On March 14, 2008, I had an all-laser LASIK surgery performed on both eyes by Dr. John D. Olkowski of Eyesight Hawai’i in Honolulu, Hawai’i. According to his website, Dr. Olkowski is a “fellowship-trained corneal surgery specialist who has been practicing in Hawaii since 1990. He has performed thousands of laser vision correction surgeries, even on other LASIK surgeons… He is experienced in corneal and refractive surgeries including LASIK, PRK, Cataracts and Corneal Transplants and is the most experienced Crystalens Cataract surgeon in Hawaii.” His website says a lot of great things about him, but back to my story.
Dr. Olkowski used the IntraLase Method to create the flap on my eye and then the VISX Star S4 IR excimer laser to perform the laser surgery. It was, as any surgery, a slightly traumatic experience that I wished to forget about once it was over and I had perfect vision.
To speak of the surgery itself, two parts of the procedure surprised me. The first was the amount of pressure applied to my eyeballs by a suction cup pressed down on them by Dr. O less than a minute before the flap creation process. I honestly thought my eyeballs had permanently been pushed half an inch deeper into my head. As it turned out, the pressure had been hard enough to create bloodspots on the whites of my eyes. Since the bloodspots remained on my eyes for about one month after the surgery, I vigilantly wore sunglasses during that time so I wouldn’t scare anyone who looked at me. I don’t think it is common for LASIK patients to experience blood spots on the eyes, but I sure wish Dr. O would have included it in the informational handout so I wouldn’t have panicked after waking up from my post-LASIK nap and looking in the mirror. The second part of the surgery which came as a surprise was the metal eye spring inserted around my eyeball to keep it open. The prongs were not exactly soft and during surgery, one of them painfully jabbed the top of my right eyeball, creating a lot of tension and discomfort for me. Ironically, my right eye is perfectly fine today.
My left eye, though, never quite made it. After placing the flap back on my left eye, I remember Dr. O brushed it a bit more than he had brushed my right eye. I wonder if he already knew then that the flap wasn’t going back on well. While the crisp, clear vision in my right eye was immediately noticeable within three days time, my left eye produced what I can only describe as a ghostly reflection of letters whenever I looked at signs.
In all the dozen or so follow-up/post-operative examinations I had (which I now believe are really just ways to stall patients who want to litigate), Dr. Olkowski kept insisting that my eyes were doing great and everything was fine. Yes, I guess since my retinas hadn’t detached and I hadn’t gone blind, everything really was going fine.
Beginning at the one week follow-up when I asked him about my left eye, he would respond that my eye hadn’t completely healed yet and it would be six months before my eyes would reflect my true vision. But at our three month follow-up when I asked him about my left eye, he began to answer differently by saying that I was [unfairly] comparing the not-as-perfect vision in my left eye to my more-than-perfect vision in my right eye.
I was concerned about the blurriness from certain angles, the pronounced ghosting, and the fact that everything I saw through my left eye appeared a little thinner than everything I saw through my right. But no one at Dr. Olkowski’s office seemed to hear me and Dr. O never addressed it. All he would say was that the vision in my left eye was 30/20 [so what was I complaining about?].
I was not apathetic about my concerns after the surgery; I sought a second opinion from another well-known lasik eye doctor in Honolulu on what had happened. After looking at my left eye, the doctor found 5 microscopic spots of “interface debris” on my cornea. The doctor guessed that perhaps it was this debris that was causing the ghosting (double vision). The doctor’s recommendation was to lift the flap, clean the area out, and replace the flap. This recommendation was different from what Dr. O proposed to do, which was another LASIK procedure.
After half a dozen unproductive post-op visits, suddenly, at my 6 month post-operative checkup, Dr. O quickly suggested an “enhancement surgery” for my left eye.
“ENHANCEMENT” SURGERY
March 6, 2009, a year after my initial LASIK surgery, I endured Dr. O’s strange inability to be honest with me and underwent another corrective surgery by him. My decision to do so was based on a hope that a lasik surgery by the same doctor who was familiar with my eye would have a higher probability of achieving successful results than a new doctor. At that time, I wrongly expected the second surgery to simultaneously burn off the interface debris AND correct the astigmatism that both doctors mentioned I had. I did not understand (the information was not shared) that the astigmatism was an unnatural one caused by a lasik-induced corneal irregularity.
Had I known that the chances for success for this kind of case were slim and the risk for damaging vision greater the second time around, I never would have elected to have the second surgery. I did not know this because I trusted Dr. O’s answer to my question to him, “What are the chances that having a second surgery will result in my eyesight getting worse?” He answered, “1%.”
The enhancement surgery was quick and pleasant compared to the first surgery. Dr. O placed the eyespring over my left eye so gently that it felt OK, not raking my eyeball. He was precise during the procedure and I was a very good patient, keeping very still as I had done before.
