Pains, Gains, Perils of Laser Eye Surgery
BGN Eye Clinic
Pains, Gains, Perils of Laser Eye Surgery Article by Cho Jin-Seo The Korea Times 2010-03-07 Corrective laser eye surgeries have become quite common in South Korea over the past decade but many are still concerned about the safety of such operations. After weeks of searching the Internet and asking for advice, this reporter, with poor vision in both eyes, decided to give it a try and see how it really works out. Among hundreds of eye clinics in Seoul, I chose one of the busiest. The BGN Eye Clinic, near Gangnam Station, where eye and cosmetic surgeons are operating is in a kind of industrial cluster. It was also one of most heavily advertised on the Internet, and its prices looked higher than average. The clinic also had a Web site in Chinese. "Myopia is more common in Asians than in other races, so we are inviting patients from China as well,'' a nurse said. Beauty Clinic Many plastic surgeons, eye surgeons and dentists in Seoul and Busan nowadays welcome foreign tourists, and this so-called "medical tourism'' has become a huge industry. BGN seems to know that well. Its lobby was filled with modern couches, cushions, a drink bar, large paintings and a dozen Internet-connected PCs so that visitors can entertain themselves while waiting. Big TV screens were hanging on the wall, showing interviews of movie stars and singers who have been patients. It was Saturday afternoon and there were about five other young patients. The general atmosphere was more like that of a fancy cafe rather than a traditional hospital. An optometrist greeted me at the door. Young and immaculately dressed, he spoke in the manner of an insurance salesman rather than a medical worker. He seemed knowledgeable about all kinds of eye surgeries, fielding my tricky questions confidently. His attitude was contagious. After two hours of consultation and check-ups, I was convinced that I wouldn't be one of the tiny, unfortunate minority of patients who suffer side effects after surgery. Various devices were used to measure how well and clearly I could see. They checked the level of my myopia and astigmatism, as well as other physical factors such as the width and depth of my lenses and corneas, range of eyesight, elasticity of eyeballs, the shape of lens cells, and the dryness of my eyes. Most of the tests accompanied no pain, though they felt tedious. The results were shared with me instantly, though I could not fully understand the technical terms. I asked one of nurses there how many operations they do each day. "Around 10 on Saturday and a little less than that on weekdays,'' she said. Bargaining The optometrist said that those eye test machines found my eyes to be strong, healthy, thick and resilient, and wet enough to endure the LASIK procedure. LASIK is simpler and less painful than other types of laser eye surgery such as LASEK, he said. We came back into the consulting room. Sipping a milk tea, I listened to the optometrist explaining different "generations'' of eye-operation machines. The early generations, he said, used metal blades to cut the cornea, the transparent covering of the eyeball. Later generations use sophisticated laser beams for the same task. And there were different versions of lasers, and he recommended one of the more recent and more expensive machines. "You can opt for the blade type if you are really concerned about price,'' he said, though his lecture so far had scared me enough that I didn't want to downgrade myself to steel from laser only to save some money. (Later, I learned that many surgeons in the United States still prefer the blade operation because it is quicker and therefore less harrowing to most patients.) Then we talked about price. Refractory operations, like cosmetic surgery, are not covered by medical insurance in Korea. The optometrist asked for 2.6 million won ($2,250) for both eyes, which was about double the rate of smaller clinics. I said that was beyond my budget. The price immediately went down to 2.3 million won. Then he made a curious offer ― if I promised to write a review of my operation on the clinic's Web site, he would give me a further 100,000-won reduction. I turned down the offer, but anyway, the ``discount'' was granted. The bill included the cost of the operation and eye checkups but not medicine, which cost another 30,000 won. Laser Burner After I paid it with my credit card, I could finally see a doctor for the first time. Doctor Bae was a middle-aged man. He talked nicely but looked quite busy, and was in no mood to waste his time in chit-chat with patients. He read my chart, asked a few technical questions to the optometrist, and looked into my eyes through a magnifying device. It didn't take more than five minutes for him to give the green light for my surgery. Operations were done on the upper floor. The waiting room was equally nicely decorated as the lower floor, but the air was quite different. Nurses were all wearing gowns and none were smiling. I was given a gown and a vinyl hat before entering the operation chamber to wear over my clothes. It was a very large room. There were two operating tables and various machines and computer screens. A nurse put a sticky mask on me, exposing only one eye at a time. Drops of anesthetic made my right eyeball numb, though I could still move it freely. Then some device grabbed my cheekbone like a vice and held my eyelid open. Suddenly fear began to emerge. With my eyeball exposed widely liked an orange peeled halfway, I could feel the doctor put some kind of metal ring on it. As he muttered "suction," the eye was sucked into the vacuum hose and held tight inside it. This was a very uncomfortable sensation. A waterfall of tears ran down. A second felt like a year. Once the eyeball was anchored on the vacuum hose, the rest of the operation was relatively easy. The nurse counted to 15 while the laser sliced the skin of the cornea to make a flap. Then another laser beam hit the inside the flap to remove excessive tissues of the cornea. I could see nothing but flashing lights of red and orange, but there was a faint smell of burning flesh. After a minute or so, the doctor closed the flap into its original place so it can heal with the rest of the cornea. The operation on the right eye took no more than five minutes but I was already exhausted by then. The same procedure went on for the left eye. This time, the suction hose failed to suck my eyeball correctly two times, making me very uneasy. The third attempt was successful but was equally agonizing as the previous two. Furthermore, the protective mask was stuck on my face so tightly that it left cuts on my nose and cheeks when a nurse took it off. Eye-Opening Moment The nurse told me to stand up and walk out to the door. To my surprise, I could see things quite well though the vision was blurred with tears. In the recovery room, the doctor came in to check out my eyes. I couldn't help but flinch when he touched the eye with a pincer. After 10 more minutes, I was told to go home. Nurses didn't support me anymore since they had next patient to be taken care of. I was out on the street barely 20 minutes after the surgery, with a pair of blurry eyes and two bottles of antibiotics and artificial tears. From the next morning, I could see things quite clearly. I returned to work the second day after the operation. The vision improved week by week until it reached 1.0 a month after, equivalent to 20/20 in America, and considered the average of people with healthy eyes. Risks Five weeks have passed and there have been no serious side effects apart from the occasional dryness of the eyes. But I'm not at ease yet. One of my cousins had LASIK a few years ago and she had to have a further operation a year after the first one. Her doctor said it was because she had a keloidal skin, which is allergic to scars and can affect the healing process of the wound. I, too, have had this problem before. My optometrist at BGN clinic said this doesn't cause trouble, usually. LASIK, LASEK and other laser refractive surgeries are not free from adverse effects. "Certain complications are unavoidable in a percentage of patients, and there is no long-term data available for current procedures," the U.S. Food and Drug Administration (FDA) says on its Web site. The risks include loss of vision, blurry vision, and severe dry-eye syndrome. The FDA suggests that patients should consult with at least two different surgeons, and have surgery on one eye at a time to minimize the risk of losing both eyes. But most Korean clinics encourage visitors to finish all the procedures in one day. In my case, it took three hours from consulting to operation. Lifestyle and career can also be an important issue when considering refractory operations. It is no secret that eye surgeons themselves prefer wearing glasses or contact lenses to surgery, because their job requires reliable and acute vision. Even my surgeon at BGN was wearing glasses when I saw him outside the hospital. After all, the risk is for the patients to take.