Good Living Article

Health

Seeing clearly

LASIK refractive surgery is widely touted as a relatively risk-free route to 20/20 vision – but is there more to ‘flap-and-zap’ surgery than meets the eye? Annabel Kantaria reports.

Glasses may be a trendy fashion accessory for some lucky people but, for many, they’re a nuisance – just ask anyone who’s had to wear them through the humidity of a Gulf summer – and what about those who play sport? How does one wear glasses when booting a ball about on the football pitch, squaring up for a ferocious game of polo or squash, or galloping a horse along Jebel Ali Beach? Obviously it’s do-able, but it’s not ideal. Contact lenses don’t fare much better in this climate – just let a strong breeze stir up the dust and sand and your miracle lenses are coated in eyeball-scratching grit, while life in an air-conditioned home or office can render the moistest eyes dry under their little plastic coatings. But what’s the solution? Laser surgery is prohibitively expensive, often inaccurate, painful and takes ages to recover from, right? Well, that’s where you’d be wrong: the latest version of corrective laser eye surgery to arrive in Dubai – LASIK – is said to be relatively painless and can give suitable patients good vision almost immediately or, at least, by the very next day.

Standing for Laser-Assisted In Situ Keratomileusis, LASIK is a refractive surgery procedure that uses a laser to permanently change the shape of the cornea (the clear covering of the front of the eye) in order to correct short- or long-sightedness. Says Dr Ashraf, a USA-qualified surgeon who practices at the Atlanta Vision Clinic in Dubai: “LASIK surgery is one of the most popular and successful cosmetic surgeries performed throughout the world today. It’s a surgery that changes peoples’ lives in just a few minutes. Every once in a while we have patients literally in tears – after being handicapped all their lives they cannot believe they can see so well without glasses, even immediately after surgery.” A glowing testimonial indeed – but is this miracle cure for everyone?

Who can benefit from LASIK?

According to Dr Ashraf, anyone who wears contact lenses or glasses can potentially benefit from the surgery, however a detailed preliminary eye examination using advanced diagnostic equipment is required to ensure the safety of the procedure for each patient. “Maybe less than five per cent of potential patients are not suitable for the procedure,” says Dr Ashraf.

Reasons why you would not be a suitable candidate include:

- Very poor vision: the American Food & Drug Administration (FDA) does not approve the procedure for those with a prescription of more than -14.00 diopters of myopia, more than 6.00 diopters of astigmatism or more than +6.00 diopters of hyperopia.

- An unstable prescription: Because our eyes constantly change as we mature, most LASIK surgeons prefer not to operate on patients younger than 18 or on anyone whose prescription has changed in the last two years. This could negate any positive effects of the treatment.

- Poor eye health: The surgeon will check the front of your eyes for any abnormalities with the conjunctiva, lids, iris, lens and sciera that could affect the outcome of the surgery, and then the backs of your eyes for signs of diseases such as glaucoma, ocular hypertension and diabetic retinopathy. A case of dry eye disease must be treated and cleared up before the surgery takes place.

- Inability to focus on a point: As this is a necessary requirement for the laser treatment, you may not be a good candidate if you cannot stare at a fixed object for 60 seconds.

- Unrealistic expectations: Dr Ashraf says: “The majority pf people that I deem as not suitable are the ones who have unrealistic expectations – they want to read a car number plate at 50 metres – but, if they can’t see this with glasses now, they probably won’t see it after the surgery.”

What does the procedure involve?

LASIK is just one of several methods of eye surgery for improving vision, but it is the most common. The first step is to have a preliminary eye examination, during which the surgeon will determine the state of health of your eyes, what kind of vision correction you need and how much laser ablation is required. He will also run some objective tests such as corneal surface scans, curvature measurements and so on. Once you are approved for surgery, the procedure is quick, easy and relatively painless, taking about one minute per eye – 10 minutes from start to finish for the entire procedure on both eyes. The patient lies back on a reclining chair in the exam room, numbing drops are placed in the eyes and a speculum is used to keep the eyes open.

