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Clare Dinhvu - Personal experience with laser vision correction

An Optometrist's Journey through Laser Vision Correction

I have been a practicing optometrist for over twenty years as well as being a clinical tutor at the University of New South Wales School of Optometry.

I have been shortsighted since childhood and was totally dependent on my glasses as I was highly shortsighted. In fact I couldn't even see the top letter in the vision chart. I could only just see the light in the chart without my glasses or contact lenses. This has been my vision without correction for as far back as I can remember. I accepted it as most shortsighted people do.

Glasses were fine when I was at school although I suffered the usual taunts from other children about 4 eyes. When I was able to wear contact lenses as a young adult there was a huge change in my self confidence and quality of life. It wasn't just how I looked and how I felt in certain social situations. There were many sporting activities I could not participate in with spectacles. There was some inconvenience to all the preparation and care in looking after contact lenses but being an optometrist I found this fairly easy. I understood very well how contact lenses worked and the intricacies of the eyes tolerance to them.

In the 1980's I heard about radial keratotomy, the so-called "Russian operation" and made some preliminary enquiries. After realizing that it was not suitable for me and that the procedure would actually weaken the cornea of my eye, I discounted it as a solution to my shortsightedness.

In the early 1990's a new procedure appeared ñ Photorefractive Keratectomy, the first laser vision correction procedure for shortsightedness and a precursor to LASIK, the procedure I eventually underwent.

Once again with my optometry background and my awareness of the function and structure of the eye, I looked into having the procedure done but decided that it was not sophisticated enough at that stage nor were the results good enough for me to consider having the procedure.

In the early 1990's I was invited to see Dr. Ronald Binetter perform a relatively new method of cataract surgery where a micro incision is made through the cornea and a folding intra-ocular flexible lens is inserted into the eye to replace the cloudy cataract lens that is removed. The opening was self sealing not requiring any stitches to close it and recovery for the patient was almost immediate. The procedure was done under topical eye drop anaesthesia, an almost unheard way of performing eye micro surgery at that time. I was astounded at the comfort for the patient and the quality of vision afterwards.

I was very impressed with Dr. Binetter's surgical skill and was grateful for the opportunity to see a new procedure for my older patients requiring cataract surgery.

A few years later when the overseas reports of LASIK started to appear I thought this might be a laser vision correction procedure which I would get done.

I had been wearing contact lenses now for 17 years, pretty well full time, and I knew that my eyes were becoming overworn from the contacts. I had seen this so many times in my practice. Happy contact lens patients who after a variable number of years could no longer tolerate their normal wearing schedule and either had to reduce their wearing time dramatically or cease contact lens wear altogether because of the side effects it was causing in their eyes.

Their only alternative was to go back to spectacles. I was already at the stage of having to take my contact lenses out during the day before I finished work because of the continual irritation they caused. I was very skilled at timing when and how I should use the contacts and also using topical eye drop medication to help me through the day and extend the times I could wear them, but even with all these skills at hand I knew that my time being a happy contact lens wearer was coming to an end.

I rang Dr. Binetter to find out whether he could give me any information about LASIK (laser assisted insitu keratomileusis). He was already performing the procedure and in fact had been one of the first eye micro-surgeons in Australia to be trained in this new laser vision correction procedure. He had trained first hand with the founders of the procedure in the United States and Canada and had brought this tremendous knowledge back to Australia in the mid 1990's and founded at that time Vista Laser Eye Clinics now known as the Australian Institute of Eye Surgery.

He advised me to wait 6-12 months until he was certain of its results for my high shortsightedness. I appreciated his honesty.

The next year I decided to make an appointment to see Dr. Binetter and his team at their purpose built Laser Surgery Centre in North Sydney.

Before I went for my consultation, being a typical optometrist, I did some further research into the laser technology itself. What I discovered was that the lasers themselves had gone through an evolution in sophistication between the early 1990's and now.

Earlier lasers, also known as Broad Beam Lasers, while still being able to reshape the cornea had some downside. One of these was that the laser beam came out as a very large pulse of light and this pulse was managed internally by a diaphragm much like the shutter of a camera limiting the amount of light reaching the film. This resulted in some undesirable effects in the cornea itself and also limited the types of eyes that could be treated. It was also much more difficult to be precise with this type of laser.

