Hi, my name is Don McConnell. I'd like to tell you my laser vision story. There are some things I've learned in this odyssey that may help you. If I can help anyone better understand the pros and cons of laser vision correction, or help someone cope with their problems then I'm glad. I encourage anyone to read as many of these stories as possible. In one way or another my story and all the others deal with the issue of "quality of vision" and the consequences of not having a good quality of vision. As you will (hopefully) come to appreciate, quality of vision is every bit as important to a person and their daily functioning as is what they can read on an eye chart. And the maddening thing is, you can't appreciate quality of vision until it has been compromised. The stories here will give you a very complete view of the "side effects" that can occur with laser vision correction. Many people don't hear about or understand these side effects, or appreciate the effect on a life that these side effects can have. Compared to some of the other stories you can read, I am relatively lucky, I guess. I can still function pretty well, and the severity of my side effects is "tolerable"……..But I'm getting ahead of myself.
My story really begins back in about 1996. I had been following laser vision correction in the news for about 6 years ever since I heard first heard about the technology. I am engineer by vocation and so things like this have always interested me. I can remember thinking that lasers ought to be able to shape eyeballs back when I was I was a teenager. (Alas, I didn't patent the idea….another opportunity lost.) I wore hard contacts in high school and some of college, but stopped wearing them. I tried RGP's after college, but couldn't adjust to them. Soft contacts weren't an option for me because of my job and RK didn't sound very appealing to me. So, I settled into my glasses.

In 1996, one of the refractive surgeons in town was starting a clinical trial I qualified for that trial and the advantages of this laser seemed to make it the laser of choice. My surgeon actually gave me the choice of PRK or LASIK. He had actually had LASIK on his eyes in Columbia, but was early in the learning curve in LASIK and PRK sounded safer to me.

Now, at this point let me tell you that I THOUGHT I asked a lot of intelligent questions about the risks of the procedures, but I really didn't. My surgeon was one of maybe 5 or 6 investigators in the nation of this laser, and already used the other two major lasers. He was not shoddy. My surgeon explained the risks and procedures but, trust me, even with my researching the surgeon and the procedures, I really could not appreciate the potential side effects. Also, no one ever thinks that THEY will be the one who doesn't have a good outcome.

I had PRK performed on November 14, 1996 on my left eye only. I was 41 and not yet presbyopic (needing bifocals or reading glasses). My vision going into the surgery was as follows: (DON'T SKIP OVER THIS INFORMATION! IT IS IMPORTANT! YOU NEED TO KNOW WHAT THIS MEANS BEFORE YOUR PROCEDURE):

· Uncorrected Visual Acuity (UCVA) Left Eye: 20/600.

· UCVA is what you see without glasses

· UCVA Right Eye: 20/600

· Best Corrected Visual Acuity (BCVA) Left Eye: 20/12.5 -1.

· BCVA is the best prescription your doctor can find that allows you to see the best.

· BCVA Right Eye: 20/12.5

· Manifest Refraction Left Eye: -5.25/-0.50/010

· Manifest Refraction is your prescription as measured without dilation of your eyes

· Manifest Refraction Right Eye: -4.50/-0.75/180

· Dilated (Cycloplegic) Refraction Left Eye: -5.00/-0.50/030

· Cycloplegic Refraction is your prescription as measured after dilating your eyes. IT SHOULD BE MEASURED TO CHECK FOR ANY ASTIGMATISM PRESENT IN YOUR EYE'S LENSE)

· Dilated (Cycloplegic) Refraction Right Eye: -4.25/-0.75/175

· Left Pupil Diameter, Bright Light: 3.5 mm

· Left Pupil Diameter, Dim Light: 4.5 mm

· Right Pupil Diameter Bright Light: 3.5 mm

· Right Pupil Diameter Dim Light: 4.5 mm

I healed abnormally from the PRK and wound up at 20/30 vision. Well, that sounds pretty good doesn't it? Now is where we get to the "quality of vision issue". My 20/30 vision was caused by induced regular astigmatism and a central island/haze. I was able to get a lense to take out the induced astigmatism, but still had a ghost due to the central island. "Quality of vision has to do with clarity, sharpness, contrast and visual "aberations" It's the same as the controls on your TV. You can have an acceptable picture, but have lousy brighness and contrast. Most of you have even probably watched a TV that had ghosts. Its exactly the same with your eye. You might be able to read acceptably well on an eye chart, but have poor contrast sensitivity, glare, or ghosting.

