LASER SURGERY IMPAIRED MY VISION
To Newsgroups: sci.med.vision, alt.lasik-eyes
Date: Thursday, September 16, 1999
My current Best Corrected Visual Acuity (BCVA) is achieved by wearing an eye patch over my left eye and facing the world with 20/50 vision in my right eye. It is a very challenging situation to be in. The other day I was in a yoga class in the middle of a balancing pose, where I balance on my hands, my nose an inch away from the floor. I tried to focus on the wood grain in the floor. It was too blurry. I used to be able to see the wood grain in the floor. For the symptoms described below I gave up my eagle-eyed nearsighted vision?
Yesterday at work I needed to use a lathe. Though I'm not a machinist, I have about ten years experience in the shop, and pride myself on that ability. Taking an inside cut on a piece of stainless steel an eighth-inch in diameter, half an inch long, used to be a piece of cake for me. Yesterday, it was too blurry to do safely. I had to let someone else do it.
STARKLY SURPRISING COINCIDENCE
All those warnings about presbyopia by the "doctor." At 41, I had never experienced any of the symptoms of presbyopia before LASIK. No problems seeing wood grain or 0-80 screw threads. Then, IMMEDIATELY after LASIK, the symptoms of presbyopia show up. Looks to me like the "doctor" knew that LASIK would "burn away" my good nearsighted vision, and covered his rear end legally by talking so much about presbyopia. Looks to me like LASIK causes a visual condition similar to presbyopia. No one told me I was trading away that fantastic nearsighted vision when I had my corneas ablated by the excimer laser. But I think some people - the "doctors" - knew.
TRUE INFORMED CONSENT
Personally, I think the patients who undergo LASIK, or any refractive surgery, deserve to be FULLY informed about the risks and benefits BEFORE the procedure. And, any recent post-op should understand the process of corneal healing. Just because the "doctor" says that you can go swimming after a week, that doesn't mean the "flap" is healed. In fact, endothelial cells are migrating across the flap as much as a year after the procedure, according to the medical journal literature.
13 months after LASIK surgery, I am using $10-$15 worth of eyedrops a week, either the Allergan Refresh Plus 42-pack or the 30-pack. Before the surgery, I had never bought eyedrops, except for the times when I tried contact lenses. Now, one of my eyes always feels like it has a dirty contact lens on it. I am reading in the medical journals now - corneal surgery frequently exacerbates ocular surface disease.
Post-LASIK, one of my eyes is now cross-eyed, resulting in double vision, in ADDITION to the image "ghosting" referred to as double vision in the "Informed Consent" Form. I also know one individual whose eyes are both Exotropic following multiple "Enhancements." I.e., his eyes look "out" - the left eye to the left, the right eye to the right.
There is a very interesting conversation between two doctors buried in the FDA clinical trials about LASIK causing latent strabismus to manifest after LASIK. Then we have the exotropic individual, and myself, with esotropia diagnosed three months after corneal ablation by excimer laser. It looks to me like there is, in a minority of cases, a cause-and-effect relationship between refractive laser surgery and eye-muscle dysfunction. Yet, on the "checklist" of contraindications and complications, the FDA puts a "Not Applicable" by "Strabismus" (cross-eyed-ness) for individuals with pre-op myopia with low to moderate astigmatism. I think they'll be changing their position on that subject.
In summary, LASIK is an ONGOING MEDICAL EXPERIMENT, a multi-billion dollar medical experiment. An open-loop medical experiment, with the "doctors" and the equipment manufacturers NOT sharing their statistics to develop an accurate picture of the true post-operative demographics of patient vision. This is an experiment where, as it turns out, the patients with complications find themselves in the position of banding together to develop that statistical information.
OCULAR RUSSIAN ROULETTE
You need to know that you are playing roulette (Russian roulette) with your eyes when you have the LASIK procedure, PRK, or RK. The acknowledged "significant complication rate" for LASIK is 1% to 15% in the medical literature. My own "doctor" acknowledges my own post-LASIK complications, yet asserts that there is no "cause-and-effect" relationship between the surgery and my complications. Before the surgery, I was a 14-hour-a-day computer nerd. Now, I get visually and mentally fatigued after 8 hours on the tube. It is a challenge to do my job. Before the surgery, it was a breeze.
