This was started on January 6th, 2001, as an article for the Costa del Sol News - an English language newspaper in Spain, where I live. The clinic I used, which isn't mentioned in the first pubished article, was Maxivison, Manchester. (click to link)
This is a series of articles, the next one hopefully to be published early April - the reason for this will be apparent!
This series will also be serialised in one of the Sunday supplements but not until the Costa del Sol News has published all the articles first, so probably end 2002/beginning 2003.
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Having worn both glasses and contact lenses for over 30 years (although not at the same time!) that sounded pretty good to me. In the UK, my contacts were OK, if a bit fiddly. Here, with heat, they dried up very quickly and soon became uncomfortable.
I'd considered laser surgery on my eyes for a while. I first looked into it in 1998 when the most popular form of surgery in the UK was PRK - (Photo-Refractive Keratectomy). This is a surface laser eye treatment and has been available for over 10 years in the UK.
The laser is used to remove microscopic amounts of tissue according to the individual patients prescription. I'm not sure why I didn't pursue it further at that time - probably because it seems a huge amount of money to spend on what is, in reality cosmetic surgery. Or maybe it was the fact that with PRK there is definitely pain for the first few days!
However, in 2000, I spoke to one or two people who?d had a relatively new procedure (for the UK) done - Lasik (Laser Assisted In-Situ Keratomileusis)
As with PRK the laser is used to remove microscopic amounts of tissue, but not on the surface of the eye, but in deeper layers.
Using an automated instrument a thin layer of cornea is lifted to create a flap, which is repositioned after the required laser treatment has been performed.
The main advantage with this is that there is very little discomfort after surgery and has a higher success rate for high prescriptions.
Also it is now commonplace to do both eyes at once, whereas with PRK, usually one eye is done then the other one a few days later. My own prescription was around - 4.00 in each eye, which put me in the low to medium range but in the end I opted for the Lasik treatment simply because it seemed the most advanced.
There is no pain during either operation (honestly! There really isn't) and both procedures take around 30 minutes in total, for both eyes, during which time you are fully awake. Of that 30 minutes, the majority of the time is spent preparing your eye.
For me the time actually under the laser was 37 seconds on each eye.
I decided to go to an English clinic, despite living in Spain. There were a couple of reasons for this - the main one being that at the time, I couldn't find a Spanish clinic. Since then, various people have recommended a clinic in Malaga, which has had some excellent results. However at that point I'd already booked my consultation at the Manchester clinic.
Another factor for me was that I was worried that my Spanish wouldn't be good enough to fully understand everything at a Spanish clinic but the Malaga one has English speakers anyway.
Also, I was going to be going back and forward to England a lot over the following few months and didn't expect to have any difficulty fitting in my appointments. With hindsight (which of course is always 20/20), I would either have chosen to have it done here or to go back to the UK for around 6 weeks after having it done. I'll explain why further on in the tale.
I was going to be in the UK for around 13 days so arranged for the initial consultation on day 2, the surgery on day 5, the 24 hour check up on day 6 and the week check up on day 12, flying home the following day. It didn't occur to me that I might not be a suitable candidate for surgery but probably more people are refused than accepted. The reasons for this are various - anyone with the following conditions are likely to be refused, or at least asked to think quite seriously before going ahead. (My thanks to www.surgicaleyes.org for the information)
� Pregnancy
� Active collagen vascular disease such as lupus or rheumatoid arthritis
� Active or severe vessel disease
� Certain medications such as Cordarone or Accutane, Prednisone 5 mg or more unless meds can be stopped
� Inability to wear contact lenses, particularly rigid gas permeable (if you have complications -they may be your only alternative)
� Herpes zoster of the eye (Even if there was no signs of it doing so pre-operatively, in herpes patients who suffer from cold sores, the virus may affect the fifth nerve, and here could be a danger.)
� Active corneal or other eye disease. Endothelial basement membrane dystrophies, epithelial dystrophies that result in recurrent corneal erosion, and keratoconus.
