Flap, Zap, it’s a Snap to See
by Margaret Swaine
As I sensed the blade cut through my cornea, I knew there was no turning back. The suction device which held my eye steady blurred my vision. Seeing only ghostly figures and pinprick lights, I felt like I was in outer space. For a split second of panic, I wondered what on earth I was doing here. But I knew the answer, and after decades of watching and waiting for science to advance enough, the time had come to go for vision correction surgery.
All of my adult life I have depended upon my “four” eyes to function. And like millions of other North Americans I longed to be free of this unhappy marriage to contacts or glasses. I became a medical report junkie, ingesting every scrap of information about surgical ways to vision acuity. Any decision to slice my eyes up couldn’t be made lightly. Correctable vision is better than none at all. Neither did I like the thought of GASH; the glare, arcs, starbursts, halos and other complications when eye operations don’t go as planned.
A surgical solution to seeing first crossed my mind in the early eighties. A skydiving friend of mine had radial keratotomy (RK) done for sporting reasons and was spectacle free. This procedure which involves making four to eight or more slits around the outside of the cornea, like spokes in the wheel, was the first vision correction method used on mass. I remember seeing news clips of Russians, who pioneered the procedure, lying on human conveyors, passing one after the other under the blade. The cuts are fairly deep, up to 90% of the thickness of the cornea, causing it to flatten enough to improve myopia. (The cornea, a clear dome, acts like a lens and provides most of the focus power of the eyes. When domed incorrectly, light doesn’t focus as it should for clear vision.)
While millions have had this done professing to be happy with the results, I just clipped the RK articles from magazines and held off for more advanced technology. RK weakens the cornea which can lead to progressive flattening hence increasing farsightedness, and makes it more vulnerable to rupture. Judging these and other troubles I’ve read, I feel fortunate to have stayed away from this procedure. Only one doctor in Canada still does RK, according to my medical sources.
Then in 1991 I started to read about laser vision correction. The excimer laser, developed by IBM to etch computer microchips, was discovered to be an excellent tool for removing corneal tissue. It precisely breaks their molecular bonds, thus vaporizes layers of the cornea away without heat damage to the eye. The excimer laser first came into Canada in 1990 as part of a five year national trial approved by Health and Welfare using a procedure called PRK or Photorefractive Keratectomy. One of my clips from an issue of the now defunct Ontario Medicine, wherein I wrote a wine column for doctors, announced this as a Canadian coup as the States chose to withhold approval. This farsightedness on the part of our government gave us a five year head start on the Americans and helped to make our surgeons the world leaders in excimer laser procedures. When the VISX (the first U.S. FDA and Canada Health Protection Branch approved excimer laser manufacturer) recently invited the ten most experienced doctors in the world to a special focus group in France, four were Canadians including Toronto’s own Dr. Sheldon Herzig and Dr. Ray Stein.
I didn’t know this four years ago when I first met the curly haired, boyish looking Dr. Stein at his home in Rosedale. His wife was hosting a “wine” shower for a couple I had brought together in a stroke of match making genius. However after he picked my brain about wine, upon learning he was an ophthalmologist, I picked his about vision correction. He was enthused but I thought I detected a hint of caution about the new procedures.
Then the big boon to public information on medical issues happened. The internet. I went to town around the globe, punching the words PRK and laser eye surgery into a multitude of search engines. I found an incredible amount of information on the net, including many blow by blow testimonials of surgery patients. Or should I say clients – this is elective with costs running $2,000 to $2,700 per eye. One cyber chatter detailed his research into PRK (Photorefractive Keratectomy) versus the newer Lasik (Laser assisted In-situ Keratomileusis). He chose Lasik surgery and filled cyber-space for months with a daily diary of his progress. This lead me to the Herzig Eye Institute’s site. Dr. Herzig who has his practice in The Colonnade on Bloor, is a major proponent of Lasik, the latest technological advance in laser surgery. He began using this procedure in 1994 and has since treated thousands of patients with it.
As fate would have it I bumped into Dr. Stein this spring at the Summerhill LCBO. By this time Dr. Stein had performed over 10,000 laser vision procedures with 150 of his patients eye doctors from across North America and published the first text book on the use of the excimer laser. Finally I felt confident that vision correction was safe enough for me. I booked into the Bochner Institute on Prince Arthur to see if I was a good laser candidate.
My eyes clocked in at left -2.50 diopters and right -6.00, well within the treatable range. (Doctors differ in opinion, but Dr. Stein believes the range to be +6.00 to -12.00 D using Lasik.) Refractive errors are measured in diopters. (Diopters do not have an absolute relation to a Snellen eye chart in that 20/40 does not necessarily mean an error of +/-1 D.) The lucky souls with no refractive error (emmetropes) have a diopter of 0. The range for vision errors is between +15 and 0 (hyperopes or the farsighted) and 0 and -25 (myopes or the nearsighted), with the +6 to -6 encompassing over 96% of the over 70 million North Americans with a sight problem. Lasers are now capable of treating myopia, hyperopia and some astigmatisms. Other tests were done to ensure my eyes were healthy and without irregular astigmatism.
