Seeing the Light
By Susan Steeves
March 12, 2001 -- The good news is, I can see; the bad news is, I can see. More on that later.
Maybe you're like most people over 40 -- the aging of your eyes is beginning to change your life in a way you don't like. It was happening to me. I'd reached the point where I couldn't see the dirt on the kitchen counter until I put on my reading glasses, and the numbers on my car speedometer were a little fuzzy.
So let me flash back to how I ended up, three days after this past Christmas, wearing plastic bubbles taped over my eyes at the laser surgery center of Zale Lipshy Hospital at the University of Texas Southwestern Medical Center in Dallas (UTSW). It may help you decide if this procedure is for you.
For several years, the idea of LASIK had lurked in the back of my mind. But until about a year and a half ago, the procedure was FDA-approved only for nearsightedness, or myopia. This is when the corneal curve is too steep, causing distant images to blur. When the operation was approved for farsightedness (the corneal curve is too shallow, causing close objects to blur), the possibility of having it done myself moved one step closer.
Then last summer, the FDA approved two laser machines for correcting farsightedness with astigmatism (where the cornea is irregularly shaped -- more like a football as opposed to a basketball). I did a story about it, using as my main source H. Dwight Cavanagh, MD, PhD, vice chairman of UTSW ophthalmology department. I listened carefully to what he had to say about the procedure; after all, he had been one of the doctors who had conducted LASIK clinical trials and also one of the researchers on a study comparing this method with another type of laser surgery called PRK. I also talked with a man in his late 60s who'd participated in the clinical trial of LASIK at the medical center, who gave a glowing review.
This was sounding more and more like a real possibility for me, but the thought of surgery made me squeamish. The surgeons use a tiny instrument called a microkeratome to cut a flap of corneal tissue, then use a laser to remove a hair-thin piece of tissue, effectively changing the shape of the eye. Cavanagh said the surgery for farsightedness was easier and safer because the laser didn't focus on the field of vision, as in the nearsightedness procedure. Rather, it removes a donut-shaped piece of tissue around the corneal edge.
A few months later I made an appointment for Cavanagh to evaluate me for LASIK. Coincidentally, my editors had just assigned me to write about the controversial issue of using the procedure on children. Cavanagh was a good sport, and not only spent a lot of time talking with me as a patient, but also fielding questions on expanding the surgery to youngsters.
After a three-and-a-half-hour exam, Cavanagh explained that the shape of my eye made contacts impossible. The other option, considering the deterioration of my vision, was bifocals, then trifocals. When he heard that I ride a horse and a bicycle, he told me I'd be safer and could continue my sports at a higher level with LASIK.
I went home and thought it over for about six weeks. He'd given me much to think about -- not the least of which are possible complications, including loss of vision, double or hazy vision, increased sensitivity to light, dry eye, and the appearance of glare and halos around lights, any of which may be temporary or permanent. In addition, an ulcer may form on the cornea, or an eyelid may become droopy. After working for years as a science writer, I know that science is an art -- the doctors can't guarantee whether your vision will improve, or to what degree. And the surgery isn't cheap: $1,900 per eye.
Eventually, I decided to go through with it. So, on Dec. 28, 2000, I found myself reclining in a dentist-type chair, about to see -- literally -- what the future would hold.
The surgery itself is pretty simple: an assistant cleaned and swabbed my eyes and applied a numbing solution. Cavanagh asked me to open my eyes wide so he could tape my eyelashes, so they wouldn't be harmed by the laser. Next he put a speculum in each eye -- yes, a miniature device similar to the type used for a gynecological exam. These were then cranked so that each eye was open as wide as possible. This was the only painful part of the procedure, and prompted me to say, "Ouch."
I was told to relax, look at a red dot that was shining into my eye, and not move. But it was hard to keep my eyes totally still even with the tape and speculum, because the light has a slight pulse. They also warned me, as the procedure began, that I would hear a slight buzzing sound.
After both eyes were done and freed from the restraining devices, I was told to blink a couple of times, then read Cavanagh's wristwatch. It was very blurry. (He explained later that was partially due to the contact lens-like bandages he'd placed over my corneas to make sure the flaps healed in place.)