� Cataract formation (signs of developing a cataract, as well as previous cataract surgery)
� Severe abnormal curvature of the cornea - what is abnormal? Most doctors feel that 47K is about as high as it can be, and then optical quality results fall way, way off. A lot of docs won't treat above 12D of myopia -- that and ectasia.) 4.. - 49 D or above, below 38 D (with some keratomes below 41 D).
� Both eyes cannot be corrected better than 20/40
� Abnormally thin cornea - what is too thin? (Average young cornea is 550 to 600 microns thick. This is really going to be dependent upon the amount of refractive error present. Essentially, 50% of the corneal thickness should remain if someone is being treated
� Certain abnormalities of the retina (predisposition to vitreous detachment, history of floaters and flashers, history of previous retinal tears, breaks; map dot fingerprint dystrophy)
� High correction and astigmatism (-12 D, 4D of astigmatism, 4D of hyperopia) or High correction : above -13 spheq Lasik or -8 PRK (to get spheq: take the 1st # of a prescription + 1/2 the second number, using the sign as is in front of the second #:eg -10 -4 x 20 = -12 spheq; -10 +4 x 20= -8 spheq. Above 4 D of astigmatism, until toric ablation, then probably above 6 D of astigmatism as long as no more than 4 D corrected in any axis
� Dry eye particularly with breakdown of the epithelial surface of the cornea. TBU less than 6 sec; TBU 6-8 sec with low tear volume
� Failure of the eyelids to protect the cornea
� Blepharitis
� Autoimmune disorders (Rheumatoid Arthritis, Sj�gren�s Syndrome, Systemic Lupus Erythematosus)
� Fuch's Dystrophy or advanced guttata
� Inadequate tear film and volume
� Large pupils( (dependent largely on optic zone-pupil size relationship in dim light) (Also will depend upon size of transition zone. The greater the zone, the more likely a person with wide pupils is to perceive glare post-op). Large pupils: As a close approximation - CENTRAL Laser zone to be used + 1.0 mm MAX.
� Eyelid ptosis
� History of corneal abrasion (recurrent corneal abrasions or any epithelial dystrophy that could result in recurrent abrasions post-op)
� Existing eye muscle imbalances, even latent.
� Tendency to form keloids, or excess scar tissue. There is a risk of forming excess scar tissue when the flap heals.
� People whose refractive error fluctuates .5D or more within past 12 months.
� Recurrent erosion of the cornea
� Very irregular corneal curvature (irregular astigmatism)
� Corneal scarring
� Glaucoma (except steroid responders, which should be absolute.)
� Amblyopia
� The worst eye cannot be corrected with lenses better than 20/40
� Breast feeding, women of child bearing age or women who have had a baby within the past 6 months
� Keratoconus suspects, or where the topography shows difference of 2.5 between upper and lower quadrant of map.
� Deep set eyes, high cheekbones, small or narrow eyes
� People taking antihistamines (can contribute to dry eyes)
� Forme fruste keratoconus (severe steepening inferiorly or on back curvature)
� History of psychological disease
� Uncontrolled uveitis�
My cornea was slightly thinner than normal and if my prescription had been higher, the best correction achieved would not have been sufficient to do without glasses altogether, but with my current prescription, it was possible. Lasik can be preformed for both long and short sightedness. However, long sightedness due to age is nor suitable because that is a natural result of age and will continue to deteriorate. If you�re having lasik for short sightedness and you�re in your mid forties, like me, you have to be prepared that the Lasik will mean that you will probably need reading glasses, especially if you currently just take off your glasses to read. I�d found that over the last couple of years, I�d needed reading glasses if I was wearing my contacts anyway.
Tests are first done by a nurse, using an auto refractor and corneal topography. Corneal topography produces an �ordinance survey map� of your cornea � showing any abnormalities, ridges, thickening etc
On the day of the surgery, my daughter came with me as you need to be accompanied home. She also wanted to watch �which was permitted through an observation window. I had another eye test then was given a valium tablet to keep me calm then taken into the lasik room. Was I nervous? No, not really. I�d done quite a lot of research on the procedure so more or less knew what to expect. I just wanted to get it over with.
