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Norwalk Plus magazine : Norwalk Plus Spring 2008 Published: Feb 25, 2008 - 10:29:36 PM


The windows of the soul - Is laser eye surgery right for you?

By Chandra Niles Folsom


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It was after mistaking a flowering hydrangea bush for the FedEx guy that I understood something had to be done to correct my vision. Nearsighted since forever, I had somehow managed to avoid getting fitted for eyeglasses until the seventh grade. Even then, the correction was limited, and glasses caused the bridge of my nose to ache. Contact lenses, which came much later, felt dry and gritty, and caring for them was a tedious task.

When the subject of laser eye surgery arose in conversation, friends and family were split about having it done: “Do it — I know someone who had 20/20 vision immediately afterwards!” Or “don’t do it — I know someone who went blind immediately afterwards!”

So, after much deliberation and consultations at two well-known area LASIK practices, I finally decided to have a procedure called CustomCornea done in Westport, by a respected board-certified ophthalmologist who seemed to offer the very best in care.

Although vision correction surgeries — including LASIK — have become a viable option for many, these procedures are not perfect for everyone and don’t come cheaply. So, which vision problems are treatable with surgery, and what choices are available? I learned a lot as a result of my experience with LASIK.

Common Vision Problems

Nearsightedness (myopia) is the most common vision problem, affecting one quarter of the U.S. population. Nearsighted people can focus sharply on objects up close, but at a distance the objects appear blurry.

Farsightedness (hyperopia) is the reverse condition. Objects can be viewed sharply at a distance, but appear blurry up close.

If the eyes cannot focus accurately at any range, it may be a condition called astigmatism, which may or may not accompany myopia or hyperopia.

Most focusing (refractive) problems are caused by the way the eye bends and focuses light to form pictures in the brain. When the ability to precisely focus light onto the retina is hampered, the result is blurred vision. It can be caused by the shape or length of the eyeball, the shape of the cornea or the power of the lens.

A different condition called presbyopia, which also produces farsightedness, is a normal part of the aging process and is caused by a stiffening of the lens of the eye.

Surgical Options

Vision correction surgery involves different procedures and techniques to reshape the cornea, restoring vision that has been compromised by myopia, hyperopia or astigmatism.

Today’s most common vision correction procedure — LASIK — was developed from surgeries dating back 60 years.

Bogotá, Colombia, was the site of the first known vision correction surgery, in 1948. The process involved surgically removing more than half of the patient’s cornea, before freezing, reshaping and sewing it back into place.

Over the years, various surgical procedures to reshape the cornea were developed and used around the world, but it wasn’t until 1989 that the first laser-assisted in-situ keratomileusis (LASIK) surgery was performed, in Greece.

One year later, LASIK was introduced in America, and today is the most widely used form of vision correction surgery, with millions of procedures successfully performed.

There are essentially two different types of laser eye surgery: PRK (the earliest form of laser surgery) and LASIK. Within each category are several variations. All laser eye surgeries are performed while the patient is awake and require the use of special eye drops to numb the cornea. Procedures usually take about 15 minutes, although a couple of hours of prep time are required, while the patient is dilated and re-examined.

With LASIK, an instrument called a microkeratome is used to create a flap in the clear outer layer of the cornea (the epithelium). An excimer laser then reshapes the cornea, and the flap is gently replaced. The cornea bonds back quickly without the need for stitches, and vision improves rapidly — in some cases, immediately.

PRK involves a surface ablation technique to remove the epithelium, rather than creating a flap. Though PRK involves a longer recovery process, it’s often considered the preferred method for patients with thin corneas and large pupils. Another drawback is that it doesn’t always produce immediate results, with vision improving gradually over a period of time.

Variations on these two types of laser surgeries include LASEK, a procedure that uses alcohol to separate the outer layer of the cornea, as an option for patients with thin corneas; Epi-LASIK, which employs a fine surgical blade, reducing the risk of creating a wide corneal flap; IntraLASIK, a blade-free procedure conducted entirely by lasers; and Wavefront LASIK, a state-of-the-art excimer laser method considered to be the most precise form of laser eye surgery. Within this system is the method I chose for its customized reshaping of the corneal surface. The laser is guided through high-speed computerized eye tracking that makes micro adjustments as the eye involuntarily moves.

