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Twenty years after LASIK and still seeing great
John F. Doane, MD, FACS, explains how his early research in refractive surgery convinced him to undergo LASIK in 1996.
John Doane is a pioneer in refractive surgery who got into the field in its early days in the U.S., having done residency research with Dan Durrie and a fellowship with Steve Slade. He evaluated some of the early FDA LASIK data, and this set him on a career path to refractive surgery.
After observing Luis Ruiz perform in Colombia and becoming contact lens intolerant (for many, the last straw before having refractive surgery), he assisted Steve Slade, who no doubt needed his help, on his LASIK in 1996. John made the astute decision to not have monovision at age 31. It should be noted that very few patients will benefit from monovision if they are not yet presbyopic. He has no regrets to this day at age 51 — still with no reading glasses and 20/12.5 distance vision.
Richard A. Norden, MD OSN Refractive Surgery Stories Editor
In July 1991, I started residency at Kansas University Medical Center. At the time it was a 4-year residency with a 4-month block of dedicated research. In many cases the research went way beyond this based upon interest. I enjoyed research so it was certainly a plus for me.
During my first year of residency I read an article in Ocular Surgery News entitled “Flap and Zap,” which reviewed Stephen G. Slade, MD’s, experiences with early excimer laser lamellar refractive surgery. At that time, the term “LASIK” was not in widespread parlance. What became intimately obvious was that this new technique could outperform radial keratotomy and certainly seemed like a more patient-friendly form of excimer laser surgery compared with photorefractive keratectomy.
So, during my first 4-month stint of research, I had the good fortune of Tim Cavanaugh, MD, and Dan Durrie, MD, then working at Hunkeler Eye Center in Kansas City, allowing me to analyze their Summit FDA PRK clinical data. I specifically evaluated decentration of PRK surgeries in their cohort of 5-mm ablations to determine at what level the decentrations bothered patients subjectively. It turned out that decentrations less than 0.89 mm from the pupil center did not adversely affect the patients. I was able to present two papers at the American Society of Cataract and Refractive Surgery meeting as a second-year resident and was the first author on a paper published in Ophthalmology.
From that point, refractive surgery became my career path. Still, I had not had refractive surgery — yet. Things came full circle when Steve Slade accepted me as his fellow. At the time, Dr. Slade, his current fellow, Stephen A. Updegraff, MD, and my fellowship’s co-director, Luis A. Ruiz, MD, of Bogota, Colombia, were conducting an international LASIK study for compound myopic astigmatism in association with Chiron Vision and Technolas GmbH. Steve Updegraff and Steve Slade invited me to go to Bogota to evaluate patients and complete the data collection of the study that Dr. Updegraff had initiated.
Image: Doane JF
The prior article I had read from Dr. Slade was career-changing, as I had thought I would go into orthopedics or cardiovascular surgery prior to ophthalmology. Once in ophthalmology, I did not quite know what I would do. After I read Dr. Slade’s article it was one thing, but then to see Dr. Ruiz’s center with excimer lasers fully available for treatment in a clinical setting (March 1995 — excimers had yet to be approved even for PRK in the U.S.), my mind was completely opened up to what vision correction surgery in the excimer laser era could be. Suffice it to say, it was breathtaking to see patient after patient treated bilaterally — walking in with poor vision and walking out seeing and the next day being totally elated.
At this point, I knew I would have LASIK. The only question was where and when. Interestingly, Dr. Updegraff diagnosed me with giant papillary conjunctivitis en route to Bogota at 30,000 feet. My contacts were rolling upward on my eyeballs with each blink due to the GPC and dryness of the cabin environment. My contact lens days were numbered. My correction was –3.5 D sphere with 0.75 D of astigmatism. I eventually had LASIK by Dr. Slade in Houston.
I did several things in advance. I refracted myself (another mentor, Richard N. Baker, OD, made sure I had the refraction ideal), I set up the microkeratome, I calibrated the laser and input my refraction, and Dr. Slade performed my surgery. I had several questions coming into the surgery in April 1996 when I was 31 years of age but within months of turning 32. Should I do monovision? I decided against this approach. My main reason for having surgery was I had become contact lens intolerant, and I hated glasses. I had pain behind my ears and across the bridge of the nose toward the end of the day with spectacles. Additionally, running in Kansas City in the winter or Houston from March to October in the morning with humidity fogging the glasses literally blinded me. I also played (and still do) full-court basketball and enjoyed tennis and swimming, and glasses were an extreme pain or not an option.
I elected to have both eyes treated for distance with hopes I could be spectacle-free until age 40 and maybe even 42. I am approaching age 52, and I still have better than 20/12.5 unaided distance vision in each eye and do not wear readers. The only time I use visual aids started approximately 3 years ago with fly fishing when I tie on literally the smallest flies (#22 or smaller) with 7X and 8X tippet, which is a visual function much smaller than J1+. Certainly, my day is coming for full-time reading help, although I am way past the time I thought.
So for me, 20 years postop with no routine glasses (yet), no nighttime symptoms and no dry eye complaints, I have benefited immensely from surgery. I could have probably done it 6 years earlier at age 25 (granted, it was not available then), but it would not have been wise to be any sooner. I obtained my first pair of glasses at age 19 — –1 D and migrated to –3.5 D with some cylinder by age 25. I was a late-onset myopic patient. So for me, LASIK affected all aspects of my life positively, my personal athletic interests have been massively improved, it has formed the backbone of my medical career, and it has allowed for me to travel the globe meeting, sharing and learning concepts about refractive surgery with wonderful colleagues. With zero regrets and much appreciation, I am most thankful to my mentor and surgeon Steve Slade for making the last 20 years a delight to see.
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- John F. Doane, MD, FACS, can be reached at Discover Vision Centers, 4741 S. Cochise Drive, Independence, MO 64055; email: jdoane@discovervision.com.
Disclosure: Doane reports no relevant financial disclosures.