My preoperative topography for my left eye (OS) is shown below.

You can clearly see the hourglass pattern indicating the astigmatism. Shown below that is my left eye topography at 9 months post op.

I had passed through a plano corneal refraction and wound up with a manifest refraction of +0.25/-1.75/025. With a corrective lense the 1.75 diopters of astigmatism could be refracted. However I still saw a ghost due to the central island. On February 5, 1998 I had a LASIK enhancement to get rid of the induced astigmatism. That procedure went well, although looking at the preop topography, the astigmatism pattern is not apparent to me.

Why did I choose a LASIK enhancement over a PTK (photo therapeutic keratectomy) or AK (astigmatic keratectomy)? I healed abnormally from the PRK despite an extended regimen of steroid drops.

LASIK offered the quickest recovery and smallest chance of abnormal wound healing without the possibility of weakening my cornea (as AK might have done).

Anyway, that procedure worked well and the induced astigmatism was gone. I measured plano on my cornea and could see 20/16. This sounds even better right. Not exactly. The central island/haze was still there as it was an apparent surface phenomenon from the PRK.

But I could function pretty well.What I saw is best shown below.

Instead of seeing one rectangle,

I saw the original, plus a ghost shifted 90 degrees outward, and another ghost image shifted slightly upward.

Even though my doctors told me I should not be able tolerate the image size difference between my right (uncorrected eye) and my left, I was able to accommodate it with glasses. In fact the right eye tended to partially mask the ghosts from the left eye. These ghosts were most apparent indoors and in dim light. In bright light, they almost disappeared. I attribute this to the contraction of the pupil in bright light. What really was happening is that the raised areas were acting as prisms and throwing off secondary images not aligned with the real image. My topography at 3 months and 1 year are shown below. As you can see the central island /haze seemed to be resolving.

But it was not resolving fast enough for me. I considered several times having a PTK procedure done to "remove the haze" as my doctors kept insisting the problem was caused by haze. I was very leery of this procedure (essentially a trans epithelial ablation) because:

1. since my cornea was now plano, I did not want to induce hyperopia,

2. the PTK procedure requires pretreatment for central islands, and I was concerned about developing another central island,

3. I was concerned about abnormal healing. I finally had this PTK procedure performed on April 15, 1999. To make a long story short, the haze is gone, I can still see 20/16 but now I have three ghosts. An additional one has appeared vertically, but with no displacement horizontally. I attribute this to a change in the faceting of the central island during the PTK procedure. My most recent topography is shown below. Hopefully the central island(s) will resolve.

How does this affect ME? As I have said before, I can still function. I can drive, work, and do the things I have always done. It makes life very unpleasant, however to see a ghost of everything, including people, and to try and ignore it. As I told my surgeon at the beginning of this odyssey, I understand that I might not get "perfect vision". However, I always thought any residual errors would be correctable or so minor as to not be a bother. That isn't always the case. I have conceded to getting a contact in my right eye, so that the images produced by my right and left eyes will be the same size. Also, presbyopia is starting to be a problem. Tolerating bifocals in eyes with two such different prescriptions is problematic. I still am hoping that a new procedure, on-line topography, or advanced spot lasers will be able to resolve my problem.

So that is my story. It is not by far the most severe outcome you will read, and I hope that technology will soon be available to allow less than desirable outcomes to be corrected. What can YOU do to optimize your chances of success? Here are some of my opinions.