Before You Decide

Before making any decision regarding laser surgery, a comprehensive eye exam and consultation with an experienced ophthalmologist (not just a technical assistant) are necessary. Patients must have healthy eyes, be clear of systematic diseases or eye diseases, have a stable eyeglass prescription and be at least 18 years of age.

The surgery is considered elective and not usually covered by health insurance. Yet the price can vary greatly depending on what technique is used, who performs it and where it is performed. Be sure to inquire about any extra costs ahead of time — sometimes the price you are quoted is not the total cost. Payment plans may be available.

Beware of practices that require you to visit a specialist of their choosing.

Don’t allow a practice to rush you into surgery or have the procedure done on the day of the initial visit. If you don’t feel comfortable with the doctor or the practice, walk away and find someone else. You might want to get a second opinion before deciding whether or not to have the procedure done at all.

Who Gets Your Business?

The most important choice you’ll make is in selecting the doctor.

Although only ophthalmologists are permitted to perform vision correction surgery, not all have the same degree of experience or supply the same level of care before, during and after surgery. A good doctor will answer all your questions and explain the procedure in detail, including the benefits and possible risks associated with each type of available treatment.

It’s always a good idea to pick a board-certified ophthalmologist with a practice that uses the latest testing equipment as well as lasers that are FDA approved. Doctors with specialized training in corneal surgery are far preferable to those with limited training —should complications arise during or after surgery.

Ask how long the doctor has been performing the surgery and his or her rate of success.

Inquire how many surgeries the doctor performs during the day — you probably won’t want to be positioned anywhere on a long list.

Be certain that the doctor who examines your eyes is the same doctor who performs the surgery.

Make sure that the doctor — not an assistant — will examine your eyes again on the day of surgery, before and after the procedure.

Ask if the doctor will perform follow-up examinations and whether or not an extra cost is involved.

Pre-Op

Patients are required to read and sign consent forms that explain in detail what to expect from surgery, possible side effects and the rare but serious complications that could potentially arise.

During the days leading up to surgery, a doctor may require you to begin a regimen that includes lubrication drops, antibiotic drops and special washes to cleanse the eyelids. Following these requests precisely will minimize the possibility of complications.

On the day of surgery, a clean, makeup- and lotion-free face is required before going under the laser. Remember, you will be awake during surgery, although a mild sedative may be given, and numbing drops will be placed in the eyes. The Laser Room will be cold, so dress warmly for the event. There may be several other people present, in addition to the surgeon, to assist in the procedure. Be prepared to have your hair netted and eyelids taped open, and be aware that the laser light is extremely bright. You will be asked to focus on objects or to remain still during the procedure by the doctor (or if the Wavefront system is used, a computerized voice may also instruct you). Warning: There will be a slight burning odor (similar to burning hair) while the laser does its job.

Although a bit scary, the entire procedure is quick and painless.

Post-Op

You may be asked to remain at the surgical center for a couple of hours afterward, but have someone standing by to drive you home. You should then rest in a dark room. The eyes need to recover and might sting or tear and be sensitive to light. My eyes stung and were quite teary for several hours after the procedure, but my vision was nearly perfect within 48 hours.

Although many patients claim to have excellent vision immediately after surgery with little or no pain, others need a day or two of light activity before their eyes feel fully recovered. Dry eyes, requiring the use of lubricating drops, may also result from surgery.

Post-operative instructions may include the following: wearing goggles or eye shields while sleeping for two weeks to prevent damage to the corneas; no eye-rubbing for at least one month; no swimming, hot-tubbing or saunas for three weeks; no eye makeup for three weeks; no shower spray near the eyes for two weeks; and limited exercise for one week.

Later On

Although the vast majority of patients usually see improvement and stabilization in their eyesight over a period of several months, there can be side effects and complications.

These can include under-correction or over-correction, which may require an additional laser treatment or the wearing of eyeglasses or contact lenses. Some patients may require mild reading glasses after myopic vision correction, as I did.

Early side effects, which usually improve over a period of weeks or months, include sensitivity to light, halos and double vision. I experienced light sensitivity and halos, which mostly disappeared after a month or so.

Infections can occur after surgery, so it’s very important to use the antibiotic drops provided by the doctor. Infections can lead to damaged corneas and the possibility of permanent loss of vision.

Life With Perfect Vision

Each day that passes since the surgery, I notice something new that I hadn’t before — the patterns in the leaves on the trees, the crests on the waves in the ocean, the wings on the butterflies in the garden and the FedEx guy standing at my gate.

It was all well worth it!




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