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First LASIK is easier said than done
No matter how many times beginning surgeons have observed the procedure, emotion can take over and make them forget everything they have learned.
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ROME – Performing LASIK for the first time is not as easy as it may seem. The surgeon may have assisted on dozens of procedures, but it is a completely different matter when that first LASIK patient is on the table. Openly and sincerely, Letizia Vacchini, MD, confessed to the trainees of a LASIK course at the meeting of the Italian Ophthalmologic Society the emotional and practical difficulties she encountered with her first LASIK, so that other beginners could benefit from her experience.
“What worried me most was the positioning of the suction ring and the engagement of the microkeratome. I took a lot of care in placing the patient in the right position, with the eye well exposed,” Dr. Vacchini said. “I then realized how important it is to give your arm the right inclination for the success of these maneuvers, but after a little hesitation everything went well. I watched the microkeratome pass smoothly over the eye and perform the cut. I thought the worst was over and felt relieved.”
Unexpected challenges
After performing the ablation, Dr. Vacchini washed the eye and was ready to reposition the flap. Unexpectedly, this step, which she had underestimated, proved to be the real challenge of her first LASIK.
“What seemed so easy in expert hands became a real nightmare in my hands,” she said. “I repositioned the flap, but realized that a small part of it that had folded under. I tried to unfold it with the cannula and a little water, but the maneuver turned out to be far more complicated than I had expected. I kept trying unsuccessfully for a long time, and with a feeling of anxiety growing at every attempt. After a while I was panic-stricken.”
A video showed the frantic maneuvers of Dr. Vacchini wrestling with the indomitable flap. Her maneuvers only resulted in making it spring back open a few times and return with the fold still in position.
“I was so agitated I couldn’t hear my tutor saying, ‘Open the flap, straighten the fold with the forceps!’ In the end I did it, but panic had taken over, and I tried to reposition the flap with the forceps instead of the cannula, and the edge folded under again!”
After a few more attempts, the flap was straightened and well positioned on the eye, but both the surgeons and the patient were rather distressed.
“All’s well that ends well. The day after surgery, in spite of all that messing about in his eye, my patient had 20/20 visual acuity. However, I would have been happier to spare him and myself that experience,” she said.
Learning from mistakes
Without doubt, you learn from your mistakes.
“Having a video of your surgery is extremely useful, as you can go through it with your tutor and understand where and why you have gone wrong,” Dr. Vacchini suggested.
“I also understood how important it is having a tutor watching you during your first experiences with a new technique and helping you to control your anxiety. If he hadn’t been there, I would have given up and handed the operation over to someone else.” An experienced assistant is also important, she said.
The emotional impact of the first experience with a technique should not be underestimated, she added. Although you may be a calm, self-possessed person, when things start going wrong emotions take over, and you may find that you are incapable of dominating them.
“I was surprised at my own reactions; I didn’t think I was the kind of person to be panic-stricken. My hands were doing things that my brain didn’t want to,” she said.
Dr. Vacchini found that other types of surgery were emotionally less stressful than LASIK.
“I felt very different when I did my first cataract. I think refractive surgery is more demanding, because you know the patient is a young person who has high expectations,” she said.
Fast improvement
Dr. Vacchini’s second LASIK was much easier.
“Remembering the first difficult experience, I was rather worried, but my hands had gained confidence. It gets better and better each time, and the procedure becomes almost automatic, if you have the chance of performing it often,” she said.
Improvement is very quick, she said, almost exponential to the number of times you perform the technique, and the learning curve is much shorter than with other types of anterior segment surgery.
She advised the apprentice LASIK surgeons not to worry too much at the beginning, pointing out that the surgeries would become easier with experience. She recommended that they have an expert to guide them through their first experiences.
“Never start without someone else being present, and make sure that when you perform LASIK for the first time you have already watched the procedure many times, and have all the stages of the surgery very clear in your mind,” she said.
For Your Information:
- Letizia Vacchini, MD, can be reached at Centro Oftalmo-chirurgico Carones, Via Pietro Mascagni 20, 20122 Milan, Italy; (39) 02-7631-8174; fax: (39) 02-7631-8506; e-mail: info@carones.com.