested the laser techniques in 1990, later approved by the FDA in 1991.

“It was painful, the healing took months and the results were unpredictable,” Belmont said.

Popular and effective
Other types of treatment developed later have included threading plastic bands onto the cornea to flatten it, corrective implants on the lens and variations on Lasik surgery, in which the cornea is flatted through incisions or lasers. There tends to be a smaller range of patients, however, who are good candidates for these procedures.

Lasik, which stands for laser in-situ keratomileusis, has been the most popular and effective. It involves cutting a small flap in the cornea, lifting it, zapping away some tissue and smoothing the flap back down. The procedure is performed in less than five to seven minutes per eye, initial healing takes about a week, and perfect vision often can be measured within a day.

Some patients, though, find that it takes several months for side effects such as dryness or fluctuations in vision to settle.

All this sounded fine. Intellectually, I could handle it. Even the thorough warnings from Dr. Rosin about the potential dangers, such as infection and scarring; overcorrection, making patients far-sighted, and permanent discomforts, ranging from dry eyes and itchiness to haloing and starbursts.

The latter two are caused when pupils widen, as they typically do at night to allow in more light, beyond the point of correction on the corneal surface. The area of the pupil that expands past the lasered portion is still fuzzy. At night, car headlights, streetlights and all glowing bulbs have a ring of fire around them, making it difficult to see.

Rejected
Well guess who has unusually large pupils? After measuring my pupil width in a darkened room, Dr. Rosin turned me down flat. I was at too much of a risk for haloing. He wasn’t willing to do the procedure.

This is why I trusted him.

Of the almost 2 million procedures performed this year, all are required to be performed by ophthalmologists–medical doctors, not optometrists–who have had manufacturer’s training. (The only state with an exception to this rule is Oklahoma.) Yet, not all have had extensive experience with the Lasik procedure or the expertise to correctly evaluate the patient’s risk factors.

The evaluation process may sometimes be done by someone other than the doctor performing the surgery. At times, the emphasis is on selling the procedure, which, at a cost ranging from $500 to $2,500 per eye, has become a profitable and booming business in the eye-care world.

New technology
Last summer, Dr. Rosin told me to wait. He said that new software was soon to be approved in which a wider area of the cornea could be removed without collapsing it, becoming better suited to my pupil size and decreasing my chances of halos.

This summer, the technology was ready and so was I. The preparation involved two extensive eye exams, in which my vision was tested, pupils measured, tear secretions measured (to test for dry eyes), cornea thickness gauged and a photographic map made of the surface of my eye.

Dr. Rosin wanted to know if I had ever had herpes simplex in my eyes? No. Was I pregnant–hormonal changes can affect eye tissue and shape? No. Did I have rosacea, a type of acne, where excessive oiliness, particularly on the eyelids, could clog tear ducts and cause dry eyes. Well, yes, but a mild enough case that it wouldn’t be a problem.

Contact lenses were forbidden for at least three weeks ahead. I was to spend a week washing my eyelids with baby shampoo before bedtime, in order to clear out any buildup on my eyelids. I was to report to surgery without wearing any makeup, lotions, perfumes or scented products.

Contemplating the risks
Of course I waited until the night before to fully read the lengthy consent form that had been mailed two weeks earlier. One form listed the risks of the surgery in general and another the pros and cons of consenting to bilateral Lasik, or having both eyes done at once. Some patients–and some doctors–prefer to have surgeries spaced out so they can see the results of the first before continuing.

All of this I had discussed at length with Dr. Rosin. But having to agree to it on paper was something else. There is nothing like a consent form to put the fear of God into you. What was all this about permanent damage? For all that I had been mentally prepared for up to this point, the dangers suddenly seemed real.

It didn’t help to arrive at the hospital and be given a large name badge to wear. Oh great, I thought; this is so if I go blind and am found wandering around the streets of Chicago, some stranger can take me home.

It didn’t help to be offered a Valium, my first experience with it and my last. It made me feel sleepy and doped-up, but just as anxious as ever.

Too late: They called my name.

A bunny for comfort
Another eye exam, briefer this time, another explanation of what was going to happen and a briefing on what to do after surgery. I was given antibiotic drops, anti-inflammatory drops and plain old lubricating drops. I was also handed a pair of plastic goggles to be worn during sleep for a week to avoid involuntarily rubbing my still-healing eyes.

On to the surgical room, where Dr. Rosin and his team, wearing scrub outfits, had me lie back in a reclining chair and then pulled my hair back with a net. It all seemed just like something on television, until they handed over the bunny.

Yes, there was a selection of stuffed animals they wanted me to choose from and hold onto. It is so important that you don’t move during surgery, Dr. Rosin wants patients to have their hands occupied, preferably with a fuzzy miniature pet.

