LASIK Eye Surgery: for your eyes only

I’ve seen this before. Or at least some version of it for the past 17 years that my eyes have been myopic or near-sighted. The image always starts out blurred, then it becomes sharp until you realize it is a highway and not some white fuzzy nothing. The most recent one, it was a farmhouse. Brown with red and green grass. The machine’s called an auto refractometer, a common feature in optical shops and ophthalmologists’ clinics. It’s the first step that tells you, yes, there is something wrong with your vision.

Over the years, my grade had reached 575. Just how bad is this, friends with 20/20 vision ask me, unable to visualize how blurred the images can get when they can read street signs half a mile away. They’d raise two or three fingers in front of me and say, "Can you see this, how about this–can you see this?" I inevitably raise my middle finger and ask, "What about this, can you see this?"

Suffice it to say I can barely see beyond my nose, much less do anything useful. I’ve jumped in fright thinking there’s a dead mouse on the floor when it’s only a pile of dirt. I’ve stubbed my toe on all sorts of things when I stumble through my small house on the way to the bathroom at night. I’ve inadvertently snubbed people–or waved in greeting at the wrong ones–in the mall. I’ve stopped watching films with subtitles because I can not read them, even from the short distance between my bed and the TV.

The thing about having 20/575 vision is that you can never get 20/20 even with contact lenses or eyeglasses because the exact grade almost always gives you a headache. Or the kind of vision in horror films: floors that look like they’re about to swallow you, walls that concave ominously at you.

Undercorrection: optometrists like to use that term. Actually, it really is nothing more than settling for a not-so-perfect vision . But last week, I set my sights on something that would really change the way I see things.

When somebody first broached the idea of laser eye surgery, I had all the fears of vision-impaired persons who thought it was too good to be true. But the prospect of not having to wear contact lenses or eyeglasses just to look at the clock when you wake up in the morning seemed like a miracle.

Like many of those who considered doing it, I was filled with appre-hension: Was there a big risk of something going wrong and leading to blindness? Was it painful and was it advisable for diabetics?

A USA Today report says that majority of laser eye surgeries are successful but five percent of patients who have LASIK (short for Laser-Assisted In-Situ Keratomileusis) report complications that can lead to poorer vision. "The major symptoms are ghosting, or seeing a fainter second image of an object; halos, or lights appear as glare or surrounded by rings; starburst bright lights are seen as spiked circles of light; double vision, two overlapping images are seen at the same time; and dry-eye syndrome, or the eyes do not produce enough tears to stay moist and comfortable." But for the 95 percent of successful surgeries, the patients experience an all-new, easier lifestyle.

Dr. Jack G. Arroyo, head of the Associated Eye Specialists at the American Eye Center, says that in any surgical procedure, there is always a risk but the American Eye Center exercises all precautions to prevent infection that may lead to complications. "When you’re thinking of having refractive surgery, you look at track record, experience and the technology they are using," says Arroyo. "Our center uses the best and latest equipment from the US. What the best hospitals in the US use, we have them. Our laser is the only one in the world that uses radar to track the eye. Since surgery is a skill, it is directly related to experience. Our center has over 15,000 done eyes of experience since 1995."

The American Eye Center is staffed by nine of the best ophthalmologists in the country, all of them UP graduates and trained in hospitals abroad. Aside from laser surgery the center offers diagnosis and treatment of all eye problems such as cataract, glaucoma and diabetic retinopathy.

The center does cataract surgery every day and operates on about 20 cataract patients a week. Dr. Arroyo explains that it is easier to remove cataracts in their early stage. "Our eye has a natural lens inside. The lens is supposed to be crystal clear. The images coming from outside pass through the lens and focus on the retina inside the eye–that’s how you get vision. These lenses, because of the natural aging process, becomes a bit opaque so the light cannot efficiently pass through the lens anymore. The treatment is to remove the obstruction to light, which is the opaque lens, and insert an artificial lens inside the eye."

The center screens all patients to see if they are candidates for laser surgery. Arroyo says the procedure can be done on all people with errors in refraction (near-sighted, far-sighted and astigmatic) except for those who have abnormally-shaped cornea. "During pregnancy is not a good time to have it because you retain water, so the water retention on the cornea changes it a little bit. You want the cornea in its normal state of turgidity."

