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I WAS vain.
That’s the only way I can explain why I willingly let a doctor cut my corneas with a laser: vanity.
Little did I know when I chose Lasik surgery that I would not end up
satisfied like the friends and acquaintances who raved about their
post-glasses existence. Instead, my days are complicated, since I am
dealing with side effects that are far more bothersome than being
unfashionably four-eyed.
I had been wearing eyeglasses since I was 8, and I was tired of
never seeing the stars without glare, of not being able to go
rock-climbing unless I secured my glasses. Not to mention the
horn-rimmed barrier between me and a date.
I had trouble figuring out which side of a contact lens to stick onto my eye, so I never really gave contacts a chance.
I had been considering Lasik — short for laser-assisted in situ
keratomileusis, which entails cutting and reshaping the cornea — since
the Food and Drug Administration approved it in the late ’90s. Because
I was not too nearsighted and not too old, ophthalmologists told me I
was an excellent candidate. But I wanted to wait until more people had
gone under the laser.
Roughly 800,000 patients have had Lasik annually since 2000,
spending about $2.5 billion on the procedure every year, said David
Harmon, the president of Market Scope, a research company for the
ophthalmic industry in Manchester, Mo.
The American Society of Cataract and Refractive Surgery reports a
95.4-percent patient satisfaction rate for Lasik, based on a recent
analysis of research worldwide. The researchers found 19 studies
specifically addressing patient satisfaction from the last decade,
encompassing roughly 2,022 patients. (Some had been post-op for a
month; others for a decade).
Most ophthalmologists are confident about the efficacy of Lasik, as
well as another popular procedure — photorefractive keratectomy, or
P.R.K. Both are designed to correct nearsightedness, farsightedness and
astigmatism.
“It’s very few people who don’t have a superb outcome, especially
with the new technology,” said Dr. Marguerite McDonald, the president
of the International Society of Refractive Surgery of the American
Academy of Ophthalmology.
About five of my friends had undergone the surgery. “Life-changing,”
they cooed. “Miraculous!” Because my 40th birthday was looming, my
parents offered me either a cello or Lasik. I chose Lasik. But first, I
looked up studies online and consulted three doctors. Each did a spate
of tests and pronounced me an excellent candidate.
I asked about the risks, and they explained that some people come
away with dry eye, double vision, decreased contrast sensitivity and
decreased night vision. Some see halos around lights. I was assured
these side effects were rare, and usually fleeting.
Ultimately, I chose Dr. Sandra Belmont, the founding director of the
Laser Vision Correction Center at NewYork-Presbyterian Hospital/Weill
Cornell Medical Center. Dr. Belmont also runs a corneal fellowship
program at Manhattan Eye, Ear and Throat Hospital.
A doctor who was a patient of hers recommended her. She charges
between $4,500 and $5,500; I paid $4,500, nearly $1,000 less than other
quotes I had received, a consideration since my insurance, like most,
does not cover elective surgery.
I signed a consent form confirming that I understood the risks. I
thought I did understand them. I did not know then that 5 to 10 percent
of patients need to have their vision fine-tuned — or in industry
parlance, “enhanced” — after surgery because of an under- or
over-correction, according to John Ciccone, a spokesman for the
American Society of Cataract and Refractive Surgery.
Nor had I spoken to any individuals who wished they had never had
the procedure — of which, I have since learned, there are plenty.
On April 13, 2007, I had the surgery. Dr. Belmont’s colleague
examined me the next day. My vision was a little blurry, but apparently
that was normal. Dr. Belmont said that everything looked good on
subsequent visits, too. But the blurriness never went away.
At night, I saw halos around streetlights; neon signs bled; the moon
had two rings around it like Saturn. My eyes felt sore, a result of dry
eye, which also causes sporadic blurriness.
Dr. Belmont told me that sometimes women of a certain age who are
undergoing hormonal changes or who take certain medications get dry
eye. It would have been nice if I’d known my advanced age (39) might be
problematic before I sat in the chair.
I cut out all prescription and nonprescription pills. Didn’t help.
The doctor told me to use Refresh Plus, over-the-counter drops that
temporarily help dry eye. The drops cost around $12 a box; I go through
two boxes a week. She also prescribed Restasis eye drops, which can
help increase tear production. They didn’t for me.
True, I no longer wear glasses. But the 20/20 line on the eye chart
is blurry. I can make it out only if I squint, and it takes about a
minute to read. My doctor views this as proof of the surgery’s success.
“I do see it as a success,” Dr. Belmont told me in a recent
interview. She also has said repeatedly that these troubles will pass.
“In 18 years of practice, I’ve never had a patient whose symptoms don’t
go away. Most patients take three to six months to heal.”
But I see my slow-squint reading as a sign of failure. I thought I’d
be able to decipher words in the real world at a glance. My consent
form said: “The patient understands that the benefit of the
Lasik/P.R.K. procedure is to have an improved uncorrected visual
acuity.” I took that to mean that my eyesight would be 20/20. Most
doctors, on the other hand, focus on the words “improved uncorrected
visual acuity.”
“Not every patient has the potential to see 20/20,” Dr. Belmont told
me this month. So, if your eye can see 20/20 with glasses or contacts,
the doctors try to replicate that, but there are no guarantees. Dr.
Belmont said, “You do the best that you can.”
On its Web site (www.fda.gov/cdrh/lasik/risks.htm), the F.D.A.
cautions patients to “Be wary of eye centers that advertise ‘20/20
vision or your money back’ or ‘package deals.’ ” (Still, some
refractive eye surgeons’ phone numbers end in 2020.)
Nearly a year later, my problems remain. Still, I’m not mad at my
doctor. I’m mad at myself. No one forced me to do it. In our quick-fix
culture, we forget that there are risks with any surgery, elective or
not.
Between 1998 and 2006 the F.D.A. received 140 negative reports
relating to Lasik, including double vision, dry eye and halos, said
Mary Long, a spokeswoman. Granted, this is not that many, but Ms. Long
said, “If this many people are responding to an adverse event, there
are probably others who are not.”
After concluding that too few well-designed studies have examined
quality of life after Lasik, the F.D.A. put together a task force in
2006 to design a clinical trial to explore the subject. A pilot study
is now under way at the National Eye Institute in Bethesda, Md.
LOOKING back, I do not think my doctor and the other experts I
consulted adequately represented the pitfalls. It’s one thing to say
that dry eye is “annoying,” as Dr. Belmont did; it’s another to explain
how feeling as if your eyes are coated in Vaseline may make every
waking moment a chore.
Perhaps it depends on what your definition of success is.
“People say, ‘Well, you don’t wear glasses anymore,’ ” said Barbara
Berney, 53, of Rockford, Ill., who had the surgery in 2001 and now
reports dry eye, night blindness, dimmed vision, halos and starbursts.
“Unless you see what I see, you have no frame of reference.”
Unhappy Lasik patients, some with worse experiences than mine (one
man I spoke to needed a corneal transplant), have created about a dozen
Web sites. The 12 patients I talked with all reported feeling as I did,
gaslighted. They said they kept telling their doctors that they
couldn’t see, and that their doctors kept telling them that they could.
A few doctors have told me that they think they can help my dry eye,
but I worry they will suggest more surgery, and I haven’t gone to see
them. A few optometrists said they could fit me with special lenses to
moisten my eyes, and I may have to go that route.
Meanwhile, I walk by eyeglass shops and wish I needed to go inside.
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