My LASIK Experience
I’m an optometric technician who has worked in the business for twenty six years. I had the opportunity to have Lasik done for free by the Lasik corporation that my employers co-manage. That way, I could promote the surgery to patients who came to our office. Little did I know that I would end up permanently visually impaired, and that I would spend much time in the future warning patients about the dangers of Lasik.
Actually, I thought that I knew everything about Lasik. I had read all the information that the Lasik corporation had given our office in order to prepare the doctors to co-manage patients for them. I wondered why the statistics for visual complications on the back of the Lasik pamphlets often listed “Not Available” for very nearsighted people like myself but I figured that it probably took a year or more to put together enough data to list. Looking back, since a year and a half has now passed, and the pamphlets still say “Not Available“, I realize that perhaps Lasik corporations don’t want high myopes to know that their risks are much higher than those who are moderately nearsighted.
There were other warning signs that I should have noticed, but I trusted that the surgeon would tell me if I wasn’t a good candidate. After all, I had my optometrist with me, and I was “in the business.” Actually, the surgeon never mentioned whether I was a good or bad candidate. She joked with us, “Couldn’t you find someone LESS nearsighted in your office?”, never mentioning that at -9.00 with -2.50 diopters of astigmatism, I was risking far more than the average patient. If she had said it in a serious voice, I would've taken her remarks at face value, but this doctor was highly respected in the field, and she said nothing to discourage me from going ahead. She did caution me that since my corneas were steep, I could have a buttonhole flap, but if that happened, she would close up the flap, let it heal, and do the surgery a few months later. She made it sound like we were talking about nothing more serious than skinning your knee. However, this was the first time I had heard any mention that I was at risk for a possible complication. After all, as nearsighted as I was, I was still within the guidelines that the Lasik corporation published for it's co-managing optometrists. “Should I go ahead and do it?“ I asked, looking for her advice. “Absolutely,” she assured me with a smile, “you’ll be very happy!“
So with her seal of approval, I went ahead. The surgery went well and she assured me that everything was going perfectly. She cautioned me that it would take me “longer” to heal, having been very nearsighted, so I figured it would take a few weeks as opposed to the few days that the testamonials liked to flaunt. But a few weeks went by and my vision wasn’t clearing up even though my “flaps” looked great and I had no signs of infection or epithelial ingrowth.
In fact, my vision was beginning to scare the life out of me. Everyone looked like they had two sets of eyebrows and two pairs of glasses on their faces. When measuring people for bifocals, as my job required, I couldn’t tell which line was the real one. The lines on the streets hovered six inches above the pavement, and in low light people appeared to have two heads! I couldn't recognize faces or make out their expressions even when a few feet in front of me. Once, while waiting in a doctor's office, I was embarassed when I answered someone's question only to have them reply, "I wasn't talking to you!" Reading, which is my favorite hobby, was next to impossible. Besides all the letters being doubled and tripled upon themselves, the print was washed out like newspaper left out in the sun for a long time. Glasses didn’t help at all. Soft contacts were next to useless. What was going on?
Part of my job requires taking each patient’s visual acuity as part of their pre-testing for their exam. I would take one look at the eye chart tripled upon itself and start to cry. It was extremely difficult for me to work as everything looked tripled on the back-lit instrumentation that I used. I was taking night classes at the time and couldn’t drive on the highway because there were three stop signs instead of one and my night vision was horrible. I started to think that I should sleep in my car in the parking lot and drive home in the morning when daylight would allow me to see enough to drive.
Worse, the depression was crushing. I blamed myself over and over for having risked my excellent, corrected vision, and cried all the time. Every moment of the day I was reminded of my predicament by the absurd visual distortions. The only relief was sleep and even that was next to impossible, as I beat myself up for being so "stupid". The trust that I had that a doctor has the patient's best interest in mind was irrevocably broken. I was nothing more than a statistic, the unlucky 1 - 3% with complications. The information that I read said that the worst that could happen would be the loss of a couple of lines from the "bottom of the chart." Nowhere did it mention that the quality of the rest of the chart, including the “Big E” at the top, could be so distorted that it was nearly illegible. I had reasonable expectations and understood that I might need a pair of glasses or contacts after surgery, but no one warned me that there was a possibility that glasses and contacts would be useless to improve my vision! Moreover, I understood the risk of an interoperative complication or an infection afterwards, but none of that happened to me. What happened to me is that the present day lasers are not accurate enough and the technology to fix the lasers' shortcomings does not presently exist.