Once I decided to have the surgery, I was given a complete eye exam, first involving four complex machines that measure and map the eyes. An optometrist also measures my grade with the eye chart. The eyes are then dilated and Dr. Arnold Salud, who specializes in the retina and diabetic patients, examines my retina.

To permanently correct the errors of refraction, the corneal surface is reshaped: flattened for myopia, steepened for hypropia and made more spherical for astigmatism. The Excimer laser is a cold laser which works via photochemical ablation. It uses an argon-fluoride gas mixture to break the molecular bonds of corneal tissue. As a result, fragments of corneal tissue rapidly expand and are ejected at high speed from the corneal surface. The Excimer laser is computer-controlled, allowing precise removal of tissue to the micron level.

A week of not wearing contact lens later, I was in scrubs, waiting for my eyes to be "photographed" by a computer to create a map of the eyes’ surface, which is then used by the surgeon to calibrate the laser to make the required changes.

For the final time, my grade is checked–again with the machines and the eye chart. A nurse briefs me on the procedure. "Focus on the red light." I hear this many times over. She puts drops in my eyes to dilate them. At every American Eye Center procedure, there are always two attending ophthal-mologists; I have Dr. Arroyo, who will perform the surgery, and Dr. Alnette Tan.

Dr. Arroyo marks my eye for the astigmatism correction. Then anesthetic drops are placed in the eyes. It used to be that for eye surgeries, patients were sedated; much later local anesthesia was injected around the eye. But since American Eye Center opened in 1995, the technology for such procedure has made leaps and bounds.

"How long is it going to take?" I ask.

"Five to seven minutes," Dr. Arroyo says.

For a second I am tempted to tell the "Doctor, can I play the piano after the operation" joke, but I didn’t think anyone would laugh–let alone me, who at the moment is nervously trying to focus on the red light through the eye holder that keeps my eye open.

A microsurgical instrument creates a flap in the cornea, which is folded back. Then a beam of laser light is used to reshape the inner layers of the cornea to duplicate the effects of the patient’s prescription for contacts or glasses. The flap is then put back in place to heal naturally. The procedure on my right eye takes about 11 minutes because of bleeding, an effect from years of wearing contact lens; the left only takes about five minutes.

Later, I am asked by friends if the procedure was painful even with the anesthesia. It was pretty uncomfortable, that’s for sure. It did sting, but you are so focused on the red light and hearing Dr. Arroyo’s reassuring voice reminding you to focus on the red light that soon enough, it is over.

After the procedure, my eyes are covered with gauze for 20 minutes as I wait in the room outside the OR. I am barely able to open my eyes when the gauze is removed. The eyes are very sensitive to light, and the sensation at this time is like wearing dirty contact lens. Clear plastic eye patches are taped on my forehead and Dr. Arroyo checks my eyes for the last time.

The thing about laser surgery is that it is a walk in the park for some (like the guy before me, who walked back to the reception area like nothing happened) but can be a stinging, tearing, I-have-to-keep-my-eyes-closed-for-five-hours for others. It was the latter for me. As soon as I got home, I popped ordinary painkillers and, impossible as it may be to be able to sleep through the sensation, I slept for four hours.

When I woke up, it was time to put the eye drops again. The stinging sensation was abating and for the first time in a really long time, I was able to see the clock without groping for my glasses. In the days to come, I would sometimes forget that I was not wearing contact lenses. I would look for the solution only to realize I had thrown them all away the moment I was able to see the clock upon waking up. (Believe me, small things like that are a big deal to us.)

A day after the surgery, I went back to the American Eye Center. I didn’t wear the goggles, my eyes didn’t hurt when exposed to light. My husband thought I was well enough to take a cab home because he was going to work.

After the eye chart exam (I could almost read all the 20-point letters–almost, because the vision would still be fluctuating for a week), Dr. Arroyo checked my eyes, just to make sure the flap was healing.

"Did you have surgery?" he asked with a smile. Obviously, everything was going well.

This time, I told him the piano joke.