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Good personal experience leads to fellowship in refractive surgery
Luke Rebenitsch, MD, explains why he thinks it is a good idea to have refractive surgery before starting an internship.
Luke Rebenitsch had refractive surgery about 5 years ago, in between medical school and starting his internship. He makes a strong case for other medical students to have refractive surgery before embarking on their internship and residency to reduce the annoyance of wearing contacts and glasses with little sleep.
He describes this all as an engineering student with the analytic mind that engineers have, which typically makes them demanding patients. Rebenitsch is now a refractive surgeon, and his procedure outcome has withstood the test of time with 20/8 in both eyes.
State-of-the-art LASIK has continued to produce more and more outstanding, consistent and long-lasting results with vision better than with glasses or contact lenses and with unsurpassed safety.
Richard A. Norden, MD
OSN Refractive Surgery Stories Editor
Luke Rebenitsch
I guess you could say that I was always going to have refractive surgery. Everyone in my family was highly myopic. I had an aunt who received the “gift” of RK for her –10 D. She did not have 20/20 uncorrected distance vision in either eye, but she was functional without her glasses. As a child, I was one of the first in my class to need glasses. Like many children, I refused to wear them, preferring to listen in class rather than truly see what was happening. I remember watching futuristic TV shows with my father and asking him why no one was wearing glasses. His sage-like response was that in the future there would be a “cure” for glasses and contacts. I had no idea he would be correct, at least partially.
I muddled through contact lenses when I could and wore glasses when I could not throughout high school, college and medical school. I had significant seasonal allergies and had difficulty wearing contact lenses for more than 6 to 8 hours at a time for much of the year. Until medical school, that had been sufficient, but as I started “working” longer hours, I was having to wear glasses more often. As an engineering undergraduate, I had the personality that could not help but discriminate between the quality of vision of my two worlds, and it bothered me. I had always wanted LASIK but was told by many of my medical peers that it was too risky. “You’re going to be a doctor, and you need your eyes,” was a phrase I heard all too often.
Taking the plunge
At the end of medical school, I was frustrated enough to take the plunge. I had a high respect for the ophthalmology residency program where I was studying, and I contacted the cornea fellow who was at the end of her training. I knew that she was an excellent surgeon who wanted a few more cases under her belt and that she would have an experienced surgeon in the room as well. She was someone I trusted implicitly, and I asked for her advice. She explained the pros and cons matter of factly, and I told her I wished to proceed.
At the time, I did not understand refractive surgery as well as I do now, but I knew that I wanted the “best.” I was at the end of my training and living off of student loans, but I made certain to have the best technology. I did my research, and at the time, that meant an IntraLase FS60 femtosecond laser and Visx Star S4 excimer custom treatment (Abbott Medical Optics). Cost was a factor because I had to be able to make a monthly payment on an intern’s salary that would allow me to pay it off in a year. Quality was paramount, and I did not want to wait for PRK unless I had to.
Technique
The surgical experience was eye opening and shaped how I practice today. I was a moderate myope at –4 D sphere with –0.75 D of with-the-rule cylinder and a normal topography. My corneal thickness was approximately 520 µm. I was a “slam dunk.”
What I remember from the experience was mostly positive. The surgeon spent time with me to explain my testing and the procedure. I chose to forgo the Valium because I thought I did not need it — my mistake. Having never been exposed to a refractive surgery case in medical school, I did not know what to expect. I also discovered that I was a “squeezer” and probably a difficult patient overall. There may be something to be said for doctors (and engineers) being more challenging patients.
My postop period was straightforward, and I did my follow-up at the resident clinic. It was intriguing to many of the residents who had never seen a LASIK postop. It became a challenge to see how well I could see. At 3 months, I was 20/8 in both eyes, with a manifest refraction of a near perfect +0.25 D in both eyes. One thing I wish that I had known better was what to expect over the postoperative period. I had significant dry eyes for about a year. However, I did not regret having the surgery. I remember calling to ask about intermittent poor vision during my internship and seeing an ophthalmologist who recommended a simple panacea: artificial tears.
After LASIK, I became an advocate of refractive surgery, referring my roommate and many other medical students. We were all going to be working many hours during internship, and we did not want to bother with contact lenses and glasses. This experience even prompted me to pursue an ophthalmology residency that trained residents in refractive surgery and ultimately pursue a refractive surgery fellowship.
Results
Today, 1 year out of refractive surgery fellowship, I am +0.25 –0.50 with the rule in the right eye and +0.25 D in the left eye. My uncorrected distance visual acuity is 20/15 in the right eye, 20/10 in the left eye and 20/8 in both eyes. My dry eye has resolved completely. I have no halos or glare to speak of, and I have years until presbyopia hits. With this experience and with a full understanding of all the risks and benefits, I am proud to be a refractive surgeon, and I would have refractive surgery again. The only change I may have considered with current technology would be the ICL (STAAR Surgical), although I feel I could go either way.
This experience taught me a number of things:
- Education and time with the surgeon are of utmost importance, even when the patient appears to have knowledge of the procedure.
- My surgeon will always be my surgeon, even years in the future.
- Explanation and verbal anesthesia during the procedure are worth even more than the Valium preop.
- Follow-up and postops are just as important as preops.
- Refractive surgery can and should be celebrated with patients after risks and natural history are fully understood. It is life-changing for many people.
For more information:
Luke Rebenitsch, MD, can be reached at Northern Lights Lasik, 4776 28th Ave S., Suite 201, Fargo, ND 58104; email: lukerebenitsch@northernlightslasik.com.Disclosure: Rebenitsch reports he is an ophthalmic devices consultant at the FDA and a member of the Refractive Surgery Alliance.