Since I was in third grade I have worn glasses. My prescription quickly worsened, and my glasses quickly got thicker. After being called “four eyes” and being bullied for years, I finally got contacts in 10th grade My prescription quickly worsened to over a -9.00 in my right eye, and over a -10.00 in my left eye, with astigmatism in both eyes. . Unfortunately, you can’t wear contacts all the time, you can’t wear them in the water, and worse yet you can get problems with contact lenses. That problem hit home in my first year of college, where complications from my contacts forced me to wear my ugly thick glasses for much of that important first year. This played a big part in my decision to pursue a career in ophthalmology, which required a lot of work and preparation. You see, medical school is tough to get into, but ophthalmology is even tougher being one of the most competitive residency training fields to get a position in. I was driven by my need to do something about my own eyes. When I finally finished my ophthalmology residency, the excimer laser for refractive surgery has been approved for correction of eyes just two years before. It was a new field, and finding proper training in the United States was extremely difficult. It was a brand new field, one that was being invented and developed from the ground up, and it was a very different language than just normal ophthalmology. I then went and got one of the best refractive surgeons in the world at that time, Dr. Enrique Suarez of Caracas, Venezuela to allow me to come and learn with him. He was doing more LASIK in a day than many doctors were performing in a month in the United States. I was absolutely determined to become so good at laser eye surgery that I could perfect the techniques to fix my own complicated eyes. I knew this was where my future was going to be.
You see, I was in an ironically difficult position- I didn’t have enough corneal tissue to correct my eyes with LASIK, not even the thin-flap LASIK that became available a few years later. PRK could be done, but at my high correction would result in very high amounts of haze and regression. On top of that, there were serious problems with performing very high prescriptions and getting bad night glare, halos, and loss of contrast sensitivity. The first steps toward rectifying this latter problem were the prolate aspheric ablations that I started performing with the Nidek laser in late 2002, and taken to another level with the Allegretto 400 that I use now.
Finding a solution to not having enough corneal tissue was a lot harder. I obtained the equipment and learned the technique of Epi-Lasik, and performed it on many people in my own position. It is the only true flapless LASIK procedure in which an epithelial only flap is made, leaving all the corneal tissue available for correction. Unfortunately not many surgeons did this procedure, and co-ordination and logistical difficulties made it even more difficult. Finally, I decided with the advances in PRK haze control, pain control, as well as accuracy I would have my laser performed as PRK in two parts to avoid the haze and regression issues. The first phase would eliminate about 75% of my correction, and the second phase would eliminate about the other 25% and also leave me with some monovision in my left eye so I could read without reading glasses.
That first phase PRK was absolutely amazing. All the things that I had told my patients, and talked about over the years were being performed on me. I had my eyes done on the Allegretto 400 laser, had absolutely no pain, and for the first time I actually experienced what my patients did. I discovered the laser lights weren’t as bright as I thought, that it really did feel quick, and that I was able to see more clearly even as the eye was finished.
I got up from the laser bed, and even though I had just had it done, had bandage contacts in my eyes, and medicine in my eyes, I could see. I could actually see pretty well! As I was being driven home, it was dark and I could tell that the elimination of my astigmatism which had been done in Phase 1 had really made some of the tails and streaks I saw around lights better. Even though I was still undercorrected, my vision was so good that I was absolutely stunned.
I had no pain that night, and was in such shock that I couldn’t even go to sleep. I could see the television in my room very well, I could read my iPad, my phone, and I had absolutely no pain. I finally went to sleep, and had the same experience the next day. My most frustrating time was on day three, when the epithelium was closing over in the center of my eye and that day I was pretty blurry, and not even able to read properly. By the next day, I was clearing and could read again. By day 5 I was seeing patients again, and day 6 I was performing surgery without a problem.
As I write this I am awaiting phase 2, wearing glasses that about a -2.00. I am finally reaching the goal that I set out for myself all those years ago, and it is absolutely amazing!
Update from Phase 2:
Phase 2 was done in May 2013. I had this phase done on the Nidek laser which I also own using the same ablation pattern. Now I have had my eyes done on both lasers. During my healing time I also went on Restasis, a medication that when used for four months increases the quality of your tears. That helped dramatically decrease my need for tears as time went on, and today I use tears occasionally. The outcome was nothing short of fantastic.
The clarity is amazing, but more noticeable was the sense of liberation. There is a profound freedom from being able to see everything clearly without a “visual crutch,” one that I never really experienced even with contact lenses. The peripheral vision, the clarity and brightness of objects, the almost 3D vision was not something that I was quite prepared for, even with all the procedures that I have done. I didn’t think it would be all that different from contact lenses, but it is, and I didn’t get the full effect until Phase 2 was complete.
The sense of liberation is very uplifting, and because I also did a -1.50 monovision on my left eye, I was able to do all my reading without reading glasses. I now do all of my reading and up close work without any need for glasses. I was very happy with my monovision, but to my surprise, it got better. Even with all the advice I gave my patients about monovision, all the years of performing my Balanced Monovision algorithm on patients, and even with using monovision in my contact lenses, I wasn’t prepared for the improvement I saw 3 months out. I realized one day in August while walking into the shower in the morning that I was seeing even more clearly. It caught me by surprise, but I realized upon further evaluation looking around my bathroom that my brain had neuro-adapted even further and my distance clarity was even better than it had been before. I didn’t expect that, as I had used monovision with contact lenses before laser, and although I had my laser in two phases, I had set the balance to be different in both eyes from the get go. My inescapable conclusion is that, at least in my case, monovision with Lasik is significantly better than with contact lenses. That is something that I had seen with many patients before, that they did much better with my Balanced Monovision algorithm than they had done in monovision contact lenses, and quite a number of patients who didn’t do well with monovision contacts did well with my Lasik Balanced Monovision algorithm. I just didn’t expect to see it for myself as I wasn’t unhappy with my monovision contact lenses.
To me this surgery has been a no-brainer, and the monovision has been even a bigger no-brainer. I have no problems driving at night, I don’t use readers for anything, and the Restasis has taken away the dry eyes I had. My only regret is that it took me so many years to have it done.