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[【学科前沿】] Lasik:虚荣的代名词?

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发表于 2008-4-5 07:43:40 | 显示全部楼层 |阅读模式
Lasik Surgery: When the Fine Print Applies to You

That’s the only way I can explain why I willingly let a doctor cut my corneas with a laser: vanity.

Little did I know when I chose Lasik surgery that I would not end up satisfied like the friends and acquaintances who raved about their post-glasses existence. Instead, my days are complicated, since I am dealing with side effects that are far more bothersome than being unfashionably four-eyed.

I had been wearing eyeglasses since I was 8, and I was tired of never seeing the stars without glare, of not being able to go rock-climbing unless I secured my glasses. Not to mention the horn-rimmed barrier between me and a date.

I had trouble figuring out which side of a contact lens to stick onto my eye, so I never really gave contacts a chance.

I had been considering Lasik — short for laser-assisted in situ keratomileusis, which entails cutting and reshaping the cornea — since the Food and Drug Administration approved it in the late ’90s. Because I was not too nearsighted and not too old, ophthalmologists told me I was an excellent candidate. But I wanted to wait until more people had gone under the laser.

Roughly 800,000 patients have had Lasik annually since 2000, spending about $2.5 billion on the procedure every year, said David Harmon, the president of Market Scope, a research company for the ophthalmic industry in Manchester, Mo.

The American Society of Cataract and Refractive Surgery reports a 95.4-percent patient satisfaction rate for Lasik, based on a recent analysis of research worldwide. The researchers found 19 studies specifically addressing patient satisfaction from the last decade, encompassing roughly 2,022 patients. (Some had been post-op for a month; others for a decade).

Most ophthalmologists are confident about the efficacy of Lasik, as well as another popular procedure — photorefractive keratectomy, or P.R.K. Both are designed to correct nearsightedness, farsightedness and astigmatism.

“It’s very few people who don’t have a superb outcome, especially with the new technology,” said Dr. Marguerite McDonald, the president of the International Society of Refractive Surgery of the American Academy of Ophthalmology.

About five of my friends had undergone the surgery. “Life-changing,” they cooed. “Miraculous!” Because my 40th birthday was looming, my parents offered me either a cello or Lasik. I chose Lasik. But first, I looked up studies online and consulted three doctors. Each did a spate of tests and pronounced me an excellent candidate.

I asked about the risks, and they explained that some people come away with dry eye, double vision, decreased contrast sensitivity and decreased night vision. Some see halos around lights. I was assured these side effects were rare, and usually fleeting.

Ultimately, I chose Dr. Sandra Belmont, the founding director of the Laser Vision Correction Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Belmont also runs a corneal fellowship program at Manhattan Eye, Ear and Throat Hospital.

A doctor who was a patient of hers recommended her. She charges between $4,500 and $5,500; I paid $4,500, nearly $1,000 less than other quotes I had received, a consideration since my insurance, like most, does not cover elective surgery.

I signed a consent form confirming that I understood the risks. I thought I did understand them. I did not know then that 5 to 10 percent of patients need to have their vision fine-tuned — or in industry parlance, “enhanced” — after surgery because of an under- or over-correction, according to John Ciccone, a spokesman for the American Society of Cataract and Refractive Surgery.

Nor had I spoken to any individuals who wished they had never had the procedure — of which, I have since learned, there are plenty.

On April 13, 2007, I had the surgery. Dr. Belmont’s colleague examined me the next day. My vision was a little blurry, but apparently that was normal. Dr. Belmont said that everything looked good on subsequent visits, too. But the blurriness never went away.

At night, I saw halos around streetlights; neon signs bled; the moon had two rings around it like Saturn. My eyes felt sore, a result of dry eye, which also causes sporadic blurriness.

Dr. Belmont told me that sometimes women of a certain age who are undergoing hormonal changes or who take certain medications get dry eye. It would have been nice if I’d known my advanced age (39) might be problematic before I sat in the chair.

I cut out all prescription and nonprescription pills. Didn’t help. The doctor told me to use Refresh Plus, over-the-counter drops that temporarily help dry eye. The drops cost around $12 a box; I go through two boxes a week. She also prescribed Restasis eye drops, which can help increase tear production. They didn’t for me.

