This article is more than 5 years old. Information may no longer be current.
Good results of refractive surgery with early femtosecond laser hold strong today
With proper preoperative treatment, dry eye patients can successfully undergo refractive surgery.
Click Here to Manage Email Alerts
Richard A. Norden
This story from Karl Stonecipher, MD, is the second in our series of columns by refractive surgeons undergoing refractive surgery. Our hope is to change the paradigm in how many ophthalmologists view refractive surgery. If you are a refractive surgeon and have had laser vision correction, don’t be shy! Send us your story so that we can share it.
Richard A. Norden, MD, FACS
OSN Refractive Surgery Stories Editor
Karl G. Stonecipher
I remember my first set of glasses. I was 11 years old, and my football coach told my dad that I was not very good at catching anything. Lucky for me, my dad felt there must be something else going on, so off to W. Stanley Muenzler’s office I went. My first set of glasses was like a new world. License plates and leaves on trees came into view and so did the football.
When I was 13 years old, Muenzler suggested that I was ready for contact lenses, and for the next 25-plus years of my life, that is what I wore. My manifest was close to –6.0 D spherical, so even though I was part of the radial keratotomy era, I knew that I was better suited for laser vision correction. Unfortunately for me, as laser vision correction became available, my dry eye disease kicked in. I have a “dry eye family tree.” So as a corneal fellow, my long hours forced me to have bilateral thermal cauterization of my lower puncta by my good friend Vernon Parmley, who was also completing his corneal fellowship at the same time. This intervention allowed me to continue my contact lens wear for the next several years, but with time, my long hours and dry eye progressed. In 2002, cyclosporine was approved, and that was my only option if I wanted to continue not having to wear glasses, which, as a refractive surgeon, was not an option in my mind.
It was at this time that I had been working with 10 amazing surgeons in a clinical trial with a new laser. The femtosecond laser had been recently approved, and my dry eye issue was in good control on topical cyclosporine, so I decided it was my time. It was never a question of if but when, and the time was right. So for the first time in more than 30 years, I started wearing glasses.
The American Society of Cataract and Refractive Surgery meeting was in San Diego, and my good friend Mickey Gordon lived just up the road. I asked him to help me, and he said yes. I figured I could go out and play a little golf and present my papers while I recovered. I also wanted to have surgery when I could rehabilitate in the more humid months as opposed to winter. For me, wearing glasses was never an option because I always felt my depth perception and visual field were hindered when wearing them. Now, before going out to Mickey, I started to back off my contact lenses in my nondominant eye. Why did I do that even though I was not presbyopic? Because I knew I would be, as we always say, “Lord willing and if the creek don’t rise.” I pushed myself as far as I could tolerate, which was –1 D. So I told Mickey to target plano in my dominant eye and –1 D in my nondominant eye. I continue to have friends and family ask me how I can still read without glasses. I tell both them and my patients that monovision is my friend. I play golf, water and snow ski, hike and bike, and I am even known to surf (or try to surf). But the point is I can do pretty much what I want to do without contact lenses.
It has been more than 10 years, and I still function fully thanks to all of my caretakers over the years.
Some final thoughts: First, thanks to Guy Kezirian and our colleagues who got LASIK approved for the general patient with numbers to include mine. Second, dry eye disease has been shown to be treated preoperatively, and patients can go on to have laser vision correction with successful outcomes. Finally, we need to be aware of the fact that dry eye disease can influence outcomes, including enhancement rates, so with diligence, patients and doctors can successfully undergo surgery with great results.
Note: W. Stanley Muenzler was my first ophthalmologist and wrote my recommendation for medical school. He also was instrumental in my becoming an ophthalmologist and wrote recommendations for my residency and fellowship. He passed away suddenly in August 2013. He knew that I was truly appreciative of all he did for me because I made it a point to tell him several times over the 35-plus years we had together as colleagues and friends.