By Henrylito D. Tacio
Since he was 10 years old, David Ho has eyesight problems. For instance, he had trouble seeing his alarm clock clearly when he got up from bed. He could not play games like water polo, which loves doing. To correct his vision, he used glasses and sometimes contact lenses. Both were inconvenient.
“My glasses were leaving an imprint on my nose and I had to spend money to buy new pairs every other year or when they break,” says the Singaporean computer programmer, now 49 years old.
Dr Bernard Cheong can relate. After four decades of poor vision and dependence on glasses, the 46-year-old general practitioner was looking for help. “The worse thing is not being able to see while in bed, in the bedroom, in the bathroom, and in the swimming pool. No one really wears contacts or glasses in these places.”
A few years ago, David and Bernard would have been out of luck. Eye surgery, at least as it existed then, could not address their problems.
But thanks to new technologies and new therapies, surgeons can now treat many kinds of eyesight problems, including myopia, a condition of nearsightedness. Both walked into the Clearvision Eye Clinic in Singapore, and walked out with smiles on their faces and glasses in their pockets.
Laser eye surgery, a high-tech, relatively painless way to correct eyesight problem, is now in Asia. Bernard got the procedure known as Lasik. Dr Tony Ho, his attending surgeon and director of the clinic, used a laser to change the shape of his corneas, correcting one eye so she could see faraway objects clearly and tuning the other for up-close objects. “I am the luckiest guy around,” Bernard says now. “I see perfectly as I go to bed, and on waking up, I can enjoy the view of the hilltop from my bed as I look out through the window lying down.”
David, however, needed a different solution since he also suffered from astigmatism, an abnormal condition of the eye in which the curve of the cornea is unequal. His brother performed another form of laser surgery, called wavefront, because it posed less risk and give the patient better vision. David still can’t believe how well things went. “My dream has come true,” he says. “I no longer need eye glasses.”
Dr Ho observes: “Ten years ago, these things would have been impossible. In fact, I would have turned them down outright.”
Eyesight problems differ and solutions also vary. Among those that can now be performed are the PRK (Photorefractive Keratectomy), Lasek, CK (Conductive Keratoplasty), and Intraocular lenses. Today, doctors are treating patients who would have been routinely rejected before, and patients are experiencing fewer side effects. “Thanks to modern science, we now have the solution to most eyesight problems,” says Dr Gerard Chuah, consultant ophthalmologist at the Mt. Elizabeth Medical Centre and author of several books, including A Patient’s Guide to Myopia and Myopia Treatment. “Name it and we may have the technology for it.”
Even for people wearing reading glasses, a solution is at hand. With the technique known as monovision, surgeons have been able to address presbyopia, a stiffening of the eye lens that makes focusing close up—when reading newspapers, books, or your computer screen, for example—nearly impossible. So surgeons correct one eye for reading, the other for distance. Since monovision won’t work for everyone, researchers are still scrambling for a better fix for this common problem.
Despite this, Asians are seeing the light in droves. At the Asian Eye Institute in Makati City, for instance, about 1,000 people take the plunge every year. “On the average, there is an increase of 20 percent per year in the number of Lasik being done at the institute,” reports Dr Maria Imelda Yap-Veloso, an ophthalmologist professor and a full-time consultant at the institute.
Most eye procedures are about as safe and effective as surgery can get. Overall, more than nine in ten people without severe vision problems wind up with 20/40 vision or better—good enough to drive a car without glasses. (The results are even better with the new wavefront lasers.) That’s nearly perfect eyesight cost US$750 an eye in Taiwan (although in some Asian countries may be lesser or higher than this). And less than 1 percent of all patients experience a serious surgical complication.
However, for an industry that promises clarity, many centers have kept their patients in the dark about the risks and realities. Governments are no help either as there are no laws on buying medical instruments and equipments. But the good thing is: most hospitals – government or private – insist that some form of medical accreditation must be done before allowing any doctor to perform eye surgery.
Despite the stellar record of the surgery, stories about eye operations that go awry abound. As some patients in industrialized countries have discovered, the technique may not be as effective and safe as originally thought. The consumer advocate website surgicaleyes.com posts a sobering archive of unhappy endings—a litany of botched flaps, infected corneas, triple vision, daily nausea and permanently marred eyesight. The message boards are full of people who came out of Lasik with 20/20 or 20/40 vision but are still in misery, handicapped by poor night vision, stinging dry eyes and worse.
That’s why it’s vital to research the subject if you’re considering surgery. Here’s a step-by-step guide to help you see things clearly.
Know What You’re Getting Into
If you believe all the ads, after eye surgery, you’ll be able to read the bottom line of an eye chart through a brick wall. If only it were true. “Of course, people who have eye problems want to have a perfect vision,” says Dr Fung-Rong Hu, a professor of ophthalmology at the National Taiwan University Hospital, “but not everyone can have that. I advice that patients should study carefully first the pros and cons before undergoing any surgery.”
• You may not wind up with 20/20 vision. The research on Lasik indicates that more than 80 percent of patients with mild or moderate nearsightedness wind up with 20/20, while 95 percent get 20/40 or better. And experts estimate that more than 98 percent of people who qualify for wavefront get 20/20. Not surprisingly, the numbers are lower for people with more serious myopia, farsightedness or an astigmatism. Your doctor should be able to tell you what he’s likely to achieve given your vision problem.