Inflammation Is The Causal Link Between Psoriasis brand viagra canada And Cardiovascular diseases becomes apparent. The drugs start acting cialis generic canada within 30 minutes of intake. Simply put, this is the misalignment of our spinal column. viagra store in india Atria are the blood receiving chambers and the order viagra prescription ventricles are full, an electrical signal travels along the ventricular nerve branches and causes them to contract. With up to 6 D of myopia, there is a 96% chance of obtaining 20/40 or better vision within 2 to 4 weeks with PRK. However with over 5 D, Lasik is often recommended over PRK because there is less chance of haze. I was glad of this. I’m also a big sissy and knew from reading testimonials with Lasik there’s no pain, while with PRK discomfort ranges from a grit in the eye feeling to outright hurting for several days. With PRK the epithelium, or top layer of cornea, is scraped away and for many this causes some pain (controllable with anesthetic drops) until it grows back. With Lasik a flap is cut in it which is folded back into place once the laser has done its job. However this procedure is much more dependent on the surgeon’s operating skills, than the computerized precision of PRK. Dr. Stein as Chief of Ophthalmology at Scarborough General has spent years doing cornea surgery and transplants. I certainly felt safe in his hands. And if anything went wrong he’s the guy who knows how to fix things.
Alas as we age, sometime after we hit forty, most of us have to don reading glasses. This natural hardening of the lens with age, called presbyopia is not reversable. I chose to deal with this eventuality by leaving my left eye untouched. Its more moderate myopia gives that eye a natural focal point good for reading. (The optimal myopia range for forestalling reading glasses is approximately -1.5 to -2.5. This is the singular advantage we myopes have over the 20/20’s.) Around 10% of myopes, elect like me to have monovision, where one eye is fixed to focus well in the distance and the other left untreated or deliberately undercorrected for reading.
The decisions made, I booked a surgery time. One week before I had to remove my soft contacts to allow my corneas to stabilize in shape. That was the hardest part. Glasses just don’t correct my vision sufficiently. I was covered in bruises from encounters with walls and furniture by the time I returned to the Bochner on the appointed day. I wore comfortable street cloths but no make-up as advised.
My eyes were checked again, including the computerized keratography to check for astigmatism. Then I sat down to a cookie and coffee as I read the consent form. It drove home the risks I was taking, almost driving me home. I knew Dr. Stein hadn’t had seen an infection in five years and only had a 2 to 3% retreatment rate for his tens of thousands of laser procedures. That’s what kept me there. But in the hands of the wrong guy, the flap could be incomplete, separated, too thin, too thick or otherwise messed up and so my vision. Then from the laser, GASH is a possibility. I signed, then swallowed my valium. Finally after drops were put into my eye, the moment of reckoning.
Walking into the laser room was like going to the dentist. People in white coats gathered around me while I sat in a reclining chair. But instead of a rubber dam popping up my teeth while my mouth strained open, a suction ring exposed my eye, Clockwork Orange style. Then the slash, followed by 54 seconds of zaps. It sounds scary, but in fact took two painless minutes. I was awake and listening to the doc gently explain his every motion, while asking me to watch a pin of light. I walked out of the room able to see better out of the operated eye than I could when I walked in.
All post surgery patients are advised to go home to rest. The heady mixture of part relief all had gone well with part valium made me feel too good for that. I joined my friends who came by to take me home after the operation for pasta at Fieramosca next door. A few hours later I took the Tylenol #3 I was provided with just in case, and crashed.
It was the post operative days which were the most frustrating. My vision tested the next day at between 20/30 and 20/40 (around – 0.75 D) which was a vast improvement but still too blurry for me. My poor car sustained an appropriately bright red injury after an encounter with another in a gas station. Anything at reading distance was completely washed out of focus. These temporary problems can all be expected but until actually experienced it’s hard to imagine the impact. Vision, depth perception and focus can fluctuate for days or weeks. It was fortunate I had only one eye done. Reading is as necessary as water to a journalist.
Finally two weeks later I tested 20/20 with a + 0.5 overcorrection. While I could read the Snellen charts perfectly well, Dr. Stein looked fuzzy, albeit happy in my eyes. The eye can be expected to regress slightly over the two to three months it takes to stabilize. My vision was exactly where the doctor wanted it. (The flap itself takes about six months to complete the scar tissue that adheres it solidly back in place.) Meanwhile when I get up in the morning I don’t bump into walls.
All my four eyed friends have stopped, at least temporarily, asking for my advice on wine. They want to know about laser surgery instead. I say with mild myopia (under -2.5D) leave well enough alone or try monovision. Don’t like it, it’s easy to do the other eye. It’s optimal for old age – you could avoid reading glasses well into your sixties. For those who see less clearly, definitely go for it and pick Lasik. But don’t buy a bargain special, like I saw advertised in the Globe. Make sure you pick a skilled surgeon with plenty of practice with the blade. Lasik is several hundred dollars more per eye than PRK but since it leaves the epithelium intact, the eye heals faster, vision improvement is almost instant and there’s less GASH hazards with higher corrections. (There’s a site on the internet “EyeKnowWhy Refractive Surgeons Wear Glasses” chock full of gory details about these two surgeries.) If you’re a perfectionist, forget all of this. The goal of this surgery is to decrease dependence on corrective lenses. No doctor will guarantee you can throw them away. If you can’t live with uncertainty don’t. Though prognosis is good, PRK with only ten years of results and Lasik with but five don’t yet have long-term human subject results.
Bottom line. After all I have experienced and learned, would I do it again? Absolutely. Same doctor, same procedure. My vision’s a far sight better.
Dated August 26, 1996