Eyes Wide Open

Take a Look Then Leap into Laser Eye Surgery

An edited version of this article appeared in Liberty Magazine in June 2006 – though Liberty is no longer in circulation, this article is still available online here.  

I got my first pair of glasses when I was in the second grade, and I loved them. The only bespectacled kid in my class, I was wholly unique until Becky Harris trumped me two years later with orthodontics and a full arm cast. By the time I reached high school, however, my love affair with my glasses was well and truly over, so much so that I saved all my babysitting money to buy contact lenses. Though my contacts improved my appearance by leaps and bounds, I was destined to spend another twenty years chained to those gossamer lenses, expensive solution, leaky cases, annual check ups and a perpetual pain in my keister.

Sick of devoting so much time to seeing clearly without my hideous, cumbersome glasses, I looked into getting permanent vision correction surgery when the procedure first became available several years ago, but two factors kept me from pursuing that option any further—finances and (more importantly) fear. What if the doctor made a mistake? What if I went blind? What if, as my mother so often prophesied, I finally put my eye out?

I still had questions that would need answers before I let anyone mess around with my sight. Here’s what I found out…

What is Laser Eye Surgery?

One fact I didn’t know is that corrective eye surgery has been around since the 1940s. Today there are several types of refractive surgery, but the surgeries currently available mainly evolved from one of two earlier procedures, radial keratotomy (RK) and photorefractive keratectomy (PRK).

According to the experts at Bausch and Lomb, radial keratotomy (RK) fixes nearsightedness by flattening your cornea (the cornea is the transparent front part of the eye) with a series of peripheral cuts radiating from the central cornea like the spokes of a wagon wheel. Your doctor uses a hand-held knife with a retractable diamond cutting tip to perform the operation. After marking off the central cornea with a circular ring, the doctor measures corneal thickness, adjusts the knife accordingly and makes the incisions from the edge of the optical zone out to the edge of the cornea, leaving the central optical zone untouched. RK, unfortunately, can only treat low degrees of myopia and astigmatism.

Unlike RK, photorefractive keratectomy (PRK) is a surgical procedure that uses an extremely precise laser to remove tissue from the surface of the cornea, basically scouring away unnecessary tissue. Because the outer layer of corneal cells need to be removed, and there are nerve fibres that run through it, PRK hurts a little at first—about like a badly scratched eye or a corneal abrasion. It can cause pain, irritation, watering of the eye, blurry vision or the sensation of having a particle in your eye. A bandage contact lens helps reduce the irritation and encourage healing. After getting PRK, your vision is blurry the first few days, but it generally improves once your cornea has healed and the bandage lens is removed. Your vision should be reasonably good by one week, really good by one month, and is often completely stabilized by six months.

The next generation of laser surgery is the LASIK procedure. LASIK, which evolved from PRK, is an acronym that stands for Laser Assisted in Situ Keratomileusis, in other words, creating a flap in your cornea with a microkeratome and using a laser to reshape the underlying cornea. LASIK provides the same visual-correction benefits, but it usually has fewer and less severe side effects than PRK. A step up from PRK, LASIK uses an excimer laser to reshape the cornea. Since LASIK does not disturb the sensitive top layer of the cornea, it hurts less and you recover faster.

An excimer laser is a precise computerized instrument that uses invisible ultra-violet light to modify the cornea. A cool light laser, it produces almost no damage to the surrounding tissue, making it a safer procedure. Each pulse of the laser removes just the tiniest amount of corneal tissue — about 1/500th of the thickness of a human hair. The newest type of excimer laser is the Zyoptix™ system.

What is Zyoptix?

If I was going to have this surgery, I wanted the best equipment possible. In 2003, the FDA approved the use of Bausch & Lomb’s Zyoptix™ — a new personalized laser vision correction system that allows your doctor to customize an eye surgery procedure exclusively for your cornea. Some people still need glasses/contacts after the surgery, but in a clinical study 91.5% of subjects achieved 20/20 or better vision after having the Zyoptix™ procedure. Prior to Zyoptix™, everyone with the same prescription had the same LASIK procedure done. A Zyoptix™ procedure, though, is specific to your eye; no one else can have the identical operation you will have.

