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I had taken my youngest daughter to the Melbourne, FL Eyeglass World to pick up her new glasses. While there, I noted a sign advertising Lasik for just $1,288 per eye for the first 500 eyes. I had been considering refractive surgery since the late 1980’s, where I had almost done RK. I didn’t, afraid of night vision problems and that my vision might not be fully corrected such that I would have to wear glasses. As they told me I could not wear contacts following RK, and I hate wearing glasses, I felt the risk was too great. In discussing RK with my OD, he told me about PRK coming closer to getting FDA approval. As an engineer, I found it intriguing that a laser could be used to correct for vision problems. I followed it for a while, but was told it wasn’t yet approved to treat astigmatism, so I put it off. When Lasik came out, I thought that was the way to go. I did some investigation in 1998, but the cost held me back. I can afford it, but spending nearly $5,000 was more than what I wanted to pay. I mean, I dislike my contacts (torics), but I do not dislike them to the tune of $5,000. But, seeing the advertisement, I did a quick mental calculation and decided that it would be worth about $2,500 for me not have to wear contacts or glasses again (at least for distance vision). Now, part of my decision may have been due to my advancing age (44) and my brand new need for reading glasses to read fine details. This is called presbyopia and it had been sneaking up on me, and wearing two sets of lenses didn’t sit well with me. Anyway, I asked about the "500 eye special" and the OD told me that Eyeglass World had managed to buy the newest Nidek laser and had just set up a laser center in Altamonte Springs, FL. I filled out the questionnaire to sign up, and someone from the laser center called me up a few days later. My personal, long term OD (not at Eyeglass World) had previously told me I would be a great candidate, and the Eyeglass World OD did a quick check and confirmed this opinion. I set up an appointment for the surgery for January 11, and was told I need to be out of my contacts for two weeks prior to a comprehensive eye exam, that the local OD, Dr. Markle, would do on January 8.

I was excited, but decided to check out the Internet for help – just to make sure. I quickly discovered two exceptional web sites complete with bulletin boards. One is Dr. Jerry Horn’s at www.chicagelasercenter.com and the other is hosted by Dr. Gerald Walman, which you can reach from the Council for Refractive Surgery at www.usaeyes.org. Another mandatory site is at www.surgicaleyes.com. This site is basically an anti-refractive surgery site, but it is a must read site and it spells out the risks. It certainly quelled my initial excitement for Lasik, which is good, but not enough to make me cancel out – just enough to continue with my research.

Here are my own thoughts on Lasik and the risks. (If my own Lasik goes bad, then I might then change my mind!) But, anyway, there are risks in everything. People have gone blind wearing contacts, whereas no one in the US has lost their sight via Lasik given by a licensed and manufacturer-certified MD. I discovered that the most common ailment is night vision problems. I learned that large sized pupils are directly related to night vision problems as, at night, the pupil opens up to admit more light and, with large pupils, some of the light that enters passes though the part of the part of the cornea that was zapped with the laser. If this part of the cornea is not smooth, then the light gets scattered and halos and starbursts around bright objects exists. I was concerned about this as I have larger than normal pupils, and because I am a bit of a amateur astronomer. Not much of one, but I do have a telescope and the thoughts of having lousy views though it was unsettling. Remember, night vision problems were a major reason I backed out of RK.

At Dr. Horn’s web site, I learned that pupils over about 7 mm or so, measured in dim light, might have problems, depending upon the steepness of the cornea and the degree of vision correction needed. Thus, steep corneas would bend the light even more and cause more problems. I decided that if my pupils were larger 7 mm or larger I would cancel the surgery.

Participating on the bulletin boards, I learned there was on-going controversy regarding which laser was "best". For persons whose myopia is mild or moderate, it was generally accepted that most any laser would give good results, and that the choice of surgeon was the most important factor. With higher degrees of myopia, I felt that a laser giving a smooth ablation profile became increasingly important. Here, it seemed that Autonomous laser seemed to get high rankings, followed by the Visx Star and Nidek EC5000, with the Chiron and Summit coming in last.

I talked to the counselor at the laser center some more and asked some questions. They told me they used the Nidek, a brand new machine, and the doctor, Nancy Tanchel, MD, had done some 1,300 Lasik procedures. That made me feel better, though I wondered if I should still back out as I was not sure the Nidek was good enough. More research led me to believe it was probably as good as the Visx, and that the reason the Nidek was not as widely accepted was because most surgeons in the US had experience with the Visx. I also learned that Visx had been, perhaps, a bit ruthless in a patent infringement claim against Nidek (claims that had been rejected in court in other countries and, I believe, now in the US). Nidek claims Visx engaged in unfair trade practices against them, propagating a myth that the laser is not as good and that those who purchased the Nidek might not be able to use it if Visx won their law suit. I am not taking sides here, but the bottom line is that both machines are very good and one should place the surgeon as being more important that which machine they use.

Anyway, I would encourage anyone contemplating Lasik to do their own independent research and participate in the bulletin boards. Don’t go ahead just because you read of the good result someone else had, nor should you decide against it because of a bad report you read.

