Vision correction surgery - DON'T

Preparation, Preparedness & Prevention Emergency First-Aid
1

Stick with glasses or contact lenses - they are much safer than vision correction surgery.

My wife had Lasik more than 10 years ago. Yesterday, our 18 month old son accidently poked/scratched her eye. She had to go to the emergency room, where she was seen by a physician’s assistant (why she was not seen by an MD and referred immediately to an eye specialist is a subject I will take up with the hospital very soon) who informed her that she had a hole in her cornea, told her to call her eye Dr. in the morning, and sent her home with antibiotic eye drops and pain medication.

This morning, she visited her optometrist, who informed her that the injury had become worse overnight, and by that time the cornea had been essentially torn off. He cleaned the wound, applied a contact lens bandage, and wants to see her tomorrow morning. Fortunately he expects full recovery, although nothing is 100% certain until it happens. She is visiting an opthamologist this afternoon just to be sure - we conly get one set of eyes.

She was informed by her optometrist that the Lasik surgery had weakened her cornea, and made it more susceptible to injury. In fact the injury might not have been as severe as it was but for the surgery.

When I met with an FBI recruiter in my last year of law school (1997), he informed me that anyone who had vision correction surgery would not be accepted as a special agent. Now I know why - even more than 10 years later, the eye is more susceptible to injury.

I have worn daily wear contact lenses for 28 years, through high school wrestling practices, traditional martial arts training, and now MMA training, with no issues. They are very tough to knock out of one’s eye, although others do make credible claims of having lost them during training. Just keep a few spare pairs of disposable lenses in various places (car, work). If you prefer glasses, then get a pair with polycarbonate lenses and spring hinges, and unless/until they get knocked off in a fight, you will be wearing what amounts to partial safety glasses.

Whatever you do, DO NOT GET VISION CORRECTION SURGERY.

2

I forwarded this to my wife. She’s considered lasik for a while now?

Thanks for the info!!

3

I would like to think when it comes to vision correction surgery, there is a huge difference on what is done now versus 10 years ago.

4

I used to wear contacts, got sick of them, and now wear my glasses full time. There are definite trade-offs, and I have been considering Lasik for a while now. What always gets me is that even the people I talk to that are “100% happy” ultimately wind up conceding that there are some negatives. Increased sensitivity to light, halos at night, etc. and I just can’t deal with that kind of thing.

5

I think you’re overreacting and painting with a pretty broad brush. Don’t get me wrong, I understand the reaction, and in the same circumstances might react the same way, but it’s still a pretty sweeping generalization to make.

I agree wholeheartedly that we need to protect our vision, it’s our most important sense. And there are definite risks and drawbacks to the various procedures.

I’ve been wanting LASIK all my life, but it turns out that I am too high of a prescription for those type procedures, so I’m looking into some of the (very much more expensive) alternatives. I am completely helpless without my glasses or contacts, I’m talking literally can’t see past my nose clearly. It can be worth some tradeoffs, but everyone needs to understand them upfront before making decisions.

6

I had LASIK about a month and half ago. I have not noticed any increase in sensitivity to light or halos at night.

The ability to wake up at night not reaching for glasses or with contacts stuck to my eyes is priceless.

It was the best grand I have ever spent.

7

I think you are over generalizing. There is no way to perform refractive surgery without removing tissue from the cornea. It sounds like she had an abrasion not a full thickness corneal penetration or she would have been referred. I don’t know why you are blaming the surgical procedure for the abrasion. People who sleep in contact lenses have abrasions all the time.

8

A poke in the eye that results in an immediate trip to the ER is probably something that isn’t your “run of the mill” eye incident.

Just sayin’.

9

The eye being more prone to injury after is something that is dependant on the type of eye correction used.

Some types, and I forget the particulars, will eliminate you from certian MOS within the military, airborne, piolts etc.

IIRC, the early types which required a flap to the cut in the eye is the problem. The newer versions use a laser to re-shape the corena, and no blades/cuts are required.