Someone brushed my eyes with disinfectant, then held my lashes back with surgical tape. Numbing drops were administered. Metal props were fitted along each lid in order to keep my eyes open. And I swear to you, that slight pressure felt when they were put in place was the only sense of physical discomfort I felt during the entire operation.

A ‘blob of jellied fear’
I didn’t feel anything when the flaps were cut open and lifted back. I felt nothing from the laser, which lasted for around 31 seconds in the right eye, 34 seconds in the left. (I counted.) I didn’t feel the flaps being repositioned.

What I did feel was a sense of total vulnerability that was shocking. It is human nature to close your eyes when something scares you, and I couldn’t. I couldn’t move or curl up or just get up and run home. For a few minutes, I had turned into a pathetic blob of jellied fear and all there was to do was just lie there and wait for it to be over. That bunny’s neck was in a death grip.

Adding to the unreality of the whole thing were the final touches of the surgery, when the corneal flap is smoothed into place with tiny surgical sponges. You watch this happening, from inside your eye. The laser is just a red dot to focus on. The flap being reattached is like being in a car, watching someone run a squeegee over your window.

Then it was over. Finished in about 20 minutes. Props removed, tape removed, eyes closed. Now I had to open them again. And what was the first thing I saw on the wall–a clock. I could read it. And I suddenly felt so overwhelmed with emotion that I wanted to weep.

Everyone was congratulating me. Who were those nice people? Why had I been so scared? Where did the bunny go?

Eyes shut
Then it was home to sleep, to give my eyes plenty of rest. They felt scratchy and somewhat blurry, which is what happens after being manipulated in such a way. Once home, I kept my eyes closed virtually the rest of the day until bedtime, passing the hours–not having a radio–listening to television instead of watching it. I sat on the couch and called out the answers to “Jeopardy” and “Who Wants to Be Millionaire.” I put in my drops and wore goggles to bed.

And oh, the next morning. What a gift. It was truly one of the happiest days of my life. To wake up on another beautiful day and to see everything! On my own! No fumbling for glasses or stumbling to the bathroom to put in contacts. My eyes felt enormous. There was no pain or soreness. Just clear, beautiful vision. My follow-up appointment was that morning, and Dr. Rosin found everything to be just fine. My vision, in fact, tested better than 20-20. I felt like crying again. It was amazing.

That was more than a month ago. My eyes are still adjusting, and I still put in drops to keep them moist while the tear-producing glands that were cut during the surgery grow back. I use lubricating drops less frequently every week. If my eyes get too dry, or if I spend too many hours on the computer, I definitely see some halos at night. But they, too, are diminishing.

And sometimes I still reach for my glasses, on the nightstand or on my face; it takes a minute to realize I don’t use them anymore. It’s just habit.

So here’s the new habit I never thought I’d have: I can see, I can see, I can see.

What to ask and consider before surgery
My experience with Lasik surgery was, thankfully, a great success. It’s not for everyone, however, and there is the potential for serious complications even for those who don’t have initial risk factors.

You are not a good candidate if you have an eye disease, are pregnant or diabetic, are under age 18 (because the eye is still growing, or otherwise have a prescription that is still changing), have an autoimmune disease or a history of ocular herpes.

For those who are cleared for Lasik, here’s what you should know, according to the American Academy of Ophthalmology and Dr. Jonathan Rosin:

All refractive surgery, including Lasik, is meant only to minimize reliance on glasses and contact lenses.

There is no guarantee of 20-20 vision, nor should you be told that you will achieve it. Undergo the surgery only if you are prepared to settle for improved eyesight.

What to ask
Interview the surgeon; questions to ask include the following:

The risks
You should expect a thorough discussion of the risks involved, including:

These symptoms may last for a few days to a few months.

The level of correction
If your eyes are overcorrected, you may find yourself needing reading glasses even if you didn’t before. Regardless, people 40 and older are likely to need reading glasses down the road, the same as the general population.

If the vision is undercorrected, discuss with your doctor beforehand what your options are. Can you get additional surgery for free or at a reduced cost to improve your eyesight?

“Regression,” in which your eyes are initially improved but return to a level of nearsightedness within six months, is an uncommon condition but can happen in 10 percent of patients.

Complications
Rare complications include:

If all this sounds daunting, good. We’re talking about your eyes.

Educate yourself as much as possible before picking a surgeon and agreeing to the operation.

And never pick a laser center based only on price. This is one time when the adage “You get what you pay for” could have real consequences.

For more information about refractive surgery, check out the American Academy of Ophthalmology Web site at www.aao.org or the partner Web site at www.medem.com.

– Kristin Eddy