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Refractive Surgery | Jul/Aug 2009

A Father and Son’s Experience With iLASIK

At 57 years old, the elder surgeon desired a refractive correction that would leave him spectacle independent.

As a father-and-son team practicing refractive surgery at the Diagnostica Oftalmologica e Microchirurgia Ambulatoriale in Rome, we strive to provide every patient with the best care possible. Therefore, when one of us (Massimo) decided to undergo LASIK, there was no question who would perform the procedure. This article describes our experience.

MASSIMO GUALDI, MD

After 20 years of practicing refractive surgery, I can truly say that I now understand how my patients feel. In July 2008, at 57 years of age, I underwent iLASIK, which is LASIK with flap creation performed with the IntraLase femtosecond laser keratome (Abbott Medical Optics Inc., Santa Ana, California). Through this process, I have become a more effective surgeon because I can share my firsthand experience with iLASIK and thus confidently recommend the procedure to my patients, describing exactly what they will feel and go through.

Before surgery, I was wearing multifocal spectacles for distance (1.75 D) and near (4.50 D) vision. As my desire for spectacle independence grew, I decided to undergo refractive correction for 1.75 D sphere in my right eye and 2.00 D in my left. My son Luca performed the preoperative measurements with CustomVue software (Abbott Medical Optics Inc.). Because I had to return to work as soon as possible, I chose iLASIK; it offers a fast visual recovery that would allow me to return to work on the first postoperative day. iLASIK also insures a safe procedure;1 I find it safer than conventional LASIK with a mechanical microkeratome. I trusted the results of iLASIK enough for my own patients—especially hyperopes—and therefore I knew it was good enough for me, too.

My son and I have similar surgical strategies, and we agreed to aim for a hypercorrection of 0.40 D in the nondominant eye and 0.30 D in the contralateral eye, due to the slight regression we knew I would experience after hyperopic LASIK. It should be noted, however, that the rate of regression is usually low for hyperopic treatments.2

I did not have a scheduled appointment; on July 15, 2008, after performing 12 procedures together, my son and I decided to begin my own procedure. Therefore, I had no time to be nervous or anticipate what would happen next. I was curious to experience the sensations that patients feel under the laser. During the treatment, I consciously processed all of the sensations I was feeling, so that I could more accurately describe them to my future patients. Although I was not afraid, because I knew the surgeon so well, I felt some pain during the suction phase. I trusted my son to leave the interface clean with no striae.

On the first postoperative day, I was approximately -0.25 to -0.50 D myopic. One to 2 months later, and still today, I am perfectly plano. Although I had dry eye before the procedure, it increased postoperatively. I tried every kind of artificial tear; however, it increasingly got worse. The only thing that seems to help me is continual blinking. Forty days after my hyperopic iLASIK treatment, my refractive outcome stabilized. Today, my UCVA is 24/20 in the right eye and 22/20 in the left. I could not be happier. I wear 2.00 D spectacles for near vision (as opposed to 2.75 D preoperatively) because of my hyperprolate cornea. I see J2 without correction at 45 cm, with a good natural intermediate distance.

LUCA GUALDI, MD
As my father mentioned, we decided on his treatment together, which is the custom process we share for any of our patients. The surgery was done on a whim one day after we had treated 12 patients together. I analyzed his refraction with the CustomVue. Because his scotopic pupil was small (3.9 mm), his wavefront presented almost no aberrations to achieve a customized treatment. I did not want to induce corneal higher-order aberrations, and therefore we decided upon a hypercorrection of 0.40 D in the nondominant eye and 0.30 D in the contralateral eye.

Because he was 57 years old at the time—and would eventually require cataract surgery—we decided on a conventional treatment using the Visx S4IR (Abbott Medical Optics Inc.) age-specific nomogram to insure quality vision, even after phacoemulsification. Our choice proved to be appropriate, as today he is 22/20 without correction.

I treated my father just as I would treat any other patient, and my only fear was wondering how I would navigate a complication if it arose: There was no other ophthalmologist in the room to take the place of my father. With my father under the laser, I was quiet. Fortunately, everything went as planned and my father was happy with his results.

My father was the optimal patient during surgery; however, his postoperative compliance was less exemplary. He slept with ocular protection only for the first postoperative night (instead of 1 week) and returned to swimming 36 hours later (instead of avoiding water for 20 days). There was not much I could say to him—he is my father!

I was honored that my father chose me to perform his iLASIK surgery. After performing refractive surgery for more than 20 years, he knows a lot of colleagues who could have performed the operation. I was flattered that he chose me—maybe only because he knew I was less expensive—and I think this process has benefited our practice for many reasons. Most important, it shows that we trust each other and we trust the technology and procedures that we offer to our patients. I would undoubtedly perform LASIK on any other family member or friend who was interested in refractive surgery.

Luca Gualdi, MD, is a cataract and refractive surgeon at the Diagnostica Oftalmologica e Microchirurgia Ambulatoriale, Rome. Dr. Gualdi states that he has no financial interest in the products or companies mentioned. Dr. Gualdi may be reached at tel: +39 068084256; e-mail: luca@gualdi.it.

Massimo Gualdi, MD, is the Director of Diagnostica Oftalmologica e Microchirurgia Ambulatoriale, Rome. Dr. Gualdi states that he has no financial interest in the products or companies mentioned. Dr. Gualdi may be reached at tel: +39 068084256.

  1. iLASIK Web site. Straight Facts About the iLASIK Procedure. Available at: http://www.ilasik.com/lasik-safety.aspx. Accessed July 13, 2009.
  2. Cheng A. Repair of corneal refractive complications wavefront vs topography-guided. Paper presented at the World Ophthalmology Congress 2008; June 28, 2008; Hong Kong.

 

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