1. Research, Research, Research. Check out any doctor you are considering, and don't be afraid to ask questions. How many procedures has he done? What laser does he/she use? I know that the VISX Star laser is FDA approved for PRK and LASIK for both farsightedness and nearsightedness. Recently the CIBA LADARVISION spot laser has been approved for PRK. The CHIRON TECHNOLAS scanning laser may also be FDA approved. Make sure the laser your surgeon is using is FDA approved. What is the occurrence of central islands and irregular astigmatism? Don't settle for guesses. Make them produce the total number of eyes done, and the number of eyes that have developed central islands or irregular astigmatism. In my opinion, you should not go with anyone who has an occurrence of irregular astigmatism of higher than 1/5000 to 1/3000. The same goes for central islands. Why? Central islands from LASIK tend to be longer lasting and harder to resolve. YOU DON'T WANT ONE! Irregular astigmatism can't be corrected with lenses, except possibly by a hard or RGP contact that will mold your cornea.

2. Do not accept any recommendation to have PRK performed. Most surgeons these days are performing LASIK for all but the mildest cases of nearsightedness. Why not get PRK done? The main reason to me is not the pain, or longer recovery time. It is the fact that the wound healing response simply cannot be predicted or controlled enough to insure an acceptable outcome. This is LESS of a problem with LASIK as the underlying corneal tissue is considered to be mainly inert. If someone recommends PRK, I would politely thank them and go the out the door.

3. If you are considering getting a laser procedure done, I would look for a refractive surgeon who actually tries to talk you out of it. Why? Because he or she will be giving you all the possible problems in the worst possible light. If you understand these problems in this light, and still want to do the procedure, then you will be in the best possible frame of mind to accept a less than perfect outcome.

4. You should understand the basic measurements of your vision prior to the procedure. It seems to me that the best and worst candidate for a laser vision correction procedure is the person who can see with glasses or contacts better than 20/20 and doesn't have severe astigmatism or nearsightedness. Why the best and worst? It you thoroughly understand the risks, you can afford to give up one or two lines of vision and still be 20/20. On the other hand, if you do see very well, at say 20/12 like I did, you may realize that you see pretty darn good, and don't want to give up any lines of vision, even for the chance of giving up glasses. On the other hand a person who can barely be corrected to 20/20 with glasses has NO ironclad guarantee that laser vision correction will get them back to 20/20. And, as you have seen, you could end up with less than 20/20 vision and it not be correctable back to 20/20.

5. Do not accept any argument from a refractive surgeon, OD or other technician, that "everyone has different vision needs…." Granted an artist may uses his or her eyes differently than a carpenter, but EVERYONE WANTS TO SEE THE BEST THAT THEY CAN! No one should con themselves into thinking that they "don't need to see detail", or "can accept less good vision". That is wrong thinking!

6. Finally, and first, ask yourself why you want to do this? I think the real reason anyone wants to get laser vision correction is that they have a better self-image of themselves without glasses. That is okay! I'm that way, even at 41! I don't think there are too many careers that require 20/20 vision AND will accept persons with laser vision correction, i.e., the Air Force and Navy do not accept people who have had Laser Vision Correction as pilot candidates. It is okay to not want to wear glasses, or to wear much less thick glasses. But if that is the real reason you want to do this, then go ahead and admit it. Also, as you have seen, if you REALLY want EXACTLY AS GOOD VISION AS YOU HAVE WITH GLASSES, then WAIT for the next generation of lasers for a few years, or be willing to undergo multiple procedures.(….with no guarantees)

7. Resist the temptation to have both eyes done simultaneously. Why? By having both eyes corrected simultaneously, you remove any frame of reference to what your old vision was like. If you could be corrected to 20/20 with glasses before your operation, then by having one eye still dependent on glasses (at least temporarily) gives you a way to remember what 20/20 vision looks like. If you have both eyes corrected simultaneously, you will soon forget what 20/20 looked like prior to your surgery. Now, if you are lucky and have an optimal outcome, it won't matter. But if you have a sub-par outcome, all you will know is that it is bad. Also, if you do have a subpar outcome, you may be able to get along better with your uncorrected eye and contacts. Not what you probably hoped for, but at least you are still seeing reasonably.

8. Caveat Emptor!