I was booked in for surgery with Mr Pillai, at my request as I knew he was the head surgeon. However, on the day I found I was scheduled for surgery with Dr Khan. At that point, there didn't seem a lot I could do about it.
My hair was covered and anaesthetic drops applied to the first eye to be treated. I lay down on a type of couch, similar to a dentist�s chair. Then a clamp is applied to keep the eye open and a suction device applied to the eye to stop it moving. That was the most uncomfortable part as it exerts a fair amount of pressure on the eye. Then the surgeon performs a Keratectomy in which a very thin superficial layer of the cornea (approximately the thickness of a human hair and a quarter of the cornea's thickness) is cut and lifted. Then the computer-controlled excimer laser removes the tissue under the flap and reshapes the cornea of the affected eye. In less than 60 seconds, ultraviolet light and high-energy pulses from the excimer laser reshape the internal cornea (the stroma) with accuracy up to 0.25 microns, or 1/4000 of a millimetre. Whilst the laser is being used all you can see is a red and green light. You have to concentrate on the red light but if your eye moves off it, the laser immediately stops until it repositions again.
And that�s more or less it. The suction cap is removed, the clamp removed, eyes drops put in and you�re done. After both eyes are treated I waited in the waiting room with my daughter. Although my eyes were watering, I could see the clock � which I hadn�t been able to do previously.
After about 20 minutes, my eyes were checked, I was given some drops to put in four times a day and had eye shields put on and was advised to go an lie down for about 4 hours to speed up the healing process. The eye shields are to be worn for the next 24 hours then each night for about a week, to protect your eyes for accidental knocks etc.
Discomfort afterwards varies from patient to patient. Another patient walked out of the clinic with virtually no watering and obviously not in any discomfort. My eyes felt like I�d sliced a chilli then rubbed then and wouldn�t stop watering and it was a relief to go to bed to keep them closed. When I awoke a couple of hours later, the discomfort was virtually gone and I spent the evening watching TV. It�s hard to tell how clear my vision was at that point because of having to wear the eye shields but it must have improved drastically to even allow me to watch TV without glasses.
I awoke next morning and could see the alarm clock quite clearly. Wonderful! �
Until I remembered that it was a digital alarm, with figures 2 inches high and it was only 8 inches from my nose �and that I�d been able to see perfectly well before surgery too.
I had a 24 hour check up as arranged, when the shields were removed and it was found I had wrinkles in the flap. Wrinkles or �straie� are one of the possible �minor� complications. It was decided that at my 7 day check up, I would be seen by the surgeon who would decide what to do. Then I went shopping with my daughter. I was aware that I had better vision in one eye than the other but this is not uncommon at first. I could certainly see number plates and signs clearly. However I was conscious of the weakness of vision in the left eye and kept covering up first my right eye, then the left, to compare the vision in each. I was also very very wary of getting anything in my eye or allowing anything to go near it and wore sunglasses (in Manchester, in November) when out in case of dust.
The day before flying back I went for another check up in which the same tests as before were performed. The folds were still there.
At this point what SHOULD have happened is the flap should have been re-lifted and the wrinkles smoothed out. I�d read all the research and knew that the earlier it�s done, the better the result. However, my flight was booked for the following day so I was pleased to hear that they were going to give it another month to see if they�d smooth out on their own. Again with 20/20 hindsight, I feel this was a bad move.
As soon as I got to Spain I was worried about my eye. I was constantly checking to see if had improved. I couldn�t actually see the wrinkles but it felt as if there was a smear at the bottom of my eye and the vision was certainly worse than the other eye. Before having the surgery I�d read various online diaries written by those who�d had it done and various people had eye charts in their garages, bedrooms etc and to be honest , my main thought had been �Get a life!�. Now I was in that position and I had not one but two Snellen eye charts fastened to the living room door! I don�t think anyone could possibly accuse me of being a hypochondriac � if anything, I�m the opposite � but your vision affects EVERYTHING you do and I was soon counting the days until I could get back to the clinic to have my eyes checked.