As far as the risks go, yes, they are there, but I believe the surgeons who say that only a few percent, at most, have problems. I look at it this way. One million procedures were done last year. Out of those, I would conservatively guess that 20% were Internet-savvy. Thus, probably 200,000 of those are capable of getting on the Internet to do research and ask questions. If even 1% of the patients had significant vision problems, there would have been 2,000 people on the bulletin boards (over 160 per month) and newsgroups asking questions. In the month of December, I noted only several individuals who had problems, and most of those were of the minor kind that, with time, should take care of themselves. (I do not mean to diminish the concerns of those who do have problems. Gosh, I might be one of them.) So, I could not find any mass of people writing in complaining of post-Lasik complications. A few unfortunate people, yes, but I would imagine just as many suffer from contact lens problems. So, I concluded that the risks were low – certainly lower than for me to continue wearing contacts. Now, if my pupils were large and/or my myopia very high, my risks would be higher. But my myopia and astigmatism were in the mild-to-moderate range, being approximately:

The first number in each column is my sphere. It indicate my degree of near sightedness (if I was farsighted, the negative number would be positive.) The second set of numbers is the degree of astigmatism, with the third set being the angle to which the astigmatism is aligned. You can see it is mild in my right eye, but more pronounced in my left eye. Though I wore toric contact lenses to correct for the astigmatism, the amount in my left cannot be easily accommodated by soft lenses. Thus, I was having the lens rotate out of alignment and my vision in my left eye would be shot. I would experience this rotation more at night or when my eyes were a little dry. It was quite a bother many times and made it difficult to work at times when it happened. Even when they stayed aligned, the vision from my left eye never really seemed all that great. I longed for the vision that hard lenses gave me, but the years of wearing hard lenses had caused come blood vessels to grow in my eye that prevented me from wearing them again, and threatened my continued use of soft torics, as well.

But, with these numbers, I determined that if my pupils were less than about 7 mm, then either the Visx or Nidek would do a good job. Even if I had a few halos in my left eye, that would be ok, as I oftentimes had them with my torics, as well. In other words, my current night vision wasn’t the greatest, so I could withstand less-than-perfect correction after Lasik.

I take out my contacts for what will be the very last time! I quickly find I hate wearing my glasses, especially outside. I keep tripping over things as I get used to things appearing farther away.

As the date gets closer, I am a little apprehensive, but not much. I am still not sure what my pupil sizes are, but I will find that out at my comprehensive exam. I made an appointment with my longtime OD for Wednesday, January 5, to get his independent assessment. I continue to participate in the bulletin boards and get some of my questions answered. One thing I have to consider is mono-vision. This is where you get your dominant eye fully corrected to 20/20 (ideally), but they undercorrect your other eye. By "undercorrect", I mean that they leave you a little bit nearsighted, such as 20/25 or 20/30. The theory here is that the person can put off having to wear reading glasses a little while longer. I am not sure what I want to do yet. I have already accepted the fact that I am going to be needing readers (I have already purchased three cheap pairs at the flea market, though I can’t use them as I am now wearing glasses), so I am leaning towards no monovision. Some people opt for full monovision where they only do one eye. One eye is corrected for distance vision, but the other eye is left as is for up close up work. Thus, things in one eye are always blurry. You can have two pairs of glasses to help – one pair to correct the one eye for either reading or for distance for when you need pristine vision. I figured I would rather have to wear glasses for just one case. Still, some people adapt quite well and get used to seeing blurry out of one or the other eye all of the time.

Today I saw my longtime OD. He gave me the works! In summary, my dilated prescription shows a decrease in myopia but an increase in astigmatism. The final numbers are:

He measured my pupils at 6 mm each and the corneal topography showed some nice, even astigmatism. I was relieved, as if irregular astigmatism had been present, Lasik would have been out. He said I was a go and told me he had seen no Lasik patients with long term problems, though the ones he had seen had been treated on Visx Star’s, not Nidek’s.

There was a spot on ABC’s 20/20 television program about Lasik. I thought it was well done. It presented the risk factors that I was aware of, so my confidence in my decision to have Lasik is enhanced.

I saw Dr. Markle today, the local OD. He repeated the dilated refraction and his results matched what I gotten from the other OD. He told me he had only seen one Lasik patient with a complication, which was a wrinkled cornea due to the person crying at a funeral. He, too, said I was a go for surgery and gave me a prescription for Occflox, which is antibiotic eye drops. While there, I talked with two employees who are scheduled for the surgery, as well as one there who had had the procedure done several weeks earlier who had great results. I figured that if people there were having it done, the laser center must have been having good results! The lady who had had the surgery said the surgeon was fantastic.

My wife thinks I am nuts to do this, but is supportive. That makes me feel a little guilty as, if things go bad, she will be suffering right along with me, as will my two children. I need to carefully think this thing through. Are the risks really less if I do Lasik than if I continue to wear contacts? Should I wait for newer technology? Had I done RK back then, I would have regretted it when PRK came out. Had I done PRK, I may have regretted it when Lasik came out. If I do Lasik, will I regret it when the next technique comes out???

I am feeling good. I have decided that the risks are small and that now is the time to have refractory surgery. My glasses are still driving me nuts and I can’t wait to get out of them. I posted a final message to Dr. Horn’s bulletin board, announcing that it is my turn, and am touched to received several messages of support.