True, I no longer wear glasses. But the 20/20 line on the eye chart is blurry. I can make it out only if I squint, and it takes about a minute to read. My doctor views this as proof of the surgery’s success.

“I do see it as a success,” Dr. Belmont told me in a recent interview. She also has said repeatedly that these troubles will pass. “In 18 years of practice, I’ve never had a patient whose symptoms don’t go away. Most patients take three to six months to heal.”

But I see my slow-squint reading as a sign of failure. I thought I’d be able to decipher words in the real world at a glance. My consent form said: “The patient understands that the benefit of the Lasik/P.R.K. procedure is to have an improved uncorrected visual acuity.” I took that to mean that my eyesight would be 20/20. Most doctors, on the other hand, focus on the words “improved uncorrected visual acuity.”

“Not every patient has the potential to see 20/20,” Dr. Belmont told me this month. So, if your eye can see 20/20 with glasses or contacts, the doctors try to replicate that, but there are no guarantees. Dr. Belmont said, “You do the best that you can.”

On its Web site (www.fda.gov/cdrh/lasik/risks.htm), the F.D.A. cautions patients to “Be wary of eye centers that advertise ‘20/20 vision or your money back’ or ‘package deals.’ ” (Still, some refractive eye surgeons’ phone numbers end in 2020.)

Nearly a year later, my problems remain. Still, I’m not mad at my doctor. I’m mad at myself. No one forced me to do it. In our quick-fix culture, we forget that there are risks with any surgery, elective or not.

Between 1998 and 2006 the F.D.A. received 140 negative reports relating to Lasik, including double vision, dry eye and halos, said Mary Long, a spokeswoman. Granted, this is not that many, but Ms. Long said, “If this many people are responding to an adverse event, there are probably others who are not.”

After concluding that too few well-designed studies have examined quality of life after Lasik, the F.D.A. put together a task force in 2006 to design a clinical trial to explore the subject. A pilot study is now under way at the National Eye Institute in Bethesda, Md.

LOOKING back, I do not think my doctor and the other experts I consulted adequately represented the pitfalls. It’s one thing to say that dry eye is “annoying,” as Dr. Belmont did; it’s another to explain how feeling as if your eyes are coated in Vaseline may make every waking moment a chore.

Perhaps it depends on what your definition of success is.

“People say, ‘Well, you don’t wear glasses anymore,’ ” said Barbara Berney, 53, of Rockford, Ill., who had the surgery in 2001 and now reports dry eye, night blindness, dimmed vision, halos and starbursts. “Unless you see what I see, you have no frame of reference.”

Unhappy Lasik patients, some with worse experiences than mine (one man I spoke to needed a corneal transplant), have created about a dozen Web sites. The 12 patients I talked with all reported feeling as I did, gaslighted. They said they kept telling their doctors that they couldn’t see, and that their doctors kept telling them that they could.

A few doctors have told me that they think they can help my dry eye, but I worry they will suggest more surgery, and I haven’t gone to see them. A few optometrists said they could fit me with special lenses to moisten my eyes, and I may have to go that route.

Meanwhile, I walk by eyeglass shops and wish I needed to go inside.

事到如今,对于解释我为什么要进行Lasik手术的原因,只有一个,那就是:虚荣

不像我那些周围的朋友或是熟人,他们在选择lasik手术之前,都对手术可能带来的“眼镜后时代”充满了期待;我是什么都不了解的情况下就稀里糊涂去做了手术,因此也就不会感觉非常满意。现在我的生活变得更为复杂,现在我所面对的LASIK术后的副作用,远远超过“四只眼”带来的麻烦。

我从8岁的时候就开始戴眼镜了,我对看不清夜空中的星星烦透了,对攀岩时不得不固定镜架烦透了,更对约会时戴着眼镜的糗样烦透了。

我总是学不会隐形眼镜的正确戴法,所以我从来也没有接触过隐形眼镜。

所以我一直在考虑Lasik,就是“激光原位角膜磨镶术”,这项技术在上世纪90年代就被FDA认可了,因为我的近视不是很严重,也还年轻,眼科医师都说我很适合做这个手术。但是我还是有顾虑的,想看看更多人手术后的效果再做决定。