Why? Your cornea is as unique as your fingerprint, with its own special shape and complex characteristics that make it unlike any other. The best treatment is one that is unique to you. To better understand your particular vision and any impairments you may have, the Zyoptix™ system maps thousands of data points, giving your doctor a fully detailed, three-dimensional picture of your cornea’s shape and characteristics. Small imperfections in the shape of the eye can cause a scattering of light in distinct ways, called aberrations, which can contribute to poor vision. The Zyoptix™ system allows your doctor to measure these aberrations and create a treatment that exactly matches your eye’s individual vision errors.

Who Should I Have Perform the Surgery?

No matter where you live, you want to do a bit of investigating when it comes to choosing a physician because let’s face it—not all medical degree programs are the same, and not all doctors are equally experienced. Whatever medical procedure you need done, you don’t want to end up with an inexperienced doctor who got his diploma from the University of Cracker Jack.

Afraid I might not find a competent doctor, I considered waiting to get my surgery until I got home this summer, but one reason I wanted to get my eyes fixed is to ease my travel stress getting home. This year, I’ll be traveling to the U.S. and back via my husband’s hometown of Melbourne (yes, Australia) by myself with my nine month old son in tow—I just don’t have enough hands to wrangle a baby on my own AND fuff around with glasses and contacts and solution. For this reason, I looked for a doctor I felt comfortable with here in the UAE.

I found him at the Atlanta Vision Clinic in Dubai. Dr. Farooq Ashraf is a board-certified ophthalmologist who specializes in cornea and refractive surgery, including laser vision correction. He has personally performed over 30,000 LASIK procedures, he is one of the most experienced surgeons in the U.S. using the Bausch and Lomb Technolas excimer laser, he has extensive experience with the excimer laser even prior to the FDA approval while on faculty at Johns Hopkins University, and he has an impressive academic background. In fact, his extensive research has resulted in the publication of numerous articles in scientific journals and major textbooks on LASIK. As a fellowship trained corneal specialist, Dr Ashraf also has extensive experience in corneal transplantation, cataract surgery and anterior segment microsurgery.

Talk about credentials! Dr Ashraf’s qualifications and experience alone squelched all my concerns, but I was also pleased to learn that Dr Ashraf still practices in the States, where they’ll sue you for serving them hot coffee. In addition to his location in Dubai, Dr. Ashraf owns and operates two clinics in Atlanta, Georgia—he commutes to Dubai for a week every month to perform procedures here. If you want to know more about Dr. Ashraf, check out his entire CV at www.atlantavision2020.com.

Monday, April 24, 2006—My Consultation

I thought I probably was a candidate for laser eye surgery, but I wouldn’t know for sure until I had a qualified professional check me out. Even if you think you may not be a candidate or a doctor in the past has discouraged you from having laser eye surgery, it’s worth checking again if you’re interested. The Zyoptix™ system is more specific than any previous laser, making the procedure an option for more people than ever before.

Right across the road from the Jumeirah Beach Hotel, the Atlanta Vision Clinic is easy to find. Despite the A-List address, the cost for the procedure is not unreasonable—8,000 AED for regular LASIK and 12,000 AED for Zyoptix™. These figures include vision correction in both eyes plus a year’s worth of follow up consultations. The price is comparable to what I would pay in the States, and the bottom is this: these are my eyes. I’m not looking for a doctor in the bargain basement. The cost of the surgery is not as much as it may initially seem, considering I spend at least 300 AED a year on check ups and contact lenses, plus another 60 AED every few months on solution. And the convenience of living without glasses or contacts is priceless.

The cost of the surgery does not include the price of this initial consultation, Dhs 300, but Dr. Ashraf’s associates have to determine if I’m a candidate at all. Despite expressing initial concern that I arrived wearing my contact lenses (no one told me I wasn’t supposed to wear them for 24 hours prior to the examination), optometrist Lina Juha and her assistant Manar Dawoud were still able to complete the assessment. I spent an hour undergoing every eye test known to man.