So I went to see the experts in laser vision correction at the Australian Institute of Eye Surgery (formerly Vista Laser Eye Clinics) in North Sydney and met with Dr. Binetter. Dr. Binetter explained to me that the laser he had chosen to install at the Institute was the Bausch & Lomb Technolas 217 Scanning Excimer Laser. This was the first refractive station in the world designed specifically for the LASIK procedure and is the most advanced laser of its type. It has a unique infra-red based eye tracker resulting in a procedure which is much safer for the patient and allows the doctor more precise control of the treatment.

This Scanning Laser delivers tiny pulses of energy to the cornea so that only a fraction of the cornea in fact, less than a single cell is treated one pulse at a time compared with the older lasers where large amounts of corneal tissue were removed with each pulse. The 217 Scanning Laser uses the most advanced laser technology so that the surgeons at the Institute can create a gradual change in the surface of the cornea during the procedure. The result is a very accurate and safe change to your vision.

Dr. Binetter explained to me the essence of the procedure which I already knew. The LASIK technique itself is a combination of current laser technology with traditional eye micro-surgery. The procedure has two distinct steps:-

Firstly a thin flap of corneal tissue is lifted from the superficial layers of the cornea. This flap of tissue is then hinged and turned back on itself much like you would open the page of a book. The laser is then centred on the cornea and with the eye tracker in place the scanning laser moving at 50 times a second slowly re-shapes the deeper corneal layers using information obtained from the comprehensive assessment that is performed prior to the surgery.

Finally the flap is gently placed back in its original position and the eyes natural suction holds the flap in place until it bonds firmly to the deeper layers. I felt very reassured about two specific aspects of the LASIK procedure after talking with Dr. Binetter. The first was that they use a device which is the Gold Standard in creating the corneal flap. This device called the Hansatome is the most widely used piece of microsurgical equipment to lift the corneal flap and more eyes have been treated with this device than any others.

The second aspect of the laser correction which made me feel even more confident was that the scanning laser they use has performed the most accurate results (for laser eye surgery) ever presented to the very critical United States Food and Drug Administration and remains the bench-mark results against which all other lasers are compared. There appeared to be little else to worry about or ask. I had come to one of the pioneers of LASIK in Australia who had performed thousands of laser vision correction procedures giving his patients 20/20 vision in most and better than 20/20 vision in many. In addition they were using the most advanced microsurgical equipment and laser technology.

I went away to think about it. I was at the end of my tether with my intolerance to contact lenses and I now felt that I understood the technology, the procedure and I had every confidence in my surgeon.

The day finally arrived and although I had prepared myself for quite a while beforehand I was nonetheless very nervous by the time I arrived at North Sydney. I thought that instead of being an optometrist and well informed it might have been better to be the average patient and relatively ignorant.

I entered the Preparation area in the laser suite and had a hat placed on my head, a patch placed on my left eye and little boots to cover my shoes. The nurse then walked me into the laser room where I laid on a bed and was positioned underneath the laser. What seemed like only one to two minutes later but was in fact closer to about 10 minutes, Dr. Binetter said "We have finished your right eye Clare and everything has gone perfectly". I was so surprised it had gone so quickly and I was hardly aware of what was being done. We went straight on to treat my left eye. I was much less nervous by the time it came to treating the left eye and I think that made me more aware of what went on with the second eye as I seemed to feel more, although the procedure was identical to the first.

At the end of the procedure they put clear shields on my eyes and I rested in the recovery area with dim light until I felt fine. I was then allowed to go home. I went to bed early that night knowing that an early night's sleep with my eyes closed would hasten the recovery.

When I woke the next morning I was actually scared to open my eyes to see what had been done. Eventually I peeked out and screamed to my husband I can see!! I can see!! The result was beyond description. The vision was sharp and clear and for the rest of the day I kept checking my vision every few minutes worrying that it might become blurred again.

After so many years being dependent on contact lenses or spectacles, to be able to see without any correction at all is just mind blowing. I have perfect vision now and I am so glad I waited for the right technology and the right surgeon. I have had so many patients and friends who have asked me since then about the experience and what it felt like and I tell them all the same thing "For me it's just like being born again".

Written by Clare Dinhvu
Clinical Instructor in Optometry
University of New South Wales

Printed with Permission

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