Pak-Pak-Pak-Pak.
The staccato sound of the world's most precise laser pierced the operating room at the Center for Refractive Surgery. Less than 30 seconds later, decades of fumbling with glasses became a thing of the past for John Sylvester, a retired government and University official.
"I wish I could have had it done 50 years ago," Sylvester said.
Last week, Sylvester underwent laser refractive eye surgery, or LASIK, a technology that has experienced explosive growth during the last five years, thanks in part to the apparent simplicity of the procedure.
After taking 5 mg of Valium to relax, the patient lies on the operating bed with one eyelid taped open. While the doctor creates a flap on the cornea and allows it to dry for two or three minutes, the patient squeezes nervously on a foam, green pepper stress-reliever. The laser rotates into position, the lights are dimmed and the patient fixes his gaze on a flashing red light located on the laser apparatus.
A few seconds later, the computer-guided laser fires at a rapid 10 pulses per second. Anywhere from five to 25 seconds later, the printer churns out a treatment report signifying the completion of the surgery. When many patients get up, the once blurry wall clock is now in perfect focus.
Although the operation appears simple and Dr. Alan Carlson, the center's director, is enthusiastic about the results, he reminds would-be patients that the procedure should not be taken lightly. "People should know that it is eye surgery, and that these are their eyes," said Carlson. "It's not like getting a pair of glasses."
The Center for Refractive Surgery is located in the Duke Center for Aesthetic Services, but Carlson pointed out that LASIK surgery should not be performed for beauty reasons.
"[The procedure] is intended for people whose lives would be substantially improved as a result," he said.
Nevertheless, its relative simplicity has undoubtedly contributed to the explosive growth of LASIK surgery in the past few years.
Sometimes, Carlson and his staff complete nearly 100 eye surgeries in one week. Nationwide, there were 400,000 LASIK surgeries performed in 1998. The next year, that number jumped to 750,000 and in 2000, the number is expected to surpass the one million mark.
The procedure is becoming so popular that rumors suggest LASIK clinics may open in some shopping malls. But program coordinator Heidi Campbell pointed out that the floors of malls often shake and might reduce the laser's accuracy.
Despite its popularity, LASIK surgery is not cheap. Although the Center for Refractive Surgery offers discounts for Duke students and employees, does not charge for post-surgery touch-ups and offers financing, the procedure still costs a tick under $4,500 for both eyes.
Carlson said some Duke parents have made it a gift for graduating children in the past-a reward still considerably cheaper than a new car.
The price tag is not LASIK surgery's only limit. The procedure does not give 20/20 vision to patients who cannot see perfectly with glasses or contacts. Although the procedure does not weaken the cornea or increase susceptibility to diseases of the eye, Carlson added, it doesn't protect from other diseases either. "It fixes the same problems that wearing glasses or contacts can fix," said Carlson.
The procedure's effects are also not immediate. Although the patient experiences 85 percent of the improvement within 24 hours, it usually takes around three weeks to notice the full effects of the surgery. During that time period, blurred vision and dryness of the eye are common side effects.
The public's enthusiasm for LASIK is tempered by concerns about its safety. Carlson stated that there is a 1 to 2 percent chance that a minor complication can occur; the chances of a major complication, such as an infection, are about one-tenth of a percent. In over one million LASIK surgeries performed worldwide, there are still no documented cases of anyone going blind.
Jeanne Bradshaw, a 29-year-old physical therapist, is a typical LASIK patient. She could only wear her contact lenses comfortably for about five to six hours per day and did not particularly like glasses due to her active job. Although the lack of research on the procedure's long-term consequences worried her, she decided to have LASIK surgery after her eye doctor told her that the procedure leaves no scars on the eye. And although the cost certainly was a factor in her decision, Bradshaw decided that it would be offset by long-term costs of eye care and doctor visits.
Despite the cost, risks and side effects, few of the center's patients report regretting the procedure and LASIK professionals consider it a privilege to restore their patients' vision. Cornea specialist Terry Kim said he finds his work incredibly rewarding because he feels as if he has given his patients new sets of eyes. He terms it the "Wow" factor.
"People get off the operating table and look around and they go, 'Wow!'" said Kim.
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