Jeffrey Whitman, M.D., an ophthalmologist and owner of Key Whitman Eye Center in Dallas, Texas, talks about the benefits of Lasik for eye-vision.
Interview conducted by Ivanhoe Broadcast News in July 2016.
If you don’t take care of your contacts they can actually do some damage to your eye?
Dr. Whitman: Absolutely, what a lot of people don’t know is that routine contact lens wear, whether it be daily contact lens wear but particularly those extended wear lenses, can be very hazardous to the health of your eye. The rate of infection and ulcers is huge compared to having Lasik done to your eye.
Let’s get back to kind of the basics, like the typical reasons people might need contacts which I guess are some of the same reasons that they might need Lasik?
Dr. Whitman: Very good point. The most common reason for somebody wanting to go in to contact lenses is they just don’t want to put those glasses on. They like the look with no glasses. It’s pretty much the same thing for Lasik; usually people try glasses, they’ve tried contact lenses and now they want freedom from that. They don’t want to have to worry the contact lens solution or their frame slipping down or I can’t find my glasses. They can have Lasik performed really in a very few minutes and it can change the rest of their life to where they’re having excellent uncorrected vision and no longer have to worry about contact solutions or glasses any more.
Common reasons that people would choose Lasik; is it usually nearsightedness or farsighted or what?
Dr. Whitman: People choose Lasik because they’re nearsighted, because they’re farsighted, because they have a stigmatism. All these things can be treated with Lasik now. In fact, I always tell people that have been told in the past they could not have Lasik done because of their astigmatism, they really need to come in and let us show them what we can do for them now because we can treat nearsighted with astigmatism, farsighted with astigmatism. There is really very little that we cannot correct today.
Let’s go back to people getting contacts. Do people get contacts for the same reason?
Dr. Whitman: The reasons for wearing contacts are really identical to why people have Lasik done. They want freedom from glasses and they can have contacts for nearsightedness, farsightedness and astigmatism as well. The difference and the reason a lot of people pick Lasik is they don’t want to worry about contacts, they don’t want to worry about glasses. This gives them freedom from all of those things.
Everyone that I know that has contacts they are really diligent about taking care of them at night, or at least most of them are. Is that where things can go south?
Dr. Whitman: I think where there are problems with contact lenses is with that contact lens care. We really discourage people that wear contacts from wearing extended wear lenses. Because they trap bacteria, they trap oils from the eye under the contact and it doesn’t allow the front of the eye to breath well. Therefore, there’s a much higher rate of infection and corneal ulcers with this that can have a permanent impact in your vision if they’re not treated.
I guess with these extended wear the concept is you don’t have to take them out you can just sleep with them and everything? Is that the thought that people can sleep with their contacts?
Dr. Whitman: The problem is that people really want what Lasik can do for them and that is they don’t have to put anything in their eye. They feel like, hey, I can get these extended wear contact lenses and leave them in for a whole month and you know I’m free from any vision correction. The problem is, is that infection rate with those kind of lenses is very high. So there is a problem.
It’s kind of like guitar strings if you don’t change them you get used to them playing lousy but you should change them if you want better sound.
Dr. Whitman: People that wear daily wear lenses do better than the extended wear lens folks. Because they care for the lens, they clean the lens before they put it back in. But even with daily wear lenses there’s a higher rate of problems than there is having Lasik surgery done.
List off the problems, I guess it starts with some kind of an infection and then it can get progressively worse?
Dr. Whitman: Infections, unfortunately, start without symptoms in most contact lens patients because the contact lens is actually covering over the irritated area. Often they wait a long time before they get in to the doctor. By the time they take out the lens and can feel it, they may have already had not just an infection but an area where the bacteria has actually eaten the corneal material and they have a frank ulcer that can cause scarring and cause permanent change in your vision.
I guess that’s what happened to Becka. Let’s talk about Becka. She was a young girl who went in to the Air Force and became a mechanic. Obviously she needs her eyes, it’s very important. I guess she got a little lazy about taking care of her lenses and probably kept them in too long.
Dr. Whitman: Here’s somebody that was very professional about many things. She could repair a jet engine in the Air Force, but she didn’t think about caring for her lenses in the same way and she developed ulcers more than once. These were treated and got better but eventually she realized this was a problem and she had to stop wearing contact lenses because it became a chronic problem for her.
Why did she keep having ulcers if she got some medical treatment? Did somebody say, listen you’ve got to do a better job in this?
Dr. Whitman: The reason she continued to have problems is because she would still abuse the wear of her contact lenses; she wasn’t taking care of them properly. She would wear them too long and she would get another ulcer. Having it treated one time doesn’t mean that you can’t have the same problem again, and this was her problem. Eventually it meant she had to stop wearing contact lenses.
That meant she had to wear glasses?
Dr. Whitman: She had to wear glasses and she did not like wearing glasses.
The dreaded glasses? Becka she might not have taken great care of her contacts but she probably hated wearing glasses.
