Right on time, 9:00am, you show up at the doctor’s office. He did tell you to expect to spend the whole day, but you can’t imagine any reason that might be necessary. You’re off work all day, so it really doesn’t matter. The receptionist checks you in and hands you a sheaf of papers to fill out and sign where appropriate. He already has your records, which you sent the day after you first spoke with him. You fill out a complete health history, answer a bunch of the usual questions, and then, you get to a page asking you some specifics about your vision. Put a check in the box next to each one that applies. You check all but one. Not a good sign.
A tech escorts you back to a room full of various pieces of equipment, each of which measures something different. He dilates your eyes and says he’ll be back in a little while. When he comes back, you begin the tests. Something’s wrong. There seems to be a system malfunction affecting all of the machines. You repeat all the tests, but whatever it is still is not working properly. A third time produces the same result.
The tech takes all the printouts with him and goes to consult the doctor. When he returns, he escorts you to another room full of equipment, where you perform another battery of tests. It’s already time for lunch and you haven’t even approached the super-duper-wonder-scanner, yet. The tech tells you they’ve ordered pizza and you are welcome to join them.
After lunch, you start again. Finally, you meet Artemis, the super-duper-wonder-scanner. Here’s how it works. You stand over the scanner, with your eye in a water bath, holding it open as wide as possible, while the scanner does its thing. It shouldn’t take too long and you’ll be out of there soon. He scans both eyes, checks the results, and with a frown, asks you to do it again. You really don’t want to, but this is what you’re here for, so you dutifully plunge one eye at a time into the water bath. Again, he checks the output and frowns. He goes to consult the doctor. When he comes back, he tells you that you’re done with all the tests and the doctor will be with you shortly.
You wait a few minutes in an exam room and pretty soon, a tall, gangly guy in scrubs and a surgical mask hanging down under his chin comes in. You are short and sitting down, he is very tall and standing. With a folder under one arm, he reaches down with the other arm and puts a hand on your shoulder. “Good afternoon, I’m Dr. Xxxxxxx. Have you considered litigation?” You are so stunned to find an honest refractive surgeon that you don’t really grasp the full meaning of his words. You explain that three weeks ago, right before you spoke with him for the first time, you dropped your lawsuit for want of an expert witness. He shakes his head and says, “Oh, man. That’s too bad. I’d go to bat for you.”
He sits down next to you and goes over all the printouts and scans, explaining which particular higher order aberration (HOA) each test has measured. He points to a chart on the wall with graphic representations of each one. You have most of them in spades, which accounts for all the black boxes from this morning’s tests. The water bath scan shows some disturbing physical issues, but the actual extent of your aberrations cannot be measured, since the software is not designed to interpret them at that high level. It will eventually be rewritten. Some of the numbers do mean something to you, though, and you are horrified by what you learn. Suddenly you understand and you wish you didn’t. You have just become a case study.
First of all, according to your records, the LASIK flap was supposed to be between 130-160 microns. Yours is 220 microns, excessively thick. FDA guidelines require at least 250-300 microns of stromal tissue under the flap. You have a scant 200 in one eye and a little less in the other. Your corneas were too thin to support the extent of ablation necessary for correction of such high myopia and astigmatism. They are now extremely unstable and could lead to keratectasia, but for now, you are spared that nightmare. Your ablations (the lasered areas) were supposed to be 6mm with a 1mm blend, roughly the size of your dilated pupil. Instead they are approximately 3.4mm, smaller than your fully constricted pupil. Your pre-surgery -10.5 vision is uncorrected outside that tiny zone, causing a plethora of aberrations. In addition, your corneas are extremely irregular and uneven; they look, as another doctor once said, as though they’d been run over with a plow.
Your tear film is inadequate, you have dry eye syndrome, EBMD (epithelial base membrane disorder), map dot dystrophy, meibomitis, and conjunctivochalasis (not related to LASIK). There is a mass of scarring in the central cornea of the right eye, probably caused by advanced DLK. In short, your vision is trash and there isn’t enough cornea left to even consider doing anything to fix the refractive imbalance between the two eyes. You are, in a word, screwed.
You inquire about corneal transplants, but he refuses to even discuss the possibility. You stand to lose all your functional vision should the graft fail for any reason. You are diabetic and with your history, the risks are just too great. He tells you how sorry he is for your outcome and suggests that you see an expert fitter for prosthetic lenses. That reminds you to ask him about the pokey thing in the left eye. He pulls the scan up on the monitor and enlarges it. There is a very slight thickening of the lid, with a miniscule mass of what might be scar tissue inside, consistent with the lid being pinched by the speculum during the second surgery.
During the course of your conversation, he mentions that he recognized your name from that crazy website, but you don’t seem at all crazy. You tell him that things are changing, that you and a doctor friend now run the organization, but are planning to dissolve it and start a new one as soon as the government approves your application for nonprofit status. He’s intrigued; you ask if he’d be willing to serve on your new advisory board. He says he will think about it and get back to you, but he is definitely willing to do whatever he can to help patients you refer to him.
It’s nearly 4:00pm when you leave. Your eyes are still dilated, but not enough to keep you from driving. It’s a bright sunny day and there is still plenty of daylight. He gives you a big hug, hands you a pair of huge, dark, wraparound cataract surgery sunglasses and says to keep in touch. It seems like a silly question, but you ask him if he would be willing to accept you as a regular patient. An unrepentant hippie and definitely a warm fuzzy sort, he gives you another hug and says, “It’s cool, man.”
You fight back the tears as you get in the car. You’ve held onto them for nearly three years and you just can’t stifle them any longer. The dam breaks and you cry all the way home. You grieve for your lost clear vision. It washes over you in waves; you may never see the stars in the sky again. Toast. Burnt toast.
(to be continued)