10

As student entering physician assistant (not physician’s) school… going into EMED I feel the need to offer a defense of the hospital letting your wife be seen by a PA. ( I wont defend the treatment given by this specific PA as I wasnt there.)

Seeing a PA does not mean you are given inferior treatment, they are trained to diagnose and treat common illness and injury. If the presentation is outside of the PAs scope they should have refered it to a specialty doc. It sounds like the pa diagnosed correctly but did not refer out fast enough? Was a specialist available at that time? That may have been part of the issue. A emed doc may very well have done the same thing and the PA may have consulted with the doc in the er on your wife’s case, and quite possibly would have done the same thing/given final say on your wifes case.

My suggestion is to ask the opthomologist what he/she thinks about the PA’s treatment and go from there. It will give you more leverage when you call if the specialist is on your side.

If you are EVER not comfortable with your provider (pa, np, doc) you can ALWAYS demand another, just understand this may mean waiting longer.

I hope your wife gets better quickly, that is a scary deal.

on topic: I had interlase lasik done about 5 years ago and it is the best thing I ever did. After about a month all of the issues with halos ect went away and I see better than 20 20.

If you are nervous about the “flap” weakening the cornea check out PRK. It is lasik minus the flap. it is more painful and has a longer recovery but doesnt present the risk that caused the op’s wifes problem. It is/was the only type of laser corrective surgury the military does from what I understand.

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11

An emergency room is trained to stabilize a patient in most matters that are life threatening. For eye related matters, the opthalmologist on call is either contacted or the patient is referred to see that specialist at his own office. ER docs are not eye specialists and the hospital cannot afford to keep one of every type of specialist at the hospital. This is pretty normal SOP at most hospital emergency rooms.

Depending on the time that this happened, for example in the morning, she would have likely seen the ophthalmologist on call or been referred to an associated ophthalmologist. However, if this happened late at night, chances are the specialist would have the patient come in first thing in the morning.

Also, how did the optometrist who saw your wife in the morning know that the injury became worse overnight? Did he see it the night before? Is it possible that the flap of cornea was already mostly off due to the initial poke?

Regarding LASIK…flap complications are one of the most common side effects for the procedure. Basically a device called a micro-keratome cuts a very thin flap of cornea only a few hundred microns thick and leaves a small hinge to keep that piece attached. The flap is peeled back and the laser ablation is performed on the corneal tissue underneath. Afterwards, the flap is placed back over the treated area and over time, the area heals. The advantage to LASIK is fast healing time, quick visual recovery, and minimal pain because the patient’s own cornea goes back over the wound. The disadvantage is that the flap never 100% seals back onto the tissue underneath. Thus, a hard poke in the right (or wrong) spot and the flap can get dislodged.

12

The basic procedure is the same. LASIK and PRK are still the standard two procedures and although there are variations of both, the concept remains the same.

The main differences (technology wise) are in the lasers and the software running them.

…And of course after 15+ years of doing the procedures, surgeons have gotten better at mitigating undesirable side effects.

13

As far as which came first (I really don’t remember my history on this), I believe PRK was first. This involves removing the epithelial layer of the cornea and the laser correction is applied to the bare stroma. Over time, usually 4+ weeks, the cornea will slowly epithelialize over the treated area and the person’s vision will come in. However, the initial week is usually very painful and extremely blurry.

The LASIK procedure involves cutting a flap. The traditional method was with the micro-keratome blade. The newer method is the Intralase which uses a laser to “vaporize” a layer of the corneal tissue under the desired flap and the flap then will peel away. Both methods still involve leaving a “hinge” to hold the corneal flap in place so that it can be folded back over. The treatment is then performed over the tissue under the flap and afterwards the flap is placed back over the “wound”. However, because the procedure allows an intact layer of cornea to go over the treatment area, visual recovery is very quick (sometimes a few days), and there is minimal pain.