Dr. Whitman: That’s why she came to see us, she realized she could not wear contacts any more but didn’t like the glasses. Lasik was a good alternative for her.
Did I read correctly that she was at a point where she was basically legally blind?
Dr. Whitman: Absolutely. Becka was legally blind without wearing some type of prescription eyewear whether it be contacts or glasses. So think about it, if you’re working if you lose your glasses, your glasses fall off and you can’t see, you’re in big trouble.
Which she still is an airline mechanic or airplane mechanic. Had she wanted Lasik but chose the contacts or how did that go? Eventually she got back to the idea that maybe Lasik could help me but then there was damage in her eyes to the point where it might have been too much damage?
Dr. Whitman: Well I think she was concerned that maybe she could never have Lasik because she had the ulcers and the scars and that’s something we had to check out in her. Were any of these ulcers in the central area of her vision that would interfere with the Lasik treatment but thankfully they were not and we were able to do the treatment.
Basically with the Lasik what did you do to her eyes to change them so that now she could see?
Dr. Whitman: Very good point. When we do Lasik first of all we do a complete evaluation to make sure that the cornea is thick enough, that there isn’t too much correction to be able to treat with the laser. Basically what we’re doing is we’re taking one type of laser and lifting a flap in the superficial cornea and underneath it we use the excimer laser to reshape the front of the eye. Basically we’re putting her contact lens prescription, if you will, building it in to her cornea by reshaping the cornea, put that flap back down, it self-seals over the treatment and in twenty four hours it’s already begun to repair itself. Usually most people have excellent vision the next day.
I think in her case it was like a eureka moment.
Dr. Whitman: She saw 20/20 the next day and she could already tell as soon as she got up from the procedure table that she could see better already.
Did you do that procedure?
Dr. Whitman: Yes.
You did it, okay. Tell me about the moment when it was done what did she say, I can see or what happened?
Dr. Whitman: What’s typical of people, particularly when they are born nearsighted, when they get up from the table and there’s a clock across the room, they can see it already and often you’ll see tears in their eye. It’s not from having the procedure done, it’s realizing that hey, I can see and I have nothing in front of my eyes.
That’s pretty much what happened with her?
Dr. Whitman: Absolutely.
You lift up the flap right and then you use another laser and you do cut little slits in the eye?
Dr. Whitman: No, you’re thinking about the old radial keratotomy and we no longer do that because it’s changed over time; it wasn’t long lasting as we thought it would be. The great thing about Lasik is, again, we’re using one type of laser to lift the flap in the cornea. It’s painless, it’s all done with the laser and there are no blades. Then we use a different laser, the excimer laser, to reshape the cornea. Literally it takes twenty, thirty seconds with each laser so it doesn’t take long. The patient doesn’t feel anything from it, it’s pretty much wimp proof is the way I like to look at it. By the time you put the flap back down its self-sealing so there are no sutures or anything like that. It’s very comfortable; you can blink over it right away. The return of vision is almost instantaneous.
You’re really not cutting anything on the eye?
Dr. Whitman: There are no blades when we do Lasik at all. Everything is done with the laser so the laser that makes the flap actually lays down a bed of tiny microscopic bubbles and that gives the area to lift the flap. Then, the excimer laser itself actually changes molecular structure to burst molecular bonds in the cornea, literally. You actually get a burning type smell from the laser but there really is no heat generation, generated at all. And again, it only takes about fifteen, twenty seconds to make the flap; on average, fifteen to twenty seconds to do the reshaping of the cornea. With our latest lasers we can do them faster and more comfortable than ever before.
Is it fair to say it’s not your daddy’s laser anymore or Lasik anymore?
Dr. Whitman: We can go back fifteen years ago and the lasers were very different and there was some discomfort involved. We did not have lasers to make the flap with so we actually used a cutting blade for that. It’s gotten safer, more automated and that’s part of the safety because it’s computer controlled and more accurate.
I remember the blade was part of the procedure that was always the scary thing to me and probably a lot of people.
Dr. Whitman: Well it was always the scary thing to me.
In doing it right?
Dr. Whitman: Well you realize that you have a blade that you’re leaving in an automated machines control to make a cut in to the cornea. With laser I don’t have to worry about that, the patient doesn’t have to worry about that. There’s a tracker built in to the laser that keeps the laser centered over the eye even if the patient moves. It’s safer, more efficient and the results are more predictable than they’ve ever been.
For somebody like Becka, talk about what a difference it’s made for her.
Dr. Whitman: Becka is now like someone that never had to wear glasses that had perfect vision from birth. She can go swimming and doesn’t have to worry about whether I can see. She can go water skiing and actually see the back of the boat, just doing her normal work. She doesn’t have to worry that my glasses are going to fall off, or: oh, one of my contact lenses kind of moved over to the side and I can’t see well. She can see well twenty four seven now.
20/20 I guess now right?
