My brother had radial keratotomy about 20 years ago, and I recall him sending my partner at the time (his surgeon) his spectacles enclosed in a beautiful handmade box frame to hang on the wall in my partner’s office. It contained an inscription that read, “The best eyewear is no eyewear at all! Thank you so much for changing my life and giving me unhindered sight.”
My brother’s comments and absolute joy at seeing well without glasses did not go unnoticed and possibly ignited the passion that I have for refractive surgery today.
I never personally took to radial keratotomy, but when LASIK made its appearance in South Africa—where I was practicing at the time—it caught my attention quickly. I started doing LASIK in 1994 in South Africa and continue to perform it today in my practice in Ireland. Having performed more than 20,000 LASIK procedures by the time I had my own LASIK surgery in December 2011, I needed no further evidence of the remarkable efficacy and safety of the procedure. My sons both had LASIK 1 month after their 18th birthdays, and, again, I saw firsthand the joy that great eyesight brings to people. Six and 2 years later, respectively, both have forgotten what it was like to have depended on spectacles to see well to play sports, for example.
Having been a low myope (-2.50 D in each eye) all my working life, I had never considered LASIK, as I was not prepared to give up the near-vision advantages of low myopia.
I had treated around 3,000 patients with a monovision strategy, and I knew firsthand that the great majority did well postoperatively. However, when I tried wearing one contact lens as a trial for monovision for myself, I found it unsuitable. Therefore, I resigned myself to not being a suitable candidate for LASIK, based on the fact that I did not want reading glasses once I became presbyopic.
LIFE-CHANGING EVENT
In the summer of 2011, something happened that literally changed my life. A friend and ophthalmic colleague in Germany called and asked if I would perform LASIK on him. I was honored that he asked, and I happily obliged.
On arriving at the clinic, he stated that he wanted monovision. At first, I was reluctant to do this for him, but after he reassured me that he had worn contact lenses for 2 years simulating a plano correction in the dominant eye and -1.50 D in the other, I was happy to proceed.
On the fifth postoperative day, he called me from Germany and stated that undergoing monovision LASIK was the best thing he had ever done (how many times had I heard that before!) and that the result surpassed his wildest expectations. LASIK monovision was significantly better than monovision with contact lenses, in his opinion.
He encouraged me to think about monovision again, and so I did, even conducting a second monovision contact lens trial. This time, I did not wear only one contact lens in the dominant eye, but rather two contact lenses, thereby providing the same correction described by my colleague: plano in one eye and -1.50 D in the other. I found that this combination was significantly better than the plano and -2.50 D that I had previously subjected myself to when wearing only one contact lens. I tried a few combinations and eventually decided that my best option was the original, plano and -1.50 D.
UNDERGOING LASIK
Like my German colleague, I traveled abroad to have my LASIK performed, as my partner at the Wellington Eye Clinic had wisely declined my request to have him perform my surgery. I wanted my procedure to be performed with the same technology I was using, so I asked my good friend Matthias Maus, MD, to do it for me (Figure 1). The procedure was painless and again surpassed my expectations in every way. Today, I enjoy 6/4 unaided distance vision with N4 reading vision at an age when many people are truly enslaved by reading glasses. I have stereopsis and enjoy 3-D films as much as the bilateral emmetrope next to me. I have never seen better during surgery using the microscope, as there is no barrier between my eyes and the microscope objectives. The surgical field seems so much wider.
CONCLUSION
My brother was right: The best eyewear is no eyewear at all. Not a day goes by when I do not enjoy the fruits of my decision to go ahead with LASIK surgery. My wife is now also fed up with presbyopia and is in the process of scheduling unilateral LASIK on her nondominant eye, targeting -1.50 D. After all, it worked great in the contact lens trial and made her look 10 years younger.
Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin), is a Consultant Ophthalmologist at the Wellington Eye Clinic and UPMC Beacon Hospital in Dublin, Ireland, and Associate Chief Medical Editor of CRST Europe. Dr. Cummings may be reached at e-mail: abc@wellingtoneyeclinic.com.