The military, as far as I know from spending a few months at the San Diego Naval Hospital 10 years ago (Balboa Park), only wants their airborne personnel to do PRK because there is no flap to dislodge later on. The thought was that if pilots/airborne guys were in free-fall and their eyewear flew off, there was a possibility for the wind to shear off the corneal flap.

14

Neither can I…

What was your issue with your contacts?

15

I am glad that your wife is expected to make a full recovery, but don’t bash all laser eye surgery. They are not all equal. I had eye surgery, but it was PRK. It is accepted for flight, special operations and any other high risk units in the military. The difference is that it doesn’t cut the flap of the cornea like LASIK. It does have a longer healing time but it is not fragile like LASIK is.

Before you get eye surgery done check out all the different types of surgery and what suits your needs(LASIK, LASEK, PRK). Also check the place that is doing it. Not all lasers are equal. There are different types and styles of lasers, some older and some newer.

Another thing to make sure to do is read the pamphlets. They will explain all of the risks/rewards and possible side effects. Everybody’s eyes will react differently.

I do recommend PRK though. My vision is now 20/15, astigmatism free, and my eyes are not weakened due to the flap from LASIK.

16

As someone who has taught pathophysiology, A&P, etc., for 30+ years (though I am not a clinician!) - I have to say both camps so far have supporting data, i.e., DON’T DO IT and “best thing I’ve ever had done”. That’s pure & simple statistics.

I hate my glasses, but for reasons in the OPs camp - I’ll never have anything done surgically. In addition to statements made already, consider that a Doc doesn’t actually do the surgery - a computer does. That may give some people comfort - not me:)

Also - go to the websites for the Docs doing the surgery - and look at their pics. MOST ARE STILL WEARING GLASSES!

Cheers!

john

17

Oh, and it’s not that I’m simply anti-surgery. When I had my retinal tear and detachment - I went running to the surgeon to have it re-attached:) There is a time & place for most things.

john

18

Halos usually have to do with night blindness which is now also corrected through surgery.

19

I had refractive keratoplasty 15 years ago (pre-LASIK) and over that time period have always considered it to be a life-changing event for me. The only negative I have found over that time is that I suspect it has increased my correction requirement for reading glasses a little now that I’m presbyopic. Fortunately, those $15 hardware-store glasses are the same price no matter what the diopter correction.

I don’t get halos or starbursts, but my correction was not great and the incisions didn’t carry into the optical zone of either eye. Regarding LASIK, I’m a big fan. My daughter is an ophthalmology tech and I have several friends that are ophthalmologists. There are definitely potential trade-offs but IME it’s rare to find people who didn’t think LASIK was worth it on balance.

Pick a good surgeon, based on reputation not price.

20

I’m not sure what you mean by “night blindness” as it is a fairly generic term that people use that can be attributed to a variety of issues…kind of like saying “My gun is jammed, what’s wrong with it?”

Traditionally, night blindness is due to a vitamin A deficiency which surgery definitely isn’t going to fix.

“Halos” can be caused by multiple things, but the more common causes are uncorrected, or irregular astigmatism, and the treatment size too small relative to the size of the pupil.

The first, is fairly common even with improved methods. The newer procedures utilize a wavefront aberrometer which detects the aberrations in a persons’ cornea and attempts to correct them with the laser. This is usually produces much better results than the conventional approach.

Keep in mind, it’s very rare for a person corrected with refractive surgery to have perfect vision. Most will have residual astigmatisms or other minor corrections. This isn’t to say that they won’t be happy with their post surgical vision, but that if they were particularly sensitive to it, they’d notice it.

The other halo complaint is mainly due to pupil size and treatment size ratios. As an example, let’s say the treatment size is 8 mm in diameter. In bright sunlight, the pupils constrict and everything is great and clear. However, at night time, the pupil expands to 7-9 mm depending on the light conditions. This places the edge of the treatment inline with the visual axis of the person. The edge of the treatment will have light diffraction because it is where the edge of the untreated eye meets the treated eye and this will create different visual haloes. Patients will exhibit different amounts of pupillary dilation so measuring a dark adapted pupil is a routine part of the surgical consultation.