Four days later, my left eye was doing worse than ever. I no longer had a prominent ghosting problem, but a glare problem. Nothing I read, near or far, was clear. Letters, seen by my left eye, had no distinct edges and were all a blur. Comparing the results now, I would have preferred to have my previous condition of clear vision with ghosting over this universal blurriness.
I visited my second opinion doctor again so I could hear “the real deal” about my eye and not the fluffy nothingness I was getting from Dr. O. He looked at it, tossed his hands up and and said that while the debris were no longer an issue, I still had one diopter of astigmatism just as before. At that time, not understanding my true condition, I thought to myself, “Great, Dr. O didn’t correct my astigmatism.”
SEARCHING FOR THE TRUTH
October 2009
It has now been seven months since my “enhancement” surgery. Today I went to have my eyes examined by an optometrist in San Francisco, hoping he could at least give me some glasses to fix the “astigmatic” vision in my left eye. (Imagine yourself with one eye with clear vision and the other with blurry, it’s not very comfortable). Dr. Mak found that there were seven spots on my corneal surface and wondered if they were inducing the blurriness. He noted that they were too perfectly round to be debris, but were perhaps scars. (!!!!) He also found that the corneal flap itself was not cleanly cut and that there was a little bit of displacement. Interesting, because I always thought I could detect a little bit of a “bump” at the edge of the flap on that eye.
Dr. Mak tried to make an eyeglass prescription that would improve my eyesight, but even after putting on some test lenses, the blurriness was still there. Now he was sure it had something to do with the corneal flap or the scars he had seen on my cornea. He is having me see another doctor next week, one who went to Stanford Medical School and specialized in LASIK, to see if there is anything that can be done.
The possible truth, though illuminating, is still devastating. The vision in my left eye before LASIK was at least correctable with glasses, but now nothing, not even glasses, will be able to correct it and I will have to live with this blurry/double vision out of my left eye for the rest of my life.
UNDERSTANDING
December 7, 2009
Two months after seeing the optometrist, Dr. Mak, I saw the young Stanford trained eye doctor. He surmised that my left eye had one (or all) of three problems:
- interface debris
- far-sightedness and astigmatism
- corneal irregularity
The third issue of the corneal irregularity he could not be sure of because he did not have the equipment at the clinic to gauge the irregularity. He recommended I visit him at his office and he would take a closer look with his equipment.
I decided not to go see him, but instead, went the Stanford University Eye Center to get a comprehensive scan and checkup of my eye with all of their top-notch equipment.
After looking at the charts I had faxed from both Dr. O’s office and my second opinion doctor’s office, the doctor at Stanford, Dr. Manche, explained to me that what I had was a lasik-induced corneal irregularity which also created my far-sightedness and astigmatism. What this meant was that the surface of my cornea was not even; it abnormally dipped in some areas and bumped up in others. It was this irregularity which was creating the blurring/ghosting and the astigmatism.
How, with a Custom-Vue procedure, was this possible? Was it some strange side effect of my eye during healing that created these irregularities?
Dr. Manche recommended a hard contact lens for my left eye as the only way to correct the vision. Technology, he noted, was not yet advanced enough to correct a case like mine. He said I should return in 5 years and see whether technology could help me then.
In summary, my eyesight in both my eyes is technically better than before when they were both -3.25. I can certainly see without glasses, especially with the vision from my right eye automatically becoming the “dominant” eye. I now have the dry eye condition that afflicts most Asians who opt for LASIK, which is unfortunate but manageable (Dr. O and I never had a discussion/conversation on this at any point because I prioritized the other issue constantly). My left eye did not attain the normal vision (vision without ghosting or glare) that I hoped for and had dared to expect.
CONCLUDING THOUGHTS
From March 2008 until November 2009, I never missed a post-operative check-up with Dr. O, but he was always the same at every check-up, tight-lipped and always chirping, “You’re doing great! The operation was very successful!” when obviously the truth was staring at him in the face and he wouldn’t level with me. I understand, these days, people sue doctors for a paper cut, but I think I was very reasonable with him. I was a good patient; I was a GREAT patient. I would have appreciated just a little, just a teeny smidge, of honesty from him. He never bothered, and I have a very strong feeling it was because he believed that his patients were not capable of understanding the information. The overwhelming trend throughout my 20 months as his patient was that he only provided as much information as he thought a patient *should* know so he could do his job without any “interference”.
Six months after the second surgery, Dr. O offered me a third try at “enhancing” my left eye, but there was absolutely nothing left that would have enabled me to trust him. It was only one month later that Dr. Mak told me “enhancements” thin out the cornea and have usually just made people’s vision worse and worse to the point of blindness if taken that far. Dr. O never shared that information with me while I was his patient.