An early adopter looks at her eyes

This chart simulates what patients might see if their Lasik eye surgery goes awry.

Courtesy of Surgical Eyes

This chart simulates what patients might see if their Lasik eye surgery goes awry.

Burning. Stinging. Scratchiness.

For the past few years, I've known I was among the many Americans with painful dry eyes. But it wasn't until all the publicity about a recent federal hearing that I realized the dryness might stem from something other than age or heredity:

Lasik eye surgery.

Late last month, patients who had Lasik to improve their vision told a Food and Drug Administration panel about a litany of side effects including glare, halos, dry eyes and pain excruciating enough to drive one young man to suicide. The panel also heard that just 5 percent of patients are dissatisfied with their Lasik outcome. But considering that 7.6-million Americans have had the surgery, that's nearly 40,000 people whose quest for better vision has cost them more than just money.

I'm not unhappy enough to be among those multitudes. But my experience with Lasik is a cautionary tale.

So nearsighted I couldn't even see the big letters on eye charts, I got glasses at age 3 and contact lenses at 13. The contacts were never very comfortable, and they really irritated my eyes during the long hours I spent in the dry air of passenger jets flying overseas as a foreign correspondent.

So I was thrilled to hear about a new procedure, Lasik, in which a laser is used to reshape the cornea for sharper sight. In 1999, just a year after it was approved by the FDA, I paid $4,500 for laser surgery on both eyes.

"All in all, Lasik does seem miraculous,'' I wrote in a story recounting the speedy outpatient surgery. The story didn't mention any specific warnings because apparently I wasn't given any.

In less than two months, the miracle turned out to be something less. It was hard to drive at night because every light had a brilliant halo. And the vision in my left eye began to slip, meaning anything more than few feet away looked fuzzy or blurry.

I returned for an "enhancement'' of the left eye, in which the cornea was reshaped again. That restored perfect vision for a time. But within a year, my sight declined to the point I've had to wear glasses for driving ever since.

Dry and crying

A few years ago, I noticed that my eyes — especially the left one — seemed to burn and water a lot. I saw a series of doctors, all of whom diagnosed dry eyes. (Paradoxically, one symptom of dry eyes is excessive tearing — any irritation can cause the eyes to water, though these "reflex'' tears are not the valuable kind that lubricate the cornea.)

One doctor recommended artificial tears. Another prescribed Restasis, which increases tear production (and costs nearly $200 a month, with insurance). Still another warned against sleeping under a ceiling fan since the constant swish of air can evaporate moisture on the corneal surface. When I asked if my dry eyes might have anything do with Lasik, I got vague answers at best.

Then came the recent FDA hearing, and the revelation that dry eyes are among the most common side effects.

Why does Lasik sometimes dry out the eyes?

The surgery involves cutting corneal nerves, which can affect tear function. The nerves usually regenerate fast, meaning the dry eye problem quickly disappears in most patients — but not all. By flattening the cornea, Lasik also changes the way tears flow across the corneal surface and may create dry patches that can become irritated.

Moreover, some former contact lens wearers like me were probably prone to dry eyes even before surgery.

Could get worse

"It's a bit of a Catch-22,'' says Dr. Richard Abbott, a professor of ophthalmology at the University of California-San Francisco who has done Lasik surgery. "Many patients are having difficulty with contact lenses — it feels like they have cinders in the eye — and they don't want to wear glasses, so they seek vision correction surgery. But for some, the dry eyes and irritation remain or get worse.''

Likewise, many contact lens wearers see halos at night and learn to live with it. But after Lasik, "the expectation is that you are going to have perfect vision,'' Abbott says. "And then there are people who genuinely develop glare and halos they didn't have before surgery, and that has to do with wound healing and the way the cornea is ablated.''

Abbott's own daughter had Lasik and is 100 percent happy with it. His wife, while generally satisfied, is bothered enough with dry eyes that she uses artificial tears and wears wraparound sunglasses to reduce evaporation. Moreover, as women hit middle age and their hormone levels change, dry eyes become fairly common.

"That's why my wife has a problem and my daughter doesn't,'' Abbott says.

Not for everybody

Improved technology has reduced the amount of cutting on the cornea and made it easier to predict who will have postoperative problems. Despite the annoyance of using artificial tears several times a day, I'm still glad I had the surgery; I can read without glasses and can get around okay except for driving. But for anyone considering Lasik, here's little story Abbott told me about an interview he did with People magazine.

The photographer wanted Abbott to take off his glasses, perhaps because he didn't think it looked right for a Lasik surgeon to be wearing specs.

"I said no, because this operation isn't for everybody,'' recalls Abbott, who sees perfectly with his glasses. "You should only have vision correction surgery if your glasses are really bothering you or if you can't wear contacts. Whatever surgery you do is risky and if you don't need it, don't have it.''

Susan Taylor Martin can be contacted at susan@sptimes.com.

An early adopter looks at her eyes 05/10/08 [Last modified: Sunday, May 11, 2008 8:34pm]

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