It�s all very well saying that the UK is only 2 � hours away by plane but you have to take into account the cost involved in flying back and forward, the time taken away from work, the problems of getting to and from the UK airports. I felt far more at ease with my vision when I was in the UK and knew that the clinic was only 20 minutes away. It didn�t help that my appointment was booked for the day before the clinic closed for a Christmas break and that my return flight was the day after the clinic reopened again so I knew we were working to a tight schedule.
In the end, I changed my flight to 2 days earlier. I�ve spoken to around 40 people, in Spain, the UK and the US, who have had this surgery and without exception, they agree that you become obsessed with your vision.
One day I woke and couldn�t see anything at all � total panic! Everything was completely black. I couldn�t see the alarm clock, couldn�t see the light outside, nothing! I�d gone blind! Then my other half walked into the bedroom with a torch. It was the middle of the night and we�d had a power cut � which is why I couldn�t see the outside light or the alarm clock. It might be funny now but at the time it was absolutely terrifying.
I�d done a lot of research before deciding to go ahead but once I knew I had a complication, of course then I found every lasik disaster site on the internet (and believe me, there are many!) and it has the same effect as reading a medical dictionary. I would have felt a lot better if I could have popped into the clinic for reassurance.
At the next check up, this time with the head surgeon, with whom I should have had the original surgery, Mr Pillai, it was decided to re lift the flap and smooth it down again. Same procedure as previously except without the suction cap and laser. I was a little worried at how simple it would be to lift the flap as by now it was 5 weeks after the cut but it came up easily. Again no pain and I must admit I was relieved it was done. I really should have changed my flight and had it done earlier � if only for my own piece of mind. To protect the eye, a contact lens �bandage� was put in and I was off home in a taxi.
I was warned it might be painful for the next few days and was given some painkillers but actually there was far less discomfort this time � mainly due to the contact lens bandage. The lens was due to be removed 4 days later � which was Christmas Eve � and the clinic was closed but it was arranged that a doctor and a nurse would come in specially just to check my eyes and remove the bandage lens. After having the lens in for 4 days, my eye was feeling a bit �gritty� - not surprising having had a contact lens in for so long. However, I was surprised at how uncomfortable it was when the lens had been removed. I�d expected that by then it would be quite comfortable but actually it was painful for about 2 days � as if there was something constantly in the eye.
At the time of writing, it�s 16 days since the re-lift. The eye is more comfortable but to be honest, I can�t say the vision is any better at the moment than it was before the re-lift. The prescription in that eye is �1.50. In the other it is perfect. After all the years of wearing glasses which correct both eyes to the same vision, I find it awkward having one eye weaker than the other.
It�s still early days yet and I have another appointment in a month. If the vision hasn�t improved, then we�ll start thinking about an enhancement to correct the remaining -1.50. My vision is well within the driving standard and good enough not to need glasses or contacts but it wouldn�t be if both eyes were like my left one. I will continue with my story at a later date with details of the final outcome. I don�t regret having it done at all but I do have more reservations about the procedure now than I did before.
If you�re considering it, do some research first. Don�t just check out the clinic doing it, find out which surgeon will be performing the surgery and speak to some patients of his. Speak to the surgeon himself � before you arrive for the surgery. Below is a site which gives details of the type of questions you should be asking. There is virtually no way of doing research of this type without internet so check out the sites at the bottome of the page. These in turn throw up other sites - read up as much as you can on the subject
Also do a search in google for all the other sites with lasik diaries. Literally hundreds of patients have taken the time to write details of their experiences and put them online.
Check out the newsgroup � alt.lasik-eyes. Post you own message on there asking for others opinions on the clinic and surgeon you are intending to use.
However, do remember that the majority of people who post on the newsgroup and the web sites are doing so because they have a problem and are looking for answers. It sometimes seems as if there�s never been a successful lasik surgery performed, to read the websites but that�s because the huge percentage who are perfectly happy with their outcome don�t bother writing about it. And out of curiosity I also did a search of web sites for people who had problems following a hysterectomy and also following liposuction, as a comparison and there were equally as many, if not more, people who had problems following these two operations as there were who had complaints about Lasik. In fact it definitely put me off the idea of ever having liposuction!
