Article Date: 2/1/2004

Following My Own Well-Intentioned Advice
An optometrist who finally dropped his resistance and underwent custom ablation offers first-hand insights.
By Kevin Sehon, O.D., Slidell, La.

I comanage LASIK surgery for my patients every day. I've spent many hours explaining to patients how LASIK under appropriate circumstances is an excellent vision-enhancement option. The literature has reflected good results for LASIK as the technology has advanced, and I've had hundreds of patients over the years who were thrilled with the surgery.

But I continued to wear contact lenses. My vision was hyperopic with +3.50D in one eye and +2.75D in the other. I couldn't see near or far, and for years I corrected this with different combinations of contact lenses. The most satisfactory modality was monovision, with my nondominant left eye corrected for near, which worked for most activities, such as hunting, fishing and golfing. When I reached my early fifties, I switched to progressive eyeglasses.

Although I wasn't happy wearing eyeglasses, I was concerned that LASIK studies didn't support the procedure for hyperopes. That would soon change as two key studies reported excellent results for hyperopia. My resistance vanished and I underwent the procedure.

Basing my decision on data

LASIK unquestionably is an excellent option for myopic patients. Yet, I wanted more data about LASIK for hyperopia. Because past results for hyperopic patients were not so clear-cut, I watched the literature for better results. As researchers published more promising data, I began to feel more comfortable with LASIK for hyperopia.

One of these studies was a multicenter clinical trial in the United States and Canada using the LADARVision System. In their results, 96% of myopes had uncorrected vision of 20/25 or better, 82% had 20/20 or better, 61% had 20/16 or better, and 25% had 20/12.5 or better. Also, 88% of hyperopes had 20/25 vision or better, 63% had 20/20 or better and 25% had 20/16 or better.

Another study compared traditional LASIK surgery with Alcon's LADARVision 4000 Excimer Laser and LADARWave Custom Cornea wavefront device. Patients had traditional LASIK in one eye and custom ablation in the other. Of the three hyperopic patients in this study, two of the three custom eyes had UCVA of 20/16 1 month after surgery; and one eye had UCVA of 20/12.5. There was no BCVA loss, and one eye gained one line of BCVA.

Results were slightly less positive in the eyes that received traditional LASIK. Two eyes had 20/16 UCVA and the third had 20/32. BCVA results were the same as those of the custom eyes. In the custom eyes, the spherical equivalent after surgery ranged from +1.00D to -0.12 D, compared with -1.00D to plano in eyes with traditional LASIK.

These results and others showed comparable custom LASIK results for myopes and hyperopes. Confident that the results would be good, I decided to get the procedure.

Undergoing the procedure

When I made the decision to have the LASIK procedure, I elected to have the correction in both eyes for distance. I underwent the procedure at Brint Laser Vision Center in Metairie, La. Two colleagues I've known for years, Stephen F. Brint, M.D., (himself a LASIK patient) and D. Michael Ostrick, O.D., handled the surgery and the preoperative and follow-up visits.

They are participating in the phase III clinical trials for the LADARVision System. My procedure was part of the trial, so I had custom ablation on one eye and traditional LASIK on the other. I wasn't told which eye was which.

Because I was so familiar with the procedure and my doctors, I went into it with no anxiety. It was comfortable, and I felt no pain during or after the surgery.

My results

The recovery was easy -- I was playing golf the next day. My visual acuity after the procedure is better than 20/20 in both eyes. A -0.75D overcorrection of my nondominant left eye was a pleasant unexpected outcome. This gives me modified monovision, which is acceptable for most of my activities. I can read and see distances well -- from my morning newspaper to the far side of the lake outside my kitchen window.

From the beginning, I preferred the results in one eye, and I later learned that the preferred eye is the one that had custom ablation. Both eyes are satisfactory, but the custom eye has a noticeable advantage. I've had no side effects -- such as halos or dry eye -- in either eye.

Putting experience into practice

Even before I had this procedure, I confidently recommended LASIK when it was appropriate. In fact, most of my patients who want LASIK have already made up their minds when they come in my door.

Today, I'm more confident recommending LASIK for patients with hyperopic astigmatism. And I think my patients are more confident in the procedure when they know I've had it. The most common questions patients ask are about recovery time and pain associated with the procedure.

It's easy for me to talk about my experience with the procedure, my recovery and how much I appreciate no longer wearing contact lenses or eyeglasses. I tell patients it's the best $3,000 they'll ever spend. I think my own experience makes my patients feel better about having the procedure. Not only do they hear me talk confidently about custom LASIK. They also know that I stand by the recommendation with my own vision correction choice.

Dr. Sehon practices at Slidell Eye Clinic in Slidell, La.


Optometric Management, Issue: February 2004