At the end of it all, Dr. Juha told me that I was a candidate, but thanks to my combination myopia/astigmatism and crappy night vision, I could only have the Zyoptix™. As I suspected, I was really blind (-6.25 in one eye and -7.00 in the other—subterranean grubs could see better than I could). After getting the green light from my long suffering husband to spend the extra 4,000 AED, I made an appointment for the following week.

Sunday, April 30, 2006—Surgery Day

6:15 am: I woke to what I hoped was my last blurry morning. I reached for my evil glasses as the doctor had forbidden me to wear my contact lenses for the last six days in order to give my eyes a rest before my surgery.

7:30 am – 2:30 pm: I spent the day on tenterhooks. My colleagues kept coming by to wish me well, their tones suggesting I was off to my execution. They all harboured the unspoken fear that I would probably come to work the next day stone blind. Half of Abu Dhabi, in fact, was waiting with bated breath to see how my surgery turned out. If my procedure went well, I might create a stampede of followers.

3:00 pm: My husband arrived to pick me up from work and drive me to Dubai because, even if the surgery went off without a hitch, I wouldn’t be able to drive myself home.

4:30 pm – 5:30 pm: I sat watching patient after patient leave the clinic happy. I couldn’t sit still, wandering around the posh villa-turned-clinic, chatting with the sweet  receptionist Ms Rima Muhsen (who always calls me “dear”), taking one long last look at my baby’s face (just in case I left blind). Clinic Manager Leila Jundi stayed with me and reassured me as I waited.

5:30 pm: I finally met Dr Ashraf. A native of California, he’s very mellow and easy going, instantly putting me at ease. I covered my hair and feet with big blue hairnets and it was time.

5:35 pm: Lying on the table, I stared at the ceiling while the nurse dripped numbing drops in my eyes. Though I couldn’t feel any pain, I did get a decidedly funky sensation watching Dr Ashraf insert the eye lid spreader then cut the corneal flap and lift it away. I also got a tad queasy when I smelled burning flesh, but I wasn’t surprised as Dr Ashraf had prepared me for everything beforehand.

5:44 pm: I walked out of the operating room with fuzzy vision but still able to see better than I could when I walked in without my glasses.

6:00 pm – 8:00 pm: Though I could read billboards unassisted for the first time in years, as the doctor warned, the ride home wasn’t pleasant. While the procedure itself didn’t hurt at all, the burning and itching that came on after the numbing drops wore off were certainly uncomfortable. My eyes, extremely sensitive to even the light of the street signs, clamped themselves shut, and I had to wear my sunglasses to walk from my car to the building. As soon as I got home, I went to bed immediately.

9:30 pm: I woke up briefly to find my eyes didn’t hurt, burn, or itch at all, and while my world was still very fuzzy, I could see an improvement already. What a relief! I was able to rest easy for the remainder of the night.

The Day After

When I woke this morning, the first thing I saw was the book lying on my bedside table, and I was actually able to read the title. I’ve never had this experience before because the last time I was able to see that clearly upon waking, I was too young to read. As it turns out, all my fears were for naught—I can see my son, my husband, my way to the bathroom, the neighborhood out my window. My vision is still a little blurry around the edges, but I was able to drive myself to work this morning. Dr. Ashraf predicts that my vision will continue to improve, vastly in the next day or two and in more subtle ways over the next few weeks.

At my first follow up visit, I learned that each eye now has 20/20 vision, and when I use both eyes at the same time, I have 20/15 (which is even better than 20/20—now I can read the smallest line on the eye chart). I’ll have another check up in a week and again in a month. Between now and then I have to use antibiotic drops for a week, I can’t wear eye make-up for two weeks and I have to stay out of water for a month.

Already I have friends who are making plans to follow in my footsteps, and I heartily cheer them on. Dr. Ashraf warns that in my mid forties I may require reading glasses, but if I do, the cause will be age rather than this surgery, the effects of which should continue to last for at least several years, if not the rest of my life. At any rate, I’m looking forward to my summer travels (this year and every other) with a lot less trepidation thanks to my new eyes. I’m wondering how long it will be before I stop humming to myself, “I can see clearly now…”