Chris Duffey With LASIK, the vision of Danville's Frank Santos went from 20/50 to 20/40, but now he's seeing double.     News Category: Health From the Week of Wednesday, April 23, 2003   City of Warts Forgetting How to Die Because hospitals treat death as a failure of modern medicine, Felicidad Gomez couldn't die with the dignity she deserved. 7 Days 7 Days Antiwar activists not permitted; Hey, why steal just one?; Emeryville caves, disabled roll on; And the liberators strike again. Letters Letters for the week of April 23-29, 2003 Your snotty vulgarity only makes competition welcome. Your inspired tribute to rugby is a credit to the profession.

In 1999, during a procedure to correct her nearsightedness, an eye surgeon cut and lasered too deeply into the 37-year-old's right eye. Recognizing his error, the doctor stopped the surgery before touching the other eye. "LASIK left a hole in the back of my cornea," said Ross, a mother of four. "I've had injuries in the past, but none of them affected me like this one."

Surgery had turned her world into a blurry, warped collage. "If somebody was standing in front of a light source, whatever was in the background behind them would end up looking like it was on top of them." Not only was there distortion, but Ross saw a veiny veil over everything, as if she were seeing her own eyelid. To make matters worse, she said, her surgeon was completely unreceptive to her plight. She recalls him saying, "I don't see what your problem is; people drive with one eye every day."

Over the next year, the Oregon resident visited five different ophthalmologists searching for answers. It wasn't until she traveled to the San Ramon office of Arthur Ginsburg, director of Vision Sciences Research Corporation and Visual Forensics Corporation, that she began to understand what had happened to her. At his office, Ross went through hours of exams to measure her impairments. "My surgeon had hidden a lot of the truth," she said. "When I went down to see Dr. Ginsburg, there were several things he was able to explain to me. He was the most informative person I have spoken to. ... He's just a wonderful, amazing man."

A meticulous scientist who has devoted much of his career to vision research, the Cambridge-trained doctor of biophysics has invented a test that goes beyond the eye chart and measures "contrast sensitivity" -- for example, how well someone can distinguish shades of gray in a dimly lit setting. "With each group of tests he would explain more and more about my vision," Ross recalled.

When the surgery cut deeper than it should have, fluid in her eye leaked and caused a bulge inside. Ginsburg explained that this had thrown a permanent wrench into her central optical axis. To make matters worse, it was in her dominant eye, which made it impossible for her to ignore the distorted input.

But because her brother had already undergone successful laser vision correction in both eyes, Ross found it tough to convince her family and friends how horrific her own sight had become. "I was becoming so terribly depressed and giving up all hope," she recently recalled. "When I finally saw Dr. Ginsburg, he put that spark of hope back in, not that I was going to find a cure necessarily, but that this wasn't all in my head, that I wasn't making this up. ... I felt like 'Oh my gosh, I'm being validated. For once, somebody understands.'"

Ginsburg gave Ross several computer simulations to take home so her family and friends could experience the world she was seeing. Upon seeing those pictures, their typical response was: "How do you even function?"

When laser vision-correction surgery doesn't deliver the promised results, the impact can be profound. Ross is one of tens of thousands of patients whose lives have been turned upside down due to improper risk screening, malfunctioning machines, or shabby surgical techniques. Instead of the carefree new lifestyle these patients anticipated, they have received an involuntary lifetime admission ticket to their own personal laser light show. At best, they face glare, halos, starbursts, multiple images, or poor depth perception. At worst, they face chronic pain, corneal transplants -- even blindness in rare cases. For those already damaged, the road to rehabilitation is frustrating and slow, and sometimes the only good remedy is an entirely new pair of eyes.

Laser eye surgery is the most popular elective surgery in the United States today. Data provided by the American Academy of Ophthalmology indicates that approximately 2.5 million American patients had undergone LASIK by the end of 2002. According to a recent survey conducted for American Demographics magazine, 30 percent of all Americans would like to have the surgery.

By all accounts, the majority of patients enjoy successful surgery. Data from the 9,000-member American Society of Cataract and Refractive Surgery suggests that LASIK surgeries are successful 97 percent of the time. But transcripts of US Food and Drug Administration proceedings suggest that failure may be much more widespread. In August 2002, discussion by the members of the FDA's Ophthalmic Devices Panel indicated that 10 percent of clinical study patients have been consistently unsatisfied with their laser-based refractive surgeries. The panel also admitted that one patient in five will have a tougher time seeing in dim lighting -- the dimension of vision that Ginsburg's innovative new test examines.

Depending on which satisfaction estimate one accepts, somewhere between 75,000 and 250,000 people so far have left their eye surgeon's office with considerably less eyesight than they had when they first walked in.

According to the eye chart, at least, Steve Williams of San Lorenzo is one of LASIK's success stories.

