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Ophthalmologist describes initial LASIK and later flap-lift enhancement
Scott Hyver, MD, underwent two rounds of surgery for different needs at different ages.
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Scott Hyver has chronicled his experiences with LASIK, first in his mid-30s and then in his 40s as he developed presbyopia.
At both times, he experienced relief from his asthenopia with excellent distance and near vision outcomes. Many patients and physicians mistakenly believe that LASIK “wears off” as people reach their mid-40s, when in fact it is presbyopia that causes asthenopia and loss of reading vision. We should remember that LASIK is not always discomfort-free; however, the small amount and short-lasting nature are something quickly forgotten and well worth the lifetime of unaided excellent vision.
Richard A. Norden, MD OSN Refractive Surgery Stories Editor
As a young hyperopic astigmat, I donned my first pair of spectacles in college, wearing them principally for reading. During my ophthalmology residency, I began wearing glasses full time as did many of the ophthalmologists in my circle, seemingly a badge of the profession.
When I started my refractive surgery fellowship, I got quick feedback that wearing spectacles was contrary to the philosophy of the practice, and while I gave contact lenses a chance, they were just too uncomfortable to tolerate over the long workdays. So given that my prescription was mild, I abandoned the use of glasses altogether for the next few years. Eventually, though, the asthenopia I experienced at the end of each workday was becoming a challenge.
Around this time, the FDA cleared the first excimer laser for hyperopic astigmatism treatment, something that inspired me to consider LASIK as a potential solution. So at the age of 35, I asked my friend and mentor, Arturo Chayet, MD, to perform my surgery. Arturo felt the mild prescription in my left eye did not merit surgical correction at that time, so we decided to do LASIK on my right eye only, which he performed using a microkeratome and a Nidek laser. All I remember from the surgery was the pinching sensation of the suction ring, the massive-appearing surgical sponges as they came close to my eye, and the appearance of the large, amorphous blinking fixation light during the ablation. Although a bit surreal, the entire process was fast and easy.
I loved my new eye. My near vision was superb. I could clearly see the details of patients’ irides when draping their lids for surgery. And my asthenopia was gone. Things were great for many years until, in my early 40s, I started experiencing some regression. Ultimately, I fell back to the same original prescription and the same asthenopia, but now my near vision was worse than ever.
So I made an appointment with Arturo, and we decided we would do LASIK on my untreated left eye and a flap-lift enhancement on my right eye. Rather than a microkeratome, this time he used the IntraLase (Abbott Medical Optics) to make the flap, and that was a bit of a shock because the suction and docking pressure put on my eye was nearly unbearable. He then ablated each eye with the Allegretto wavefront-optimized platform (Alcon). Within a few weeks I was doing great, with excellent near and distance vision.
It has now been 8 years since that surgery, and I could not be happier. I am turning 50 this year, and I only need readers for small print, while my distance vision remains excellent. My asthenopia has been held in check, even after long days in the office without any glasses. I am on my fourth generation of excimer and third generation of femto lasers, and I know how far we have come as a profession. I have also experienced this evolution as a patient, and the one constant for me is that LASIK works. It works thanks to the people who develop this incredible technology and the experienced and skillful surgeons, such as Dr. Chayet, who employ it.
- For more information:
- Scott Hyver, MD, can be reached at ScottHyver Visioncare, 2901 Tasman Drive, Suite 208, Santa Clara, CA 95054.
Disclosure: Hyver reports no relevant financial disclosures.