Patient D
My name, for now, is Patient D. I first had refractive surgery in early 1996. When I walked in to the laser clinic ready to spend $2000 per eye, they were all smiles. I am dependent on close work for a living. Nevertheless, I was found to be an excellent candidate for PRK. Contact lens intolerance was used as a strong indication for surgery and the surgeon said he saw physical signs of such. I signed a consent form and was operated on, in one eye, within the month.


There was a full waiting room of patients when I arrived for surgery. After waiting all afternoon, it was my turn. The time under the laser was only about a minute. During surgery, I was required to fixate upon a simple target, which I did easily. Afterward, the surgeon quickly inserted a bandage contact lens, told me it was important for healing, and sent me to schedule the next day’s follow-up.


The next morning, the surgeon was out of town and the MD covering the follow-up visits went out of his way to display rage, contempt and spite for the stated reason of resentment for not having the day off. In a brief exam, he told me the bandage contact had fallen out overnight. He said it did not need replacement and we should get out of there. Again he stated that he really hated to have to work that day. We left the doctor’s office. Before leaving, I was given tape and gauze to patch my eye and was told I was just complaining about the severe pain; that everything was fine.


Eleven days post-op, the original surgeon installed a bandage contact due to poor healing. A week later, the bandage lens was removed. My vision was horrible. I soon had to return to work. I was in shock. I had severe multiple imaging and was going crazy trying to focus. Later I discovered my problem was monocular diplopia at most distances and polyopia at close range. I called for an unscheduled appointment right from work. The "follow-up guy" was back minding the store that day. After I related the impossibility of resuming my livelihood due to poor vision, the doctor called me a fraud and a potential insurance scammer. He refused to extend my time off and when a corneal topography was done that day, the results were not discussed with me.


For the next few months, my doctors’ visits were frustrating. I was personally attacked many times by examining "fellows", was told my complaints of poor vision were false, and to "just don’t pay attention to the eye we worked on." Then when I’d see the head surgeon, he would tell me to have more patience and to take more steroid eyedrops for indefinite months to come.


Still staggered by my vision, I sought other opinions. Then I learned from other doctors that I had a significantly decentered ablation. I eventually, late in 1996, had a PTK; a retreatment with more laser ablation. The additional tissue removal helped some of the multiple imaging but added farsightedness (hyperopia), and permanent distortion remained. After 6 ophthalmological opinions, I have had 6 ophthalmologists observe the obvious decentration, even as it still exists after 2 surgeries. A couple would say nothing about the centering error of the treatment; the rest flatly refused to put it in writing. I know, as a walking example, the profound complications of refractive surgery are being denied adequate documentation, so then the success statistics are favorably falsified.


Three years later, my night vision in the treated eye is horrible. I have never been able to read normally again. Things look as they would look underwater, or through a greased window. I have lost $70,000 in wages due to lost work time and in medical fees. I have "hit up" the healthcare system more times in these 3 years than in my previous 40. My quality of life is far lower and more stressful than with glasses. My struggle to make a once-simple living is now a daily hell. My head feels like a liberty bell struck with a sledge hammer. Double vision, in various forms, is a part of my life all day, every day. Fatigue is a constant result. And yet, I have "20/40" uncorrected vision in the treated eye.

My long research has shown that:

1. A huge percentage of the "20/40 or better" statistical successes are clinical failures!!!!! This is because the Snellen ("big E") chart does NOT measure the most severe types of vision loss often associated with refractive surgery. A "fun-house mirror" image could be a "20/20" success! Snellen measurements quoted in surgery promotions are MISLEADING.

2. The procedure (PRK, LASIK, probably RK, too) CAN NOT BE RELIABLY CENTERED OVER THE PUPIL. A judge in the sport of archery would have to say that the broad side of a barn is as good as a bulls-eye if the judge had the same standards as a refractive surgeon.

3. There are double standards in refractive surgery: One set of standards for marketing and another for post-operative damage control. "Contact lens intolerance", an indication for the use of refractive surgery, becomes "mandatory contact lens dependence" as a treatment for many aberrations induced by the surgery. This double standard is what’s REALLY intolerable. Once the safety precautions are written from a CLINICAL perspective rather than a MARKETING perspective, only then can true informed consent occur. Then, there probably won’t be as much refractive surgery. CONSUMERS ALSO NEED PROTECTION THAT CAN ASSURE AGAINST "INFORMED CONSENT" BEING USED AS CARTE BLANCHE FOR NEGLIGENCE.

4. Contrast sensitivity function is impaired to some degree in approximately 100% of refractive surgery procedures. Rather than using a Snellen chart on operated eyes, a TV test pattern would be a start toward more accurate types of measurement so badly needed. A photocopier test pattern is another excellent example of vital contrast sensitivity measurement that we seem to test on video display monitors and copy machines but not on people. Are human beings one of the only things not tested?

5. Medicine and regulatory agencies MUST make a determined effort to measure ALL types of vision loss associated with refractive surgery, and must take the next step of recognizing debilitating impairment where it exists, ABOVE AND BEYOND the readings produced by the high-contrast Snellen chart of 1862.

6. The clinical measurement inadequacies of today must be overcome so that profoundly impaired patients can rightfully qualify for the Family Medical Leave Act, the Americans with Disabilities Act, Social Security and private disability insurance policies. If the government then determines that refractive surgery is too costly, let it further, realistically restrict the marketing techniques of the industry. The refractive surgery industry in all its parts should be required to take responsibility for its downside and put some of its profits toward that end.

Patient D