The LASIK procedure then involves two main steps: first, a knife is used to make an incision to the cornea in order to create a flap, which is folded back to expose the stroma, or middle section, of the cornea. An excimer laser is then used to vaporise part of the stroma, then the flap is carefully folded back. “The cool laser beam gently reshapes the cornea in order for the eye to focus properly and clearly,” explains Dr Ashraf. “The amount of tissue that is removed may be half the thickness of a human hair – this is all it takes to bring the focus back and see clearly again.” Once the healing is done, the results are permanent.

Patients are often nervous prior to the treatment, the most common concern being: what if my eye moves while the laser’s on? “No problem,” says Dr Ashraf. “The procedure is very fast – the laser treatment time is literally only a few seconds – and most people can keep their eye trained on the fixation beam for this short period. The laser also has an eye tracker, which locks onto the patient’s eye so, with any fine movement, the laser will follow the eye, and it will stop automatically if there is any large amount of movement.”

What are the risks?

Most people are nervous about having their eyes touched, let alone singed with a laser beam. Surely there are risks involved? Says Dr Ashraf: “As with any surgical procedure, there are risks. Fortunately with this surgery, the bad potential risks or complications are extremely rare. The most common side effect that only a small percentage of patients get is mild dryness of the eyes after surgery, and this usually clears up after a few days or weeks.”

The FDA, which demands an adverse affect rate of no more than one per cent in clinical trials, agrees that most patients are pleased with the results of their refractive surgery, but points out the following potential risks:

- Loss of vision: Some patients lose lines of vision on the vision chart that cannot be corrected with glasses or contact lenses.

- Debilitating visual symptoms: Some people develop glare halos and/or double vision, which can seriously affect night-time vision. Even with good vision, some patients do not see as well in situations of low contrast, such as at night or in fog.

- Under- or over-treatment: Only a certain percentage of patients achieve 20/20 vision – it’s possible you may still need contact lenses or glasses after the treatment, even if you only had a weak prescription prior to surgery.

- Dry eye syndrome: As Dr Ashraf says, after the treatment, the eyes may not be able to produce enough tears to keep the eyes moist. This is uncomfortable and can reduce vision due to blurring but can be treated with intensive eye-drop therapy.

- Diminished results with age: If you are far-sighted, the level of improvement you experience after surgery may diminish as you age.

- Lack of long-term data: LASIK was first approved in 1998 so the long-term safety and effectiveness is not yet known.

- Equipment malfunction: Even the best-screened patient under the care of the most skilled surgeon can experience complications such as an equipment malfunction or human error. Cutting through the cornea instead of making a flap may lead to irreversible damage to the eye.

- Post-surgery complications: Inflammation or infection of the eye may require a further procedure or intensive treatment, which can lead to temporary loss of vision or, in some cases, irreversible blindness.

However, the FDA’s final summary is thus: “Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their refractive procedure.”

How do I find the right surgeon?You’ve assessed the risks and benefits, decided LASIK is going to change your quality of life for the better and assessed the financial cost (this varies, but in a reputable clinic in Dubai expect to pay about Dhs 4,000 per eye). Now for the multi-million dollar question: how do I know who’s good and who’s not? There is no simple answer. Dr Ashraf says do your homework. “There are many clinics offering this service in Dubai and I recommend that, as with any procedure, you do your research. Visit the clinics and find out how experienced the surgeons are; look at the technology of the equipment used; check the websites; and ask to speak to previous patients.” A referral from your usual eye care practitioner is also a good bet.

Dr Ashraf also recommends questioning the servicing and maintenance of a clinic’s laser equipment. “At the Atlanta Vision Clinic, we maintain the same standards, equipment and technology as in my clinic in Atlanta, USA. In addition, the servicing and maintenance of the equipment is done by the manufacturer, whose technicians fly in from Germany to maintain the proper performance of the equipment.”

