The Eyes Have It For Laser Eye Surgery

3 Nov 2010

Each year more than 100,000 people in the UK have Laser Eye Surgery, yet there are still fears about the dangers, pain and possible outcome of the procedure. Hannah Stephenson describes her experience.

These days, many of us probably know someone who’s had Laser Eye Surgery and enthused about the resulting freedom from the restrictions of glasses and contact lenses.

Thousands of people a year are having the treatment for a variety of reasons. While the old saying, “men don’t make passes at girls who wear glasses” may no longer ring true, many do discard their specs simply because of vanity, others want rid of them for practical reasons, and there are sports enthusiasts longing to be free from the worry, risks and restrictions of wearing lenses or frames.

“Over the last 12 years, eye tracking and the measuring tools for the eye have become more accurate, and screening has improved tremendously in the industry as a whole,” said ophthalmic surgeon Professor Dan Reinstein, founder of the London Vision Clinic, Harley Street, whose patients include TV presenter Phillip Schofield and singer Bonnie Tyler.

Nothing can be done to prevent the natural decline of close vision due to ageing, but it’s now possible to have both distance and near vision corrected at the same time, the effects of the surgery are longer lasting than in the past. And, as techniques develop, the risk of eyesight corrections compromising night vision, a potential nuisance for drivers, is being minimized.

“In the last five years the safety of Laser Eye Surgery, if it is undertaken by the best specialists using the best equipment and providing the best aftercare, can give a result which marches and maybe even surpasses the safety of wearing contact lenses,” said Prof Reinstein, who has over the last 12 years performed more than 18,000 laser procedures.

“The risk of significant vision loss often quoted for contact lens users has been measured at four in 10,000, while the risk in modern Laser Eye Surgery is less than one in four million.”

Contact lenses, as he points out, are effective but not without problems for some users who can suffer from excess tearing, itching, burning, sensitivity to light, dryness and long-term damage to the ocular surface. Also, it’s essential to be conscientious about cleaning lenses, otherwise there’s a risk of developing a sight-threatening eye infection. And clinical studies suggest that the extended use of contact lenses, particularly overnight, seriously increases the risk of developing corneal ulcers, which can scar the cornea or even cause blindness.

By comparison, Prof Reinstein estimates that the likelihood of a minor problem arising as a result of laser surgery is only in around one in 1,000 procedures, while the chance of an expert surgeon facing a situation he or she would not be able to improve, or correct satisfactorily, is around one in 30,000.

And he pointed out: “The effects of the surgery are permanent, and now it is possible to (surgically) adjust for any changes to age.”

Those statistics gave me the confidence to undergo the surgery.I’ve been dependent on glasses or contact lenses for distance for 30 years and as I’ve reached my mid-40s have even had to wear reading glasses as well as contact lenses for close work.I’ve also experimented with varifocals. It reached the stage where my bedside table resembled an optician’s display case.

And, as a keen swimmer and waterskier, I’ve become increasingly frustrated with having the choice of either losing my contact lenses if I wore them in the water, or not being able to see anything without them. At the initial appointment at the London Vision Clinic, I underwent a battery of tests over three hours. My cornea shape and tear production were assessed and I had a detailed talk with an optometrist about the result I wanted after surgery, and what would be a realistic expectation. He also answered my questions about the potential for complications.

One of my fears was that moving or blinking during surgery could ruin the outcome, typical of the common misconceptions about the procedure, confirmed Prof Reinstein.

He said other myths are that laser surgery cannot correct astigmatism, there’s an upper age limit on treatment, and that if the treatment does go wrong it cannot then be corrected.

I opted for PRESBYOND® Laser Blended Vision, a different ways. The vision in the dominant eye is treated so it’s effective mostly at distance, with only a small facility for close focus, while the opposite action is taken in the other eye, which is predominantly effective for close focus vision, with a smaller facility for distance. In most cases, the brain compensates for these changes quickly, combining the two images to give a greater depth of vision.

Also Prof Reinstein pointed out: “Unlike synthetic lenses that go inside the eye, PRESBYOND® Laser Blended Vision does not produce night vision disturbances because it’s based on boosting the natural depth of focus.”

Around 95 percent of refractive laser surgery carried out today is LASIK, (Laser in-situ keratomileusis), in which an instrument is used to create a corneal flap”, which is peeled back. This allows a laser to change the shape of the exposed central cornea. The flap is then replaced, but stitches aren’t needed as natural forces hold the flap in place within minutes.

It sounds unpleasant, but in reality it was completely painless as drops of local anaesthetic are used, pre0op, in each eye. One eye is lasered at a time. An eyelid clip is placed between the upper and lower eyelids which gently keeps them apart and makes it impossible to keep closed with sterile strips.

It was over in minutes. And there was a “wow” factor – when I sat up after the surgery I was amazed for the first time in 30 years to be able to see, without glasses, a distant wall clock and the time it displayed. For some people normal vision may take a few hours to return. That afternoon my eyes were, at worst, a little uncomfortable, but the next morning I could see reasonably well, and driving within 24 hours.

Over the last 10 days, there has been some blurring as each eye adjusts to its new capabilities, but that’s improving daily and I’ll have a check-up in a month. The cost of the treatment was an eye-watering £4,900, but I’m delighted and feel not only do I look far more attractive without glasses and lenses, but love not having to think about the care of lenses and no longer have the annoyance of wasted hours looking for my “lost “specs!

How To Choose When Considering Treatment

Professor Dan Reinstein said: “The only way of choosing is by results. Results all over the country have improved in the last 10 years.

“Go to a surgeon who is regularly performing laser correction and can provide his individual evidence of patient outcomes, as opposed to the company’s results or his hospital’s results in general. You’re going to be treated by a specific doctor, not a company.”

And he stressed: “If you’re over 40, go to a surgeon who can treat both distance and near (sight), otherwise as you age you are likely to need reading glasses at a later date.”

He also said that a surgeon should have a minimum of three years experience and have performed at least 500 similar procedures previously, and that he/she should be part of a clinic or practice that specialises in Laser Eye Surgery an does not merely perform it as a side-line. The Royal College of Ophthalmologists doesn’t control professional standards in the laser refractive industry, but two years ago it launched an Assessment of Competence for surgeons in this sector. Currently of how competent a laser refractive eye surgeon is.

The RCO suggests that patients should ask the following questions before deciding on a surgeon:

  • Does the surgeon hold the Certificate of Competence in Royal-College of Ophthalmologists?
  • What are the risks of surgery?
  • How many laser refractive procedures has many carried out in the past two years?
  • Will a surgeon assess my suitability to have the operation?

Professor David S Gartry, Fellow of the Royal College of Ophthalmologists, consultant surgeon and refractive service director at Moorfields Eye Hospital in London, also pointed out that there is an alternative procedure.

He said: “There is an alternative – more invasive – procedure known as intraocular surgery, which may correct al visual defects. In this procedure, a surgeon uses micro-surgery to replace the natural lens of the eye and implant a new lens.

“If required, the lens can be replaced again at a later date. This means that a person’s vision will not be affected by age-related hardening of the lens or ‘presbypia,’ and can also mean avoiding age-related cataracts. As this is a more invasive procedure and can also lead to glare and haloes when driving at night, I typically reserve this type of surgery for older patients with high prescriptions beyond the successful laser range.”