19TH CENTURY MEASUREMENT OF A 20TH CENTURY TECHNOLOGY
Another thing you should know about LASIK - there are two different 20/20's. There is "natural" 20/20, including 20/20 Best Corrected Visual Acuity (BCVA), which I had before LASIK. And there is the LASIK "doctors" 20/20. E.g. my own "doctor" says I'm 20/25 in my right eye, yet I can't read one of the "EXIT" signs at work from 50 feet away. Unless you're paid to read eye-charts for a living, this is a very important distinction. The "doctors" are pointing to the Snellen eye chart, and saying, "See how many more lines you can read!"
The Snellen eye chart has been around for quite a long time. There are far more accurate techniques to measure visual acuity, such as contrast sensitivity. Why would your "doctor" use the Snellen eye chart and leave you sitting in a chair wondering whether it's a B or an E or an S, when there are far more concise, accurate ways to measure your visual acuity? Unless, of course, your doctor is running an ocular production line, grossing $15 Million a year, is considered by his "peers" to be at the pinnacle of his profession, and is more Scam Artist than Practitioner of Medicine.
That is, post-LASIK, you can have blurry, strange vision, kind of like you're wearing someone else's eyeglasses, except they're glued permanently to your head, so you have to close one eye to see straight AND have a permanent foreign-body sensation in one eye, and be called a "success" by the refractive surgery industry.
If you're thinking about having the LASIK procedure, you should have your eyes examined pre-operatively for contraindications, by one (or two or three) ophthalmologists who have no vested interest in the Laser Surgery phenomenon, i.e. just a good old-fashioned eye doctor. You can go to the best, most experienced LASIK "doctor" in your area, and they won't diagnose and disclose contraindications. That's what happened in my case. Either my "doctor" - one of the most experienced refractive surgeons in the United States - completely missed my limited esotropia during pre-op consultations, or the trauma of the laser ablation affected the muscle function of one of my eyes. Or the appearance of my esotropia on my medical charts three months post-op is just one of "life's little mysteries."
Once you have the facts about your own eyes, THEN you want a surgeon who is experienced at the mechanics of the procedure. The paradox is that the experienced doctors don't get to be experienced by warning patients of all potential complications and risks.
Another note, about "Enhancements." After what I've been through, I don't dare have an "Enhancement." Enhancements are something that are mentioned by the "doctor" pre-operatively to address concerns regarding "what if I'm undercorrected?", but there's a good chance, after the first lasing of your cornea(s), that you won't dare to undergo a second procedure.
So I am left with one eye crossed, and one eye undercorrected, wearing a patch to achieve BCVA after trying other prosthetics, including eyeglasses with a prism correction (they sucked) and an occlusive goggle with a prism correction (under development.) And for this I traded my ability to see the myriad detail of beautiful wood grain, and the ability to machine small metal parts like those that belong in a watch. Not a good trade. I swim nearly every day and do a lot of yoga to keep my spirits up.
Again, I think the patients who undergo LASIK, or any refractive surgery, deserve to be FULLY informed about the risks and benefits BEFORE the procedure.
Editor's Note: The types of corneal surgery now in use are:
In LASIK, an incision is made across the cornea and a flap including the first three layers of the cornea is made. These layers are the epithelium, Bowman's, and stroma. Excimer energy is applied to the stroma and the flap is placed back over the ablated area.
With PRK, the epithelium is removed across the center of the cornea and excimer energy is applied through the Bowman's and stroma. Epithelial cells are the fastest reproducing cells in the human body and they quickly cover the ablated area. The problem with removing the epithelium is that while it grows back the patient feels discomfort. Like sandpaper in the eyes.
LASEK is a process where the epithelium is lifted like the LASIK flap, but no incision is made. The epithelium is released from the rest of the cornea by the use of alcohol. Excimer energy is applied through Bowman's and stroma then the epithelium "flap" is replaced. The cells quickly recover from the alcohol, reproduce to cover any open areas, and the patient has a much more comfortable experience than with regular PRK.
The reason LASEK is becoming so interesting is that surgeons are coming to understand that the LASIK flap is opening the patient up to a whole set of potential complications that PRK does not include. True customized ablations can be thwarted by induced astigmatism and other problems that flaps can create. For the very best customized ablation results, PRK makes more sense. Since PRK is not popular due to it's discomfort during recovery, LASEK creates a popular alternative. Think of LASEK as PRK without the discomfort.