• You might be a poor candidate. Eye surgery still isn’t for people with certain severe vision problems, a prescription that’s changed in the last year, or an eye disease. The same goes for folks under 18 and pregnant women, whose eyes may be undergoing changes. So don’t be shocked if an ophthalmologist gazes into your eyes and then shows you the door. “I turn down about 3-5 patients a month,” says Dr Ronald Yeoh, a senior consultant at Gleneagles Hospital in Singapore. “I found that some of my patients have corneas not thick enough for laser surgery. In some instances, I discover glaucoma, cataract or retinal problems.”
• Be prepared for side effects. Even if your surgery goes without a hitch, you may feel like your eyes need help. Many people complain of dry eyes and require eye drops known as artificial tears for months or more. Fortunately, the symptoms usually go away in time. Other patients see halos and star bursts while they drive at night. Again, these symptoms tend to be minor and fade away, but some people have serious lingering problems. These days, better knowledge can ensure that patients will get the right surgery, reducing the risk of complications.
Find a Doctor
Ask friends or family members for referrals. If no one you know has had surgery, ask around to see who’s the best in your city. Of course, you can always ask your optometrist or an ophthalmologist for a referral.
You can also look for a surgeon on the Internet. In the Philippines, for instance, the Eye Center (eyecenter.com.ph) has a list on their site that can help you find member specialists in your area.
Whatever you do, don’t make a decision based on a rock-bottom price. Sure, the procedure can be painfully expensive, and your health insurance is unlikely to help. “While I agree that patients should consider the cost of the surgery, they should not think of it as discount surgery,” says Dr Manolette Roque, consultant ophthalmologist of the Asian Hospital and Medical Center in Manila. “After all, we have only one set of eyes.”
“I understand that patients may also have a budget when it comes to medical expenses,” says Dr. Yap-Veloso. “But the low price should not be the basis for undergoing a surgery. After all, we have only one set of eyes.”
Ask the Right Questions
The process isn’t over once you’ve picked a surgeon. After all, this man or woman is going to slice your cornea and laser your eyeball. You need to grill this person, and you need to feel very comfortable and confident with the answers. If you’re not, get a second opinion. Make sure you ask your surgeon these ten questions.
1. Who will be doing the procedure?
The surgeon who will be performing your Lasik should meet you, answer your questions, and examine your eyes before you set foot in an operating room. Yet at some centers, you don’t meet your surgeon until you’re flat-out under the laser. “That’s outrageous,” says Dr Yeoh of Singapore. “Easily available and open communication with the surgeon and his team are the hallmarks of a good practice.”
2. What are your credentials?
Your doctor should be board certified, which means he’s passed a series of exams on medical and ophthalmological subjects. In Singapore, a guidebook on the city’s private medical care lists surgeon who are certified to perform Lasik. “Of course, the doctor must have done eye surgeries under the supervision of a surgeon accredited in Lasik surgery or by the company which provided the equipment,” says Dr Liza Sharmini Ahmad Tajudin, lecturer of the ophthalmology department at the Universiti Sains Malaysia.
Even better: Your doctor is a fellowship-trained corneal or refractive surgeon, a specialist who received extra training in the conditions of the cornea. It may not matter if your case is straightforward, but you’ll be thankful if a complication arises.
3. How will I be tested before you operate?
Preoperative testing can identify people who are bad candidates for surgery, but it’s one of the areas where cheap centers may cut corners. Ideally, your doctor (or his staff) will conduct a detailed eye exam, including measuring your pupils in the dark, determining corneal thickness and mapping corneal topography.
4. How much experience do you have?
In the United States, more than 500 surgeries is ideal. A study done by the University of California at Los Angeles found that the rate of surgical complications for four doctors doing Lasik was 1.3 percent in their first 1,000 procedures—and 0.47 percent for their next 3,000 surgeries. That’s some learning curve.
5. What’s your complication rate?
The best doctors have a serious surgical complication rate below 1 percent. Be wary of surgeons who can’t answer this question or centers that won’t give you information about the doctor who will be operating on you.
6. What’ your enhancement rate?
Typically, good surgeons perform enhancements (the term surgeons use to describe touch-up procedures) in 5 to 15 percent of patients. Anything below 5 percent may suggest a center is discouraging fixes that would give a patient better vision; above 20 percent can indicate sloppy surgery.
7. Will my surgeon be available to treat me after surgery?
At some centers, the surgery may be performed by itinerant surgeons who fly into town one or two days a week and then split. If that’s the case, who’s going to take care of you if a problem emerges?
8. Have you ever been sued?
Even cream-of-the-crop surgeons get sued. But more than one malpractice suit per decade of practice can be a warning flag. “In refractive laser surgery, there are bound to be cases where the surgical result is not to the patient’s satisfaction,” explains Dr Chuah of Singapore. This is expected as there is no guarantee of 100% result.”
If you’re too embarrassed to ask about your surgeon, find the information from his former patients or from other sources like medical council or organizations. “Currently, we don’t hear any doctor being sued yet as laser eye surgery is still new in Asia,” says Dr Sharmini of Malaysia. “I think in years to come, we will encounter this problem for sure.”
9. What’s included in the price?
Watch out for centers that offer a low-ball price and then charge you for extras such as postoperative visits, enhancements or a high degree of vision correction. While this can be the hook these centers use to get you in the door, it doesn’t necessarily mean they are a bad deal or offer inferior care. You just don’t want any surprises.
10. What procedures do you do?
Many of the deep discounters do nothing but Lasik. As the saying goes: If all you have is a hammer, everything begins to look like a nail. But Lasik may not be right for you, and there are plenty of options these days. The best doctors turn away a significant number of patients who are bad candidates. In some centers, nearly everyone is a “perfect candidate.” Try to go to a center that offers more than one type of surgery and make sure all your questions are answered to your satisfaction. The moment you begin to feel pressured, it’s time to walk. — ###