I started to see a psychologist who helped me to work through my grief and the anger that I felt from being betrayed by the very medical society which is supposed to save patients' vision. Over time, I began to understand why depression was crippling me as I read about others, with worse outcomes than mine, who sadly, had comitted suicide.
When I questioned the surgeon about my vision, she was somber and very vague. She thought my problems might be due to striae (tiny wrinkles), but then again, maybe not. She did a flap lift on one eye to see if that would improve my vision, and it seemed to help a little. She had warned me not to read the “horror stories” on the internet so that I wouldn’t get nervous, and assured me that it would get better over time. By her manner, I judged that she seemed to be witholding information from me.
The turning point in my life came when I disregarded her advise and finally typed “Lasik complications” into an internet search engine. What I found was www.SurgicalEyes.org, a website that is like the “Consumer Report” for Lasik surgery. I was astonished to find that not only did hundreds, if not thousands, of patients have the same complications that I did, but that there were names for these abberations! “Ghosting” for the irregular astigmatism (the two sets of eyebrows I was seeing); loss of contrast (the bleached out newspaper print) ; and central islands. Apparently, the very popular large-beamed lasers can leave raised areas on the cornea (central islands) that weren't properly treated because the large plume of smoke and debris can block the beam. These central islands prevented the cornea from healing in a smooth optical surface, causing irregular astigmastism.
At Surgical Eyes, I also found doctors that dared to answer frightened patients' questions. I found links to professional journals that discussed these very same complications, and I found friends to support me in my quest for the truth, as the surgeon wasn't offering any helpful information.
And the truth did set me free. I no longer felt like a puppet on a string when I went back to the lasik center. I asked outright about the central islands and irregular astigmatism. At first the staff would not confirm my suspicions, even while looking over my topographies. But when I mentioned a new office owned by the corporation that was going to try a new laser treatment to fix irregular astigmatism, the director smiled and suggested that I might be a candidate. I finally had my answers, no thanks to the surgeon who, by the expression on her face, knew that she could not fix what she had broken. But no one would be experimenting on my corneas again, anyway. I had asked for a copy of the operative report and was astonished to find out that my pre-op corneas were thin, very close to 500 microns. Considering the amount of tissue that had to be removed, and the thickness of the flap, which is an educated guess, I probably have close to, or less than, the bare minimum (250 microns) of untouched tissue thought to preserve the integrity of the cornea. Considering that some patients with 250 or more microns untouched have experienced breakdown of the cornea leading to the need for a transplant, some doctors are now calling for at least 300 microns left alone. Why aren't patients' corneal thickness measurements being discussed with them? I think we deserve to know how close to that "bare minimum" lasik will take us so that we can make better informed decisions.
As I learned more about the disasterous outcomes of thousands of patients, I became angry. If I, who read everything that our office had on lasik, had been so ill-informed about the true risks that I was taking, how could anyone be truely informed without spending hours and hours researching information that is not readily available from their surgeons? Why was I learning more about lasik complications from the internet than was present in optometric or opthalmic journals? Why are optometrists being courted by lasik corporations to promote the surgery to their patients, but not given adequate information with which to properly screen their patients and advise them?
As many patients have found out (but never saw mentioned in their consent form), there is only one thing that can possibly restore some of their lost vision after refractive surgery: hard contact lenses. I had read about special reverse geometry gas-permeable lenses on Surgical Eyes and was hopeful that I could be rehabilitated with them. I printed out every article that I could find for my optometrist, and together with the contact lens consultant, he was able to achieve a pretty good fit. While they are not perfect, and my eyes are so red that I look like I have a hang-over most of the time, they have improved my vision to almost normal and I have been able to get on with my life. Hopefully, I will not have any problems in the future because my corneas are so thin now.
Unfortunately, there are a lot of reasons why many post-refractives can not wear these lenses. The number one reason is that we are very difficult to fit as our corneas have been altered and are no longer normally shaped. Also, there are very few doctors who have any experience fitting post-refractive patients or even know that these lenses exist. I am one of the lucky ones who have been to Lasik-hell and back again and don't want anyone to have to go through what I did. If this hadn't happened to me, I'd be out there right now telling everyone how wonderful lasik is because I wouldn't know any better. And that's the way that many in the the lasik industry want to keep it.