Eye surgery: Suddenly I see
Tired of wearing glasses, Sally Ann Lasson went in search of a cure for her short sight – and found that things are looking up in the world of eye surgery
Tuesday 06 September 2011
Every time I leave the house, I think I must have forgotten something. What could it be? Cigarettes? No, I quit. Lighter? Don't need one. Glasses. It's glasses. I never need to wear glasses again and it is a wonderful relief. There are two ways to improve your vision surgically: one is with laser treament and the other is with lens implants. For a long time, I had thought that I wasn't a suitable candidate for laser surgery, being both middle-aged and having an astigmatism in both eyes.
Like everyone, I will eventually become presbyopic (and need reading spectacles), although it hasn't happened yet. Laser surgery is better known for its success at treating short sight, but it can also be used for long sight. A consultation is the only way to determine your precise position. I have never liked the idea of contact lenses, so I was stuck with specs to correct my short sight (myopia). This meant that if it was raining, I couldn't see; if it was cold, and I went into a shop the glass became opaque; if I put my glasses down in one room and went to another, I couldn't see well enough to find them again. A nasty feeling of panic overwhelmed me at these times, a sense of having a real disability. What would happen if I was cast away on an apparently deserted desert island and died of starvation when there was an all-inclusive resort just around the next bay?
There were also tricky social interactions. At a large dinner party, the choice was between wearing glasses and being able to see the person across the table or not wearing them and seeing the person next to me. It is impossible to read someone's feelings as they say something if they are a bit of a blur. Something had to be done.
In November 2009, I went to see Mr Julian Stevens at Moorfields Eye Hospital in London, where he treats both NHS and private patients. He came recommended by Janet Street Porter, a person in whose judgement I had perfect confidence. I knew that she would definitely have done her research and there would be hell to pay if anything went wrong. I went to the private patients' clinic for two hours of tests, followed by a consultation with Stevens, an ophthalmic surgeon. He recommended multi-focal lens implants in both eyes because I had stated that I wanted perfect vision. The only way to produce good focus is with implants. Under a local anaesthetic, my natural lenses would be extracted and nice new German ones inserted. This is also the procedure for cataracts. They do one eye at a time, usually a few weeks apart.
This sounded like a very major operation. The risks of lens implants are not insignificant. You have 1-2 per cent chance of a detached retina; there is a very small risk of blindness, with serious infection a significant risk; about 1 per cent are expected to have some sort of complication. A friend was in that 1 per cent, but it turned out she went swimming in chlorinated water only a few days after surgery. It is vital that you follow the lengthy guidance to the dos and don'ts of any surgical option.
There have been recent developments in lens implants that you may have seen written about. They are called micro lens inlays. In this procedure both your eyes are laser-corrected for distance vision, your natural lens stays in situ and a minute synthetic lens is implanted just where you would look down to read. It is like bifocal specs without the specs. Stevens is studying the long-term effects of having micro lens inlays. It might be wise to see what he has to say about that in the future. Nobody wants to be a guinea pig, although having said that, I met someone who was the first in line for laser surgery in 1989 and he is still as happy as Larry with the result.
My next stop was The London Vision Clinic, an uber-swanky laser eye clinic in a town house on Harley Street, filled with beautiful optometrists with enchanting names like Alexandra and Desiree, and an American professor called Dan Reinstein (who also plays the sax). He does something he calls "blended vision", where one of your eyes is focused for distance and the other one for close-up. This is refractive surgery, where the curvature of your cornea (at the front of your eye) is altered to cure any astigmatism. The surgeon creates a very thin flap of tissue in the cornea, the flap is lifted and a precise amount of tissue removed. The flap is replaced and starts to heal instantly, usually within six hours. Except in my case, it didn't.
I had chosen the laser surgery because it had sounded so cuddly compared with the implants. The clinic is rigorous in its pre-operative assessments and postponed my surgery for a month while I tackled my (previously known) blepharitis (see box).
The surgery was painless and quick – it takes minutes. But when I went back the day after, the professor realised I wasn't healing and sent me away with new eye drops. I went back the next day, and the next. It was then that he diagnosed an allergy to the preservative that is in all of the eye drops you need to put in every 15 minutes after surgery. The flap was not closing. This also turns out not to be uncommon – about one in 100 – and I was unlucky. It had no long-term consequences but it had meant spending a week in a darkened room. Only a great effort of will, and a lot of Radio 4 Extra, enabled me to put it out of my mind.
My vision has improved. My left eye, which does distance, can see an extra line on the chart than I could with my glasses. My near vision is compromised by having to do short and middle distance and I now need a bright reading light. I used to be able to read the A-Z in the dark, but that was a symptom of my myopia, Professor Reinstein said. Obviously, though, I have mono vision – one eye for each focus – and the advantage of the lens implants would have been stereo vision in both eyes.
Stevens told me an interesting thing: we get the eyesight we need. People who read all the time are likely to be short-sighted. Footballers are likely to be long-sighted because they need to see the ball. Perhaps their salaries are so enormous because they can only read VERY BIG NUMBERS.
London Vision Clinic: 0207 224 1005. From £4,600 for laser blended vision. Moorfields Eye Hospital: 0207 251 4835. Initial consultation costs £100, surgery costs £2,500 per eye.
Short-sightedness. My prescription was only -2.25 in one eye and -1.75 in the other, but with astigmatism in both eyes. Laser surgery, known as Lasik, can treat someone with a prescription up to -16 depending on their corneal thickness.
Very common and treatable. A normal eye is curved equally in all directions, but in astigmatism the curvature of the cornea is not the same in the horizontal and vertical directions. This means the light rays do not focus at a single point, causing distorted vision. People with a significant astigmatism may need lens implants followed by laser surgery.
As we age, the crystalline lens inside the eye becomes less flexible, making it harder for the eye to change focus from distant objects to near. It usually starts at around 45, until the lens loses most of its focusing ability around 65.
Another condition I have, sometimes called "lazy eye". It means your vision isn't fully developed. When vision is decreased it cannot be improved beyond a certain level by laser surgery.
It is a common condition and is treated with a hot mask, a mild shampoo and eye drops. Dry eye is caused by tiny blocked glands around the eye. It isn't serious but a lack of natural lubrication affects your recovery from surgery.
The lens is cloudy and vision is impaired. They are more common with increasing age, but can occur at any time. You can have your cataracts out and new lenses implanted in the same operation. The surgery is available on the NHS.
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