St Thomas’ Hospital

I´m 45 and have always lived with -8.00 in both eyes. Over the past few years my eyes have become lass and less happy with prolonged use of contact lenses (soft, daily replacements) especially as I live in Madrid where absolutely everybody smokes the most repulsive cigarettes you could possibly imagine, the fumes not only sticking to your clothes but also, seemingly, coating your contact lenses.

I am very physically active (any Hashers out there) and I have finally decided to take the plunge. I am a very cautious person by nature and I spent a few weeks trawling various web sites and I came across Ariana´s pages which I have to say are excellent from the point of view of setting one off in particular directions of research. In the end I came to the following conclusions.

Firstly, I would not have the op done in Spain. My Spanish is good but I didn´t want a single word of misunderstanding between myself and the surgeon. I would therefore go back to England for the procedure. Secondly, and particularly in the US web sites, I was beginning to see more and more clinics writing about the “new improved” PRK procedure known as LASEK – with an “e”. I must say that when I first saw LASEK in print (on this website actually) I thought it was a spelling mistake. But it´s not. I won´t get technical here but basically the LASEK procedure does not involve slicing the cornea – which is good because it is exactly this part of the procedure that introduces most of the risks of corrective surgery. Instead, the cornea is zapped on it´s surface. It is similar to the tried and trusted PRK procedure as I have said but the main difference is that the epithelial layer which runs over the cornea is “lifted” but then placed back over the zapped cornea. The result is that there is less post-surgery pain than before and with the use of the more modern lasers and with new “bandage lenses”, LASEK seems to be now coming into favour. OK, so my mind is made up about LASEK – but who does it?

Step forward David O´Brart MD, FRCS, FRCOphth whose specialist interests are Refractive, Cataract and & Corneal Surgery. All the websites recommend that you investigate your surgeons. Even the best laser equipment in the World can cock-up in a big way if in the hands of an idiot. Just because you have a Rolls Royce doesn´t mean that you are automatically a good driver – you can still cause a lot of damage.

I chose David because of his deep general knowledge of the eye. It also transpires that he takes on cases where people have had bad corrective surgery. He didn´t seem to me to be a “machine operator” – he seemed to know the biology and physics of the eye. He also offered both LASIK and LASEK and I thought that he would be more likely to guide me to the correct process whereas other clincs would only offer you the one.
In addition, he himself did the tests and he himself would do the surgery.

And so it was that I phoned his assistant to make an appointment. Liz – his wife – gave me the low-down on David and, funny, but I felt I was talking to normal people Do you know what I mean?.I made an appointment to see David on Monday 22nd April for a consultation.

The day came and I must have asked David 100 questions. He took time to answer them all in a very non-technical way, which was very good. He made it clear that the best operation was no operation and that nothing could really beat glasses from the point of view of risk.

In the end we agreed on LASEK. a) because of my -8.00 eyes and b) because the risk of cutting the cornea is not present. I got the distinct feeling the David is sold on not cutting corneas if that can be helped. He should know. Another thing that “sold” me on LASEK is that it´s PRK ancestry has 12 years of post-operative statistics to back it up. And LASIK??? About 2 years. Well ….!

So here I am, writing this introduction to what is sure to be an interesting journey. I have my first operation – one eye at the time, as recommended by the expert – on June 14th. If all goes well the right eye will be done 3 months later. David will keep close track of my op because he is an academic and he also keeps meticulous records for subsequent publication. Another good point I feel.

I´ll keep this column informed of my progress.

I have had my right eye done now (01/03/02). My 1 week check up revealed that my left eye is now 20/20 and it should stay there hopefully since this is now around 3 months after the op on that eye.

There is every reason to believe that my right eye will be just as good and it is healing nicely.

This time I had no postoperative pain at all (and obviously no pain during the op), which is probably because the protective contact lens fitted better this time round, perhaps because in the intervening 10 or so weeks between operations, I started to wear a lens in the untreated eye and got used to it.

I’ve now had both my eyes LASEKed by Mr O’Brart, and can’t recommend him too much! Part of my reasoning was his involvement in post graduate training, and the various listings you can find for him on the web. I’d rather trust a single person than an anonymous somebody at a clinic.
Both my eyes were a relatively uncomplicated -4, with slight astigmatism.
After the consultation I was confident that I had made a good choice, and all my subsequent experiences have confirmed this. I was happier with his conservative approach, and the lack of salesmanship, pointing ot that spectacles had caused no problems for 700 years.
My first eye was more painful than expected for 48 hours, and then suddenly settled down to an occasional itching. Interestingly, my second eye was less painful, and for only 4 hours!
My left eye after 6 weeks is now +0.5, and my right eye is still settling down after 1 week, but has been deliberately left slightly under corrected to compensate for the slight long sight in the left.
Suffice to say, I’m very happy with what has been done.

Had 3 month check up back in December and everything is fine. You take things for granted once you become accustomed to your improved vision. I have not had any major problems and will be doing my other eye in the next 8 weeks. Other than that, I am very pleasesd with the overall outcome. The only slight problems I have had are dry-eye, but this has been very rare- maybe 3 times in the last 2 months; and sometimes in dark areas some slight haze around some lights, but I am a perfectionist and look for imperfections!!!!

I am looking forward to getting my right eye done and finishing with contact lens for good – in my opinion – this is far better than glasses, contacts etc. Highly recommended!

Mr. O’Brart has given me the go ahead to do my right eye now (March 1st). The left eye has stabilised such that I could have 20/20 vision with a +0.5 dioptres lens. Opticians will not prescribe glasses for this level of correction. I am delighted at the outcome.

Mr. O’Brart said that he doesn’t know why people do LASIK or PRK since LASEK is so much more predictable in his experience.