The FDA recommends not basing your decision on cost and not settling for the first eye centre that you come across. It also warns potential patients away from centres offering promises such as ‘20/20 vision or your money back’, slick advertising or deals that sound too good to be true – remember they usually are, and there are no guarantees in medicine. Beware, too, of misleading claims: if a surgeon claims to have been using a laser for 15 years, question him – LASIK has only been around since 1998, so he is either bluffing or talking about another sort of laser.

The Council for Refractive Surgery Quality Assurance (CRSQA), which certifies refractive surgeons in the USA, recommends asking your potential surgeon the following questions:

- How long have you been performing refractive surgery procedures? (not less than three years).

- How many procedures have you done? (not less than 500).

- What percentage achieved 20/20 vision? (not less than 50 per cent, but be wary of a higher number).

- May I have a list of 10 patients I can contact?

As with most things, choose a clinic that makes you feel comfortable and a surgeon whom you feel you can trust.

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LASIK – a patient’s eye view

It’s all very well a surgeon telling you the surgery doesn’t hurt and isn’t scary, but how does it really feel? Good Living asked 59-year-old Sheila Duffin to tell us about her recent experience at the Atlanta Vision Clinic, Dubai:

“Although I hated wearing my glasses because I have an allergy to metal, I’d never really considered having laser eye surgery,” says Sheila, who used to wear contact lenses when she went out, but couldn’t use them for reading. With a prescription of 3.00 and 5.25, she definitely needed some sort of vision correction in order to live her everyday life.

Sheila hadn’t considered laser eye surgery until her daughter suggested it to her. “My daughter did some research and picked the clinic, and we went along to establish whether I was suitable for the treatment. I was, and the surgeon said I would benefit from it, so we booked the appointment. I actually live in Ireland, but to have the treatment there would have cost five times what it did over here in Dubai.”

For two days prior to the surgery, Sheila was asked to put drops in her eyes to dilate the pupils. Says Sheila: “I had the surgery at 8.30am. I was given anaesthetic eye drops and my eyes were kept open with a plastic vice-like contraption. It wasn’t painful at all; it wasn’t even uncomfortable. During the surgery I could see a red light and then it would go dark, and then bright red. This process was repeated throughout the treatment – that’s all there is to it really. It takes less than 10 minutes. There was no pain – all I felt was mild discomfort due to a little pressure on the eye while the treatment was being carried out. On a scale of one to five, it would be about a ‘two’.”

Some patients fear that they’re going to smell their cornea burning as the laser works on it. Is this true? “Yes,” says Sheila. “I did smell a bit of burning, but I had been told beforehand to expect this. It’s nothing to worry about. The treatment was quick and not horrible at all.”

But how quickly afterwards could she see? She explains: “Before the surgery, the consultant asked me to tell him the time from my watch. I half-guessed because I couldn’t see. The first thing he said to me after the treatment was ‘tell me the time from your watch’ – it read 9am and it was so clear it was unreal. It was really amazing. He had warned me that immediately after the operation I would see minuscule print much better than I would later, as it balances out a little afterwards – the distance vision becomes perfect and really tiny print is not so easy to read. You can have different treatments, though: distant vision was the most important thing to me and I wanted to be able to read normal print without glasses.”

Tests done since the surgery reveal that Sheila now has 20/20 vision for distance: “My distance vision is the same as when I was a 20-year-old,” she says. “It’s fantastic. For very tiny print, and I mean very small text, then I use the mildest prescription glasses that you can buy over the counter at the pharmacy. For normal print I don’t require any glasses at all.”

After the surgery Sheila had to take antibiotics as a preventative to ensure that she didn’t get an infection, and she had to use drops to ease dryness of her eyes. “I still have some dryness and I’ve been told this can last for a couple of weeks or longer. It’s not uncomfortable but, by the end of the day, my eyes do feel a little dry. I use the drops three times a day until this improves. On the whole, I’m very happy with the results and have recommended it to all my friends.”