Dr. Whitman: 20/20.
She will not need a follow up surgery down the road like the old ones?
Dr. Whitman: No, most patients never need surgery in the future, but one of the things that people often will look at is well maybe that’s a bad thing in the possibility of doing what we call enhancement surgery. If somebody’s correction changes over time, the beauty of Lasik is that we can re-lift the flap and do a little more treatment put the flap back down and set the patient back on their way.
One thing about Lasik is that it’s not for treating vision so in terms of cataracts or something like that.
Dr. Whitman: It’s not going to prevent cataracts when they get older.
It’s not to prevent other things from happening.
Dr. Whitman: A very good point is that the effect of Lasik never goes away. When the tissue is removed the tissue is removed. But other things can change in your eye. You start to you know patients get in their fifties they start getting some pre-cataract changes. They develop other problems going on in their eye which can happen whether you have Lasik or not. It can change their correction as time goes on. The neat thing is that if the patient is a suitable candidate we can go back and do a little bit more treatment and make that vision hopefully perfect again.
That’s a lot easier perhaps than going in for cataracts or things like that, it may not replace that right?
Dr. Whitman: Now there’s a big difference between Lasik surgery and cataracts surgery, they treat different things. Lasik is really to help us do better with your distance far away vision, assuming that there is no cataract. If you have cataract that’s a cloudiness of the lens inside your eye, we actually have to go in the eye, remove the lens of your eye and replace it with a lens implant. Very different profile, safety profiles. Lasik is easy for the patient to go through.
As far as like these new developments and the ability to fix these problems for people who have misused their contacts what do you call this, this isn’t necessarily a medical breakthrough but it’s like advanced usage of what you’ve got?
Dr. Whitman: Over time we’ve learned how to treat some of the problem eyes that are out there. Let’s say somebody with scarring; and sometimes we can’t do Lasik on them but we can do surface laser treatment. The same laser we use for Lasik but we don’t lift a flap, we just treat the surface. That often can get rid of the scar and let us do a treatment where perhaps we could not make a Lasik flap. We have more than one alternative when we’re using laser.
From the point of view of patient satisfaction and from your point of view of being able to help people you must feel pretty good about the way this is developing.
Dr. Whitman: I think lase has gotten better and better. In fact, in a recent study that was done and was asked by the FDA for a clinical group to do the study, we found out the results of Lasik were better than we ever thought they were. They found that the rate of twenty/twenty vision was over I think eighty five percent. This is in people that are very highly nearsighted, little astigmatism, a lot of astigmatism, and they didn’t even look at people where they retreated to even make them better. The reason we think that it’s better than it ever was, and there are less complications than there have been in any time in the past, is that we have instruments now that help us rule out who’s a bad candidate for it. The people we’re doing now are patients that are really the best candidates for Lasik, so we have the best chance of getting terrific vision.
Who would be a bad candidate?
Dr. Whitman: A bad candidate could be somebody that has a retina problem that doesn’t allow them to see well. A bad candidate can be somebody that has so much scarring in the eye that we either can’t make a flap or we can’t clearly use the laser on the surface because the scar gets in the way.
A machine helps you determine that?
Dr. Whitman: Exactly, and it also lets us know patients that have congenital abnormalities of the cornea where Lasik in fact could make their vision worse if you didn’t know that they had this problem. But now it’s easy to pick up with our instruments now and we can pick out who’s safe for the procedure.
I wanted to make sure you hit the study because wasn’t patient satisfaction of Lasik like through the roof?
Dr. Whitman: There’s a company and a small group that’s very vocal and apparently has money headed by the old head of the ophthalmic division in the FDA and he went out as a lobbyist afterwards. This company hired him and they wanted to get rid of Lasik. It was kind of weird. They brought enough clout by talking to enough people in congress, I guess, that the FDA said: well maybe there’s a smoking gun here let’s get a study done. It ended up that Lasik was far better than anybody thought. The people doing it knew that this was a very safe procedure to perform. But another study that came out recently showed that they compared patients that had Lasik to patients that were wearing their best contact lens prescription and found that people with Lasik were happier with their night driving vision than they were with their contact lenses. Lasik was actually doing better than with what they thought was their best correction by glasses or contacts.
Is there any difference between glasses and contacts when it comes to people’s satisfaction with their vision?
Dr. Whitman: No. If you can correct your vision with glasses you should be able to correct it to the same vision with a contact lens.
And then also with Lasik right?
Dr. Whitman: Exactly. Although there are many reasons that Lasik can give you somewhat better vision because something that glasses don’t do and something that contacts don’t do is that Lasik actually can correct aberrations that we detect within the corneal surface itself. It can actually improve the shape of the eye and give you better vision than glasses or contacts.
That’s partially what happened with Becka right?
Dr. Whitman: Her vision truly is better than actually any of us thought it would be afterwards and the proof is in the pudding. Just talk to Becka, she loves it.
END OF INTERVIEW
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