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Refractive Surgery | Jul/Aug 2009

LASIK Improved My Empathy for Patients

Thirty minutes after surgery, both eyes achieved 20/20 UCVA.

I began to seriously consider the possibility of gaining freedom from spectacles and contact lenses during my second year as an ophthalmology trainee in the late 90s. However, in those formative years of refractive surgery, it took only an evening on-call and a distressed patient who had undergone PRK earlier that day for me to dismiss it as a personal option.

Years later, while working in a corneal/anterior segment clinic, my interest in undergoing surgery was rekindled after speaking with a LASIK patient. Many literature searches and discussions with LASIK practitioners ensued. I was more convinced by the potential benefits of LASIK than PRK, but the risk of a dreaded buttonhole not only compromising my vision but potentially halting my career made me reluctant to undergo surgery. I chose to closely monitor the progression of technology, paying extra attention to the experiences and accounts of those who had taken the leap of undergoing LASIK. This personal interest in laser vision correction expanded into an interest in all things cornea and, in turn, became a natural area for my own subspecialty focus.

DIRECT EXPOSURE
In 2004, the first IntraLase 15-kHz femtosecond laser (Abbott Medical Optics Inc., Santa Ana, California) was installed at Centre for Sight, a National Health Service (NHS)-based private clinic. This technology seemed to promise the precision, accuracy, and safety that I was striving for; however, I needed to see the results firsthand.

That following year, during a cornea, anterior segment, and keratorefractive surgery fellowship under the mentorship of Sheraz M. Daya, MD, FACP, FACS, FRCS(Ed), I was able to get the direct exposure that I wanted. Over the following 18 months, I watched patient after patient, procedure after procedure. The femtosecond laser's evolution from 15-, to 30-, to 60-KHz technology and the refinement in treatment nomograms consistently produced improved visual outcomes and results that delighted patients. There seemed to be no complications that could parallel the buttonhole—I was ready to join the club of transformed, ever-so-slightly-smug individuals who have undergone LASIK.

Choosing a surgeon was easy. As the most experienced IntraLase surgeon in the United Kingdom, my mentor and colleague, Dr. Daya, was the obvious choice. Although he confessed momentary concern that I would be as challenging as a patient as I had been at times as his fellow, he agreed to perform my surgery.

PREOP ASSESSMENT, MEASUREMENTS
With a stable and relatively low myopic correction (-2.50 -0.50 X 160° OD and -2.75 D sphere OS) and a BCVA of 20/15 in both eyes, I was not anticipating any issues with my preoperative assessment. It is funny how the knowledge of what not to do can result in the need for multiple retests; I subconsciously did the things that we tell patients to avoid, thus requiring six wavefront analyses before achieving a reliable test. Slit-lamp examination raised no contraindications to surgery, and the date for my liberation from spectacles was scheduled for February 23, 2008. My Zywave (Bausch & Lomb, Rochester, New York) wavefront analysis demonstrated only borderline higher-order aberration levels, but choosing to have a wavefront treatment was an easy decision after having seen the multitude of patients who have benefited from the excellent visual outcomes with these treatments.

I arrived with enthusiasm on the day of my surgery. The small dose of diazepam given to take the edge off seemed to paradoxically enhance my excitement at the prospect of what was about to happen. Our excellent clinical team guided me through the process, all under the watchful eye (and video camera) of our hospital photographer.

During what seemed a brief surgical process, I was momentarily aware of the pressure applied by the IntraLase during flap creation, which went without complication in each eye. This sensation was immediately followed by a painless—and somewhat surreal—process of flap lifting that increased my blurring. The sound of the excimer laser was accompanied by a gentle whiff of burning tissue and discernible visual improvement, ending with the sudden return of misty clarity as the flap was replaced. After the process was repeated on the second eye, I was able to read the clock, which I had been unable to do before LASIK.

After 30 minutes in the recovery area with my eyes closed (I am told it was that long—it felt much quicker), where I tortured our staff with my benzodiazepine-induced need to talk, both eyes were able to achieve 20/20 UCVA. Flap check was unremarkable, and I was sent home to recuperate. With my vision slightly misty, and only minimal foreign body sensation on my way home, I woke after a few hours with noticeably less mistiness and increasingly sharp visual clarity.

The next morning, testing confirmed almost 20/12 in each eye and well-positioned, secure flaps that continued to improve over several weeks. Every time I remembered that I was looking at things in the distance without visual aids, I broke out in a wide grin.

My postoperative recovery was unremarkable, and there has been no suggestion of regression thus far. As a long-term sufferer of dry eyes preoperatively, I was well prepared for the postoperative aggravation of symptoms; however, the absence of contact-lens–induced irritation left me symptomatically better than preoperatively by the fourth postoperative week. Symptoms have since stabilized.

No matter how often I have performed, assisted, or witnessed LASIK, going through the full patient experience has helped in many ways. It has enabled greater empathy with my patients, who are now reassured by my descriptions of what is involved in the procedure. This translates into an improved rate of conversion to surgery and also to increased patient relaxation as they feel more confident of my descriptions of what they can expect from the process.

My only regret is that I did not have LASIK earlier. I have also now controlled my initial postoperative urges to physically drag people off the street to experience this wonderful phenomenon. I look forward to continuing to be a purveyor of this life-transforming procedure.

Saj Khan, MB, BS, FRCSEd(Ophth), is a Consultant Ophthalmic Surgeon, Centre for Sight, London. Mr. Khan states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +44 1342 321 201; fax: +44 1342 325873; e-mail: skhan@centreforsight.com.

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