Over a million procedures are done each year in the USA and of these over 95% are happy with the final outcome. That doesn�t mean that 95% have had no complications or have 20/20 vision though.
Of the 41 people I spoke to, only 6 had had no complications at all � i.e. they�d had the surgery, had the 1 day, 7 day, 1 month exam, 6 month and their vision was perfect and hadn�t experienced dry eyes, ghosting, double vision, hadn�t needed enhancements. The others had either had straie, like me, or had suffered from very dry eyes for a while or had needed enhancements after three months.
However, only one of them regretted having it done and that was the one person who had had severe complications and 15 months after treatment, was suffering from excessively dry eyes, starburst and blurred vision in both eyes. But don't underestimate "minor" complications!
Don�t think dry eyes is that much to pay for throwing away your glasses?
Imagine having to use eyes drops every 15 minutes just to keep your eyes comfortable. Imagine setting off to drive from Fuengirola to Malaga. You�d have to plan to be able to stop at least once just to put drops in.
Getting ready for a special night out ladies? You can�t put eye make on � the drops will ruin it even before you get to your destination.
And starburst? Well, it�s only at night so you think it�s a minor inconvenience. Well, it isn�t just at night � a lighted shop display will throw out a starburst even in the middle of the day, limiting what you can see at the side or behind it. And during winter when it gets dark at 4pm. Are you sure you�re going to be able to get home before it gets dark? No more doing your shopping after siesta, especially if you�re driving.
I only suffered from these for a couple of days but it was enough to make me realise how debilitating either would be if permanent.
If the clinic turns you down for treatment, then accept it. Don�t go searching for one who will accept you � because eventually you�ll find one willing to take a chance. The technology is changing all the time � pupils which were to large to be treated a few years ago can now be successfully operated on.
Nearly forgot to mention cost.
I can only speak for the UK clinics where the price, for Lasik seems to average at around �1000 per eye. (PRK is slightly cheaper).Yes, I know it seems expensive but it�s the cost of a holiday or a cheap second hand car � and which is going to be of more benefit to you. Don�t necessarily go for the cheapest or the most expensive clinic � price doesn�t guarantee the best treatment. It�s your eyes you�re playing around with � is it really worth using a surgeon you�re not 100% happy with just to save �100?
Also - choose a clinic you can get to easily. There are companies who are offering trips to exotic countires to have Lasik performed there, for a cost similar to having both eyes done in the UK. Sounds like a good deal - your eyes fixed and a holiday into the bargain. But I know from experience how worrying it is to be so far from the reassurance of your surgeon.
And remember, that despite the clinics using terms like �procedure� in their ads, this is SURGERY we�re talking about � and pretty invasive surgery at that. It�s not for everyone.
And my golf hasn't improved either! - Part 2 to follow
http://www.usaeyes.org - USA based site that has advice forums and outlines all the complications that can occur. Includes a list of questions you should ask your surgeon
http://www.asklasikdoctors.com - Extremely useful site manned by opthalmic surgeons who give up their time to answer your questions
http://astele.co.uk/laser - Great unbiased site for opinions about UK clinics
http://www.tlcvision.com - The clinic where Woods had his surgery
http://www.geocities.com/davey2032/frame.html - a much better UK Lasik experience site than this one!
and if you really want to be talked out of it (not for the faint hearted!)- http://www.lasikdisaster.com/
Most are US based but are still relevant to Lasik procdures anywhere
This is written on March 9 2002
Yesterday I had another meeting with Mr Pillai.
There was still some debris in my left eye (my right has been fine from the start), so it was decided to lift the flap yet again (it seems to have been up and down more times than a tarts knickers!) and not only rinse it out but also treat the mixed astimatsm that was left. (I had + and - astimagtisn).
I wasn't really prepared for it as I'd almost decided in my own mind that the constant travelling back and forwards was too much and was also not fair on my husband as each time, he was left to take care of our animals etc at home, but Mr Pillai assured me that it would improve my vision and convinced me that there was no danger it would make it worse.