Williams was nearsighted with 20/600 vision and astigmatism. He hated glasses, and never could tolerate having hard contact lenses in his eyes. "It was like having a Coke bottle in my eye," he said. "It drove me crazy. I hated them." But as an avid athlete, he wasn't happy with the way glasses inhibited his skiing, golfing, and tennis. So he considered laser vision correction. The turning point in his decision was taking off his glasses during a dip in the ocean in Hawaii, then being unable to locate his towel once he got back out. Even though he was apprehensive, he decided to have the surgery last August.

In the midst of surgery, following his first eye treatment, the laser shut down inexplicably. Williams was asked to get off the table while the doctor reset it. Then his second eye was done. Now, Williams can't help but wonder whether that glitch was behind the poorer surgical results in his left eye, the second one treated. "My right eye is a perfect 20/20, and my left eye is double-vision and fuzzy, though it's 20/30," the Internet network manager said.

Two weeks after surgery, the numbness wore off and dryness set in. "I'm pouring in drops every five minutes," he recalled. He used so many, in fact, that the skin around his eyes became red and tender, as if from a chemical burn. Conventional eyedrops only made his eyes worse, and lubricating eye gels weren't any use, either.

Williams eventually tried to resume playing tennis. But staring at the ball on a windy court caused dry, painful spots -- corneal erosions -- to develop on the surface of his eyes. "I would play once and it would take three weeks to recover," he said. "It feels like you have a stone in your eye."

He remembers the situation as "hideous." He worried that he would be one of those LASIK patients for whom dry eyes never improve. "I'm a tough guy, but believe me, it's very frustrating," he said. Then last December, Williams discovered a Web-based support and advocacy group for people injured by LASIK, http://www.surgicaleyes.org/, and read about other patients' success with an innovative prescription eyedrop. Formulated by dry-eye expert Frank J. Holly and available only at a single Dallas compounding pharmacy, Apothecure, the new drops finally made the difference for Williams. He applies them at least five times a day: first thing in the morning, before he goes to bed, and periodically throughout the rest of the day. He never leaves the house without them. "Dr. Holly's drops turned me right around," he said. "I don't know what I'd do without them. I'd be miserable, to tell you the truth."

The 47-year-old now finds he needs glasses for reading. He also has reconciled himself to once again using glasses at night and while driving. And he said he has learned to tune out the double-vision that flares up when he looks at green lights with his bad eye. "I'm right-eye dominant, and my right eye came out perfect," he said. "If I had my dominant eye 20/30 and my nondominant eye 20/20, I'd be a wreck."

But all in all, Williams considers himself a success, even though he still visits the SurgicalEyes Web site a few times a week. Skiing, golf, and tennis are easier post-LASIK, despite regular eyedrop breaks and the fuzzy double vision in his left eye. "The advantages it gives me for those kind of outweigh the negatives," he said.

The most common complaint voiced by people who aren't as happy with their own LASIK surgery is that they were never fully warned of their individual risks. How does a potential LASIK buyer beware? First, it pays to understand the procedure and its risks.

Truly savvy consumers pay a thorough visit to the Web site of the federal Food and Drug Administration at www.fda.gov/cdrh/lasik. It contains a laundry list of LASIK risk factors in plain language, and explicitly notes that the surgery is risky for people with large pupils, thin corneas, dry eyes, a history of eye diseases, or anyone prone to frequent eyesight changes. It also warns would-be patients to skip LASIK if they are pregnant, have autoimmune problems, or engage in contact sports. Finally, the FDA prominently warns that people are "probably NOT a good candidate for refractive surgery" if they are not "a risk-taker."

A good place to learn more about those risks is SurgicalEyes, where visitors encounter vivid details about what life is like when LASIK and other refractive surgeries fail.

But more typically, consumers rely on word-of-mouth from other patients or advertising from financially motivated information sources. In the Bay Area, such consumers might reasonably expect to find reliable information on the Web site of UC Berkeley's Refractive Surgery Center (http://www.caleyecare.com/). Its frequently asked questions page could, to the uninitiated, seem like a good place to start collecting salient details. Concerning LASIK safety, it reads: "Any kind of surgery carries some potential risk, but with LASER VISION CORRECTION surgery, there is a remarkably low rate of complications. Unlike the older, nonlaser procedure known as RK, the computer- controlled VISX 'excimer' laser does not weaken the eye."

This statement is surprisingly deceptive, coming from a university-backed facility. In fact, LASIK does weaken the eye. First, the surgeon slices a thin flap across the eye's center with a disposable blade. Then, while the flap is folded away, the doctor reshapes the eye with a laser. (Treating nearsightedness, for example, involves flattening the curve of the cornea.) Afterward, the flap is smoothed back, the eye is bandaged, and the healing begins. But the eye is unquestionably weaker, and that's why contact sports are off-limits for LASIK patients and why Clarke Newman, a fellow of the American Academy of Optometry, says it's still a matter of debate whether eyes ever fully heal.

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