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  health > specials > eyeWebMd
  MAIN | OVERVIEW | PROCEDURES | EVALUATION | POSTMORTEM | FUTURE |

Procedure: Mitch, 32

August 20, 1999
Web posted at: 5:05 p.m. EDT (2105 GMT)


Background

Why did you do it?

Would you call it successful?

What was your vision before the procedure?

Did this procedure meet your expectations?

Would you do it again?

Any pain?

How would you describe the experience?

What risks were you made aware of ahead of time?

Did you seek out the treatment, or was it suggested to you by a doctor?



Background:

Name: Mitch

Age: 32

Residence: South Riding, Virginia

Procedure: LASIK

Which eyes: Both

Cost: He paid $5,000 for both eyes and was to receive at least a year of follow-up exams and any enhancements needed for a lifetime. He was referred to the surgeon by another doctor, but it was not a co-managed situation.

When done: November 13, 1998

Questions:

Why did you do it?

He had always worn glasses and was interested in the possibilities of refractive surgeries. Mitch tried contacts years before but had not been able to tolerate them.

LASIK seemed like a good alternative because he does a lot of outdoor sporting activities and was not able to get his prescription just right in sporting glasses.

Would you call it successful?

"I would not call it successful. I think my daytime outdoor vision is very good," he said. On a scale from 1 to 10 he said he would rate his daytime outdoor vision as an 8, while his indoor and night vision is extremely poor.

He experiences halos and star bursts. He was overcorrected, so he is now farsighted. His eyes accommodate the farsightedness very well in daylight. He can read fine and see distances but is very dependent on good lighting.

Any setting without natural light is problematic for him, unless there are a lot of bright halogen lights, for example.

He has difficulty in some typical work situations like conference rooms. He said when he's in a conference room all the papers and people's faces have halos. Movie theaters and restaurants also present a problem. He does have "very, very, very slight" double vision in his left eye, but only in certain conditions.

Two things happen to him in dim light: His farsightedness starts affecting him more, and he sees large halos and star bursts.

He has just visited a doctor in Chicago and has received a prescription for glasses that may help with his farsightedness. He is not sure yet if he will be wearing the glasses all the time or just at night. Since he hasn't had the prescription filled yet, it is impossible to say if they will help his problem at all.

The problem of halos and star bursts cannot be corrected with glasses.

To deal with some of these problems, he has been using pilocarpine .5 percent eyedrops. Pilocarpine is a medication normally given to glaucoma patients to keep their intraocular pressure low. One of its side effects is it makes the pupils small. He said he takes it once a day in the evening, especially if he is going to drive, and it makes his pupils very small for an hour to two hours.

He doesn't feel comfortable driving at night without the medication because his contrast sensitivity is poor.

About 45 minutes after he put in the drops, his vision becomes very sharp and the star bursts and halos disappear. But the eyedrops make things very dark.

He said they definitely make him a safer driver and enable him go to restaurants and movies.

What was your vision before the procedure?

He was -6.25 in his right eye with a -2.75 astigmatism and -7.5 or so in his left eye with a -1.25 astigmatism.

He also has large pupils, between 8 and 9 millimeters. Before he had the surgery, they were not measured but were estimated to be 6 millimeters.

He said if his pupils had been 4 or 5 millimeters he thinks he would now be OK in dim light, and he said he would probably be pretty happy too.

Some doctors do screen people for pupil size and won't preform LASIK on larger pupils. "In fact they all should," Mitch said, "especially in combination with an astigmatism.

After:

He now has about 20/25 uncorrected vision, but this is with good contrast and good lighting. With lenses, doctors have been able to correct his eyes to 20/20 and 20/15 in their office.

"I am a success in terms of my visual acuity," he said.

He considers himself lucky to be able to do all the activities in daylight that he used to do.

Did this procedure meet your expectations?

"Absolutely not. I expected good daytime vision, and nighttime vision the way I used to have, except possibly with small halos and some star bursts around light, but not something that would basically cause an inability to function at night. And I didn't expect the indoor effect," he said.

Mitch said the biggest problem with his procedure is that it was ever done on someone with his pupil size. If he had been left farsighted, he said, that wouldn't have been so bad. "I could put on eyeglasses to see as I used to. That would have been OK," he said.

He also didn't expect to have to take mediation. The doctor who did his original procedure gave him the pilocarpine and told him there were no real risks or side effects. He has since been told by other doctors that the medication does raise his risk slightly for a detached retina.

In fact, a specialist he visited recently in Chicago said he would like Mitch to use it less.

The specialist gives consultations to people with problems resulting from refractive surgery. He did an Orbscan topography and made recommendations to Mitch.

"He explained more about what is going on with my eyes in that one visit than my doctor has in nine months with multiple visits," Mitch said.

"The big thing that I didn't expect out of all this is the emotional and psychological roller coaster of this whole thing," Mitch said. "I have gotten past a lot of this and am very glad for what I have."

Would you do it again?

"Absolutely not."

The original laser center has recommended he undergo an enhancement. They told him they can smooth out the edges a bit by doing a farsighted treatment. But he is waiting for better technology to address the problems he is facing.

"My problem isn't bad enough to risk a new technology," he said "I prefer to wait until they have really perfected the new technology. I have more to lose than someone with a worse result."

He said when he is extremely confident with a new procedure, he will be willing to undergo further eye surgery.

"I think refractive surgery is great if it is done in a professional manner with all the risks laid out," Mitch said.

Any pain?

He had no pain with the procedure and none after.

How would you describe the experience?

He said undergoing LASIK was a bit uncomfortable but nothing bad. "It was like having any minor surgical procedure done," he said.

He mentioned that the suction was a bit weird. He said everything goes dark and this thing cuts your eye. "You can feel something happen, but you don't know what," he said.

But overall, he said, the "procedure itself was not a big problem."

What risks were you made aware of ahead of time?

When he went for his evaluation, he was shown a video that he refers to as the "liability video." He said the person who showed the video told him, "'This video is meant to scare you, but we have done thousands of eyes, and we've never had a serious problem.'" Looking back, he said this should have been a warning to him.

The waiver form he was given did mention a lot of the problems he now has, but he said when he read it before the procedure, it seemed like any liability form.

"You never think the bad things will happen to you," he said.

Mitch said the preoperative evaluation is what really "boils my blood." Before the procedure, he said, he specifically asked the doctor if there was anything at all about his eyes that would put him at a higher risk for problems.

Mitch said he was told there was nothing about his eyes that would create any special problems, and in fact was told, "This surgery was designed for people just like you."

He said the surgeon also told him that they had done people with twice his prescription with success.

The doctor described the procedure and the after visits, saying he would have the procedure on one day, return the next for a checkup and then return a week later, a month later, three months later, six months later, and then a year. Mitch said the doctor described the subsequent visits after the procedure as "'social visits.'"

He said that attitude made him feel like the procedure was no problem.

In his case he had the procedure on a Friday, so he did not return the next day for follow-up. It wasn't until three days later, on Monday, that he saw the surgeon again.

At that visit, they found he had debris under the flap of his left eye. If he had come in the day after, they would have been able to clean it out right away. Mitch said that from what he has read, the quicker the debris is removed and the flap is repositioned, the better.

Did you seek out the treatment, or was it suggested to you by a doctor?

He sought it out after his brother's successful LASIK.

Back to Postmortem Main



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