It was the same procedure as before but this time, after 2 seconds laser for the +astig, I was swung away from the laser, the laser reset for the - astimatism and then about 11 secs for that. Eye drops in, eye shield on and back home. This time the healing is quite different. Prevously I was able to see quite clearly from the same day. This time, the left eye is very VERY blurred - like wearing very strong glasses that you don't need. It's quite worrying but I'm hoping this is because of the different types of laser.
Continued on March 11th - Had the contact lens removed this morning. Vision isn't really any better but I was told that that was probably as a result of having the lens in and taking slower to heal and I should see (groan) a big improvement over the next few days. I certainly hope so as, at the moment, I certainly couldn't drive and if I can't drive, I can't work!
So far, since November 14, I�ve needed 7 flights to and from Spain, in 13 weeks, including one flight, before Christmas, which had to be cancelled altogether (with no refund) and another one booked in order to allow me to get in to see the surgeon before the clinic closed for Christmas holidays.
(Still every cloud etc.etc.... I'm now a member of the frequent flyers club so get extra baggage allowance)
As it happens, I�m in a profession where, as long as I have a computer, I can work more or less anywhere, but I really do not know what I�d have done if I�d had to go into an office 9-5 with only 4 weeks holiday a year. (My thanks now to my editor for allowing me so much freedom, grovel grovel :-))
I�m also lucky that my daughter lives near the clinic. However, it�s added a good �600 on to the cost of the treatment.
But more importantly, it�s impossible to describe how worrying it can be if your eyes start to blur or hurt and you know that the clinic is 1500 miles away and there�s no one you can turn to for reassurance. I don't think anyone could ever describe me as a hypochondriac but minor symptoms that I don�t notice when I�m in Manchester, take on a major importance when I�m in Malaga.
If you ARE going to have Lasik done back in the UK, all this is something you have to be prepared for. It very probably won�t be necessary but be prepared just in case.
My next appoitment is on Friday for a check up (by which time I hope my vision has drastically improved!!) then back to Spain, with another appointment with Mr Pillai on April 12 (my 9th flight!)
The vision in the left eye is slightly better but not a lot. When the eye was checked it was found to have some epithelial ingrowth so I intended seeing Mr Pillai again
Unfortunately Mr Pillai was ill on the day I should have had my last check-up. These things of course can�t be helped and if I�d lived locally, it wouldn�t have been much of a problem but I had to return home to Spain without the check up. Maxivision couldn�t be faulted � they really went out of their way to try to get me to see Mr Pillai, even to the point of getting me to London but at such short notice there was nobody to come with me (my daughter couldn�t get the time off work) and there was no point in travelling all that way if no treatment could be preformed, should it be found necessary. So instead, I have an appointment in May 20. Mr Pillai has kept in touch with me by email which is very reassuring and he recommend I recommenced the anti inflammatory drops (FML), which I have been doing.
The eye is improving I think. It�s still weaker than the other eye but either it�s improving or I�m learning to live with it!! Will try to update after next checkup.
6 October
I have been very lax and not updated this site until today.
I returned to the UK a month after my last entry. Mr Pillai decided at that appointment to relift the flap yet again and clean the epithelial ingrowth and that way we could see whether it was the ingrowth that was causing the weaker vision or whether the enhancement had had no effect. This was done, another contact lens put in to protect the eye and when the lens was removed, it was definitely more comfortable than previously.
However since then there has been no improvement to the vision in that eye so Mr Pillai referred me to a clinic in Alicante � the Instituto Oftalmologico de Alicante which also has some of the most up to date equipment inn Europe, including the Wavefront Technology usually only found in the USA.Unfortunately, because of various work commitments, I�ve not yet been able to arrange an appointment but I am still trying! To be honest, I�ve learnt to live with the weaker vision in the left eye and only notice it if for some reason my right eye is obscured.
Nonetheless, I WILL try to arrange the appointment in Alicante and post the results as soon as possible here.
I should point out at this juncture that Mr Pillai is no longer with Maxivision. However, I am still in touch with him regularly and should anyone with his contact details, please email me - [email protected]