Next, plastic bubbles were placed over my eyes and taped to my face, making me look like a giant insect. I was told to sit or lie in the waiting room and keep my eyes closed. That was a little difficult because I was anxious to see if I could see, and eager to get home. Before I left, the nurse gave me a little cosmetic-type bag with postoperative instructions, three kinds of eye drops, and wraparound sunglasses. I was instructed to keep the bubbles on except when I was putting the drops in, and at night. I asked if I could drive myself back the next day for my first follow-up; yes, I was told, if I felt like it.
As a friend drove me home, I found as forewarned that my eyes were very light sensitive, but that wasn't unusual for me. Once home, I fed my dogs and let them out, then went to bed, dozing on and off. This was to be my position for the next three days.
Yes, you guessed it: I was not having the miraculous, instantly perfect eyesight experience that some ads for laser eye surgery proclaim. I do know several people who say they walked out of the procedure with greatly enhanced sight and never had any trouble.
The morning of the second day, I started to drive in for my follow-up appointment, but after about two blocks I realized that my eyes were so light sensitive and my vision so blurry, the 25-mile trip was impossible. I went home and got a friend to drive me there.
By New Year's Day, things had not improved much, and I was getting scared. I talked by phone with the ophthalmologist on call, who said that things sounded normal, but that he'd be happy to look at me. I got another friend -- one of those for whom LASIK had been an instant success -- to drive me to the hospital.
The exam turned up nothing seriously wrong. The doctor put a pressure patch over the eye that was giving me the most trouble and told me to leave it on overnight. By morning it was much improved, but not to the point that my vision was as good as it was pre-LASIK.
The next morning, five days after surgery, I saw Cavanagh for another follow-up. He declared me healing well and 20/40 in one eye and 20/25 in the other. That day I tried to do some work, but my vision was still blurry. I had to hunch over and almost press my face against the computer screen to read it.
The following evening, Jonathan Davidorf, MD, medical director of the Davidorf Eye Group and a clinical instructor at UCLA Jules Stein Eye Institute, returned my call. (I'd previously interviewed him for a story.) I didn't tell him my post-surgery progress but asked him to describe a typical recovery process for someone with farsightedness with astigmatism. His narrative exactly chronicled what I was experiencing; this made me much more confident of the final outcome. He said it could take as long as three months for my eyes to completely stabilize, and that sometimes, further correction is necessary.
Um, this was not what I'd anticipated.
By the second week I could read, but it was slow going and my eyes tired quickly. I had to put drops in my eyes every 30 to 60 minutes. (This continued two months after surgery. I still have dry eye and it seems to be worsening.)
I did have a major breakthrough in the second week: I was able to thread a needle in two tries without glasses. Before LASIK, it would have taken reading glasses and five attempts.
In the third and fourth week, I would wake with blurry vision and need to use my old prescription glasses for an hour or so. Then I would switch to weaker glasses. Some days I found that by afternoon, I could read almost anything without glasses. But the mornings were rough, and I considered asking for short-term disability leave from my job.
In the meantime, Cavanagh assured me that I was progressing nicely and probably still would achieve 20/20 vision in both eyes. However, the last time I saw him, at the end of January - one month postsurgery -- he said he expected my vision would fall off and I'd have to wear +1.75 to +2 lenses for most reading. I go for my next appointment soon.
So consider several things before getting LASIK:
- Believe the doctors when they tell you about possible side effects.
- Don't expect to have perfect vision. Very few patients achieve that, although the rate for permanent problems is only about 1%.
- If a friend offers to stay with you for the first couple of days, take him or her up on it.
Today my vision is minimally better: I can read many things without glasses. However, I haven't achieved what I'd hoped to: not having to use reading glasses. And the whole thing has made doing my job as a medical writer sheer torture on many days -- right up to today.
In the end, I suppose I can wrap up the good and the bad news like this: I can now see the dirt on the kitchen counter without my glasses.
Susan Steeves is a WebMD staff writer in Dallas.
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