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Surgeon experiences ‘humanness’ of fear during LASIK
John Berdahl, MD, knew what to expect from his LASIK surgery, but a bit of nervousness remained.
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Contemporary LASIK has advanced in many ways compared with LASIK from the mid-1990s.
We have better and more efficient instrumentation and lasers, larger ablation and blend zones, thinner flaps created by latest generation microkeratomes and femtosecond lasers, and the ability to treat larger degrees of myopia, astigmatism and hyperopia. All of this, along with sophisticated nomograms, has led to more precise outcomes with lower enhancement rates, less pronounced and less frequent side effects such as dry eye and night difficulties, and happier patients overall.
John Berdahl describes his experience with contemporary LASIK. John admits to the “humanness” of fear of the procedure despite being extremely familiar with the data regarding safety and the thought that most patients on the way into the laser room grapple with: “I sure hope something doesn’t go wrong.” He also proves he is human by doing what we all do — assume that his experience is like everyone else’s, hence the attention to dry symptoms just after the procedure.
Many patients today experience little in the way of night symptoms other than the first night or two, and few have prolonged feelings of dryness.
We encourage all refractive surgeons who would like to share their personal refractive surgery stories to send them to David W. Mullin, Editorial Director of Ocular Surgery News, at dmullin@slackinc.com.
Richard A. Norden, MD
OSN Refractive Surgery Stories Editor
John Berdahl
I was a 32-year-old –1.5 D myope in both eyes with no astigmatism during my anterior segment fellowship at Minnesota Eye Consultants. I did not think of my glasses as a burden, and like anything that has become a habit, I did not think about them much at all. However, there were three clear motivators that led to my having LASIK. First, my wife said that she liked how I looked better without glasses. Second, my glasses were often bent and smudged up, making me look less professional. Third, my patients would often ask me why I wore glasses if I was talking with them about LASIK. Ultimately, my fellowship director, David Hardten, MD, performed LASIK on me.
Preoperatively, my vision was in the range of 20/100, but I could not tolerate contact lenses well because my eyes were dry. I would wear contact lenses only for photo opportunities or special occasions, and I would wear them for short periods of time before they would become intolerable or my eyes would become red. I considered PRK and LASIK, but I knew that I wanted the fastest recovery possible, and with the delicate nature of eye surgery and being at the pinnacle of my training, I wanted to minimize the potential for lost learning. I had custom LASIK on a Visx Star S4 laser in combination with an IntraLase femtosecond flap (both Abbott Medical Optics).
I was not nervous about the procedure at all until I actually laid down under the laser. At that time, I started thinking “Wow, my life is almost perfect. I don’t really hate these glasses. What if something does go wrong? Are the miniscule risks associated with LASIK worth it?”
I point this out because I knew very well the high success rate of LASIK, but it is almost impossible to keep the humanness of fear out of the equation with data alone. Ultimately, I had incredible trust in my surgeon and his team, and that is what I relied on, despite the fact that I knew the LASIK safety and efficacy data were compelling.
I chose not to have Valium because I wanted to experience the procedure as fully as possible. I hung on every word the surgeon said. I remember him saying, “Your eyelids aren’t numb, but your eye is,” and I still say that to every patient that I do surgery on. I remember him rhythmically encouraging me to continue to look at the light. I remember feeling like it was awfully hard to keep my eye still, but upon review of the surgical video, my eye was rock-solid steady. I remember seeing the raster pattern of the IntraLase going across my cornea and knowing exactly what would happen, and I remember that it did not hurt but felt weird.
Immediately upon completion of the surgery, I could see well, and for about 20 minutes, my eye remained numb. Twenty minutes later, my eyes watered and were scratchy, and that lasted for about 2.5 hours. My wife drove me home, and on the way she said, “Let’s just stop at the grocery store so I can grab a couple of things.” I sat in the front seat with my eyes like a waterfall while my 1-year-old son sat in the backseat crying. I advise my patients now to go right home after surgery.
On the first day of recovery, I did exactly what all patients want to do but every doctor encourages patients not to do. I would compare one eye with the other, and I would look for any possible imperfections. The gain is turned up so high with such a transformative experience that you pay attention to details that you have never thought of paying attention to previously. I would cover one eye and compare it with the other. I would wonder if any small scratchy sensation could possibly be the start of an infection. If my eyes felt more irritated, I would take more than the prescribed amount of steroid. What became apparent to me is how human we are and that our human tendencies dominate our rational tendencies.
I had 20/20 uncorrected vision on day 1 and 20/15 uncorrected vision on week 1, but my visual quality was still not perfect. I had mild but real glare for about 4 months after surgery, and my eyes were dry, especially at night when I woke up. One week after surgery, I had punctal plugs placed, and it made a big difference in the comfort of my eye. The glare has subsided, my vision quality is tremendous, and my visual acuity is now 20/10. Now I am quick to use punctal plugs on LASIK patients if they are irritated. I now tell all patients that they will have dryness, they will have glare, and they will have halos, and that will all go away with time, and if the dryness lingers, we will work on treating that.
The most fascinating thing about the entire experience is that I did not realize what a burden my glasses were until they were gone. No more cleaning glasses. No more glasses fogging up as I go in and out of buildings. No more squinting through a bright day because I did not have prescription sunglasses, and no more falling asleep on the couch and bending my glasses. Most importantly, my wife liked how I looked better.
LASIK is one of the best decisions that I have made, and I benefit from it every waking moment.
For more information:
John Berdahl, MD, can be reached at Vance Thompson Vision, 3101 W. 57th St., Sioux Falls SD, 57108; email: johnberdahl@gmail.com.Disclosure: Berdahl reports he is a consultant for Alcon, Allergan, Avedro, Bausch + Lomb, ClarVista, Envisia, Glaukos, Omega Ophthalmic and Vittamed.