曼彻斯特眼科研究公司的主席David Harmon说,自从2000年以后,每年大约有800,000人进行这个手术,花费达到25亿美元。

根据一项世界范围的大型分析显示,Lasik的手术满意率达到了95.4%;这些研究总共收集了过去10年中19项研究中的2022名患者的数据。

多数的眼科医生对Lasik以及P.R.K有效性相当有自信,这两项手术的都是用来矫正视力异常的,包括近视、院士和散光。

眼科的权威人士 也说,很少有人会在术后说这个手术效果不好,尤其是手术方法改进之后。美国眼科学会国际屈光外科学会的主席Dr. Marguerite McDonald说道。

我又5个朋友做过了这个手术,都说“宛若新生”、“神奇无比”,在我40岁生日到来之前,他们商量着要给我送件礼物,或者是一把大提琴,或者是一次Lasik体验。我选了后者,但事先,我仔细研究了网上的报道,并咨询了3个医生,每个医生都对我进行了详细的检查,都宣布我非常适合进行这个手术。

我问了会有什么副作用,他们说,可能会有眼睛干涩、复视、对比敏感性下降、视力下降,有些人会有光晕感,但是他们都说这些现象很少出现,即使出现也是短暂的。

最后,我选择了纽约-长老会医院的Dr. Sandra Belmont,她本身还在进行角膜课题的研究。

有1名医生,同时也是她的手术病人,向我推荐了她,说费用大概是4500~5500美元,但是最终我只付了4500美元,这是因为保险的缘故。

我签了手术知情同意书,证明我自己已经了解了风险。但其实我根本就不知道,有5~10%的手术病人要在术后进行视力调整,这是因为调整的量很难界定,可能过头或是不够。

但是我没有和那些后悔手术的人交流过,后来我才知道,这样的人是很多的。

我在2007年4月13日做了手术,第二天就做了复查。我的视力有点儿模糊,但是显然这是正常的。Dr. Sandra Belmont在后来的检查中都说手术是成功的,看起来没什么异常,但是我的眼睛一直很模糊。

晚上我感觉街灯有光圈现象,霓虹灯很模糊,月亮看起来重影,因为眼睛干涩导致疼痛,是不是的还有视力迷糊。

Belmont医生事这样解释的,她说有一些更年期的女性或是正在服用某些药物的女性会出现这种现象。我真后悔,如果我知道年龄会产生这么大的影响,我肯定会多考虑一下再决定是否手术。

我停用了所有的处方药和非处方药,还在医生的建议下使用了两种治疗干眼症状的眼药水,但是,都没有用。

确实,我不用再戴着沉重的眼镜了,但是我再也看不清楚视力表上的小字了,除非我斜着眼睛看一分钟。我的主刀医生却把这个结果看作是成功的标志。

在最近一次随访中,Belmont医生对我说,她觉得手术还是很成功的,并不断强调,这些不适的症状会消失的,在她18年的从医经历中,还没有看到过任何一个病人额这些症状不会消失,多数的人只是会持续3到6个月。

但是我觉得这个手术是失败的。知情同意书上写的是:患者了解这项手术的益处是改善非矫正视力,我就以为自己的视力会达到最佳的20/20,但是多数眼科医生会纠缠于“改善非矫正视力”这句话。

我的手术医生告诉我,并不是每个人都能够达到20/20的视力。因此,如果你在戴框架眼镜或是隐形眼镜的情况下能够达到20/20的视力,那你做这个手术的时候,医生也会尽力让手术效果达到这个水平,但是没有绝对的保证,只能是尽力而为。

在FDA网站上有明确警告:请小心对待眼科中心的广告,说什么术后视力可以达到20/20,否则无效退款,打包服务等等。

差不多过了一年,我的症状还是老样子,我并不责怪手术医生,我只是埋怨自己——没有人强迫我去做这个手术,在这个快速达标的文化氛围里,我们忽视了其实任何手术都有风险,无论是必须进行的手术还是选择性的手术。

在1998年至2006年之间,关于Lasik负面报道总共有140起,包括复视、干眼和光圈感,女发言人
否认说,其实没有这么糟糕,但是她也承认,假如真有这么多人报告出现了副作用,那肯定会有更多人出现了副作用但是没有报道出来。

最终的结论是,现在还没有设计完善的试验来验证Lasik术后病人的生活质量,因此,FDA在2006年的时间下令进行一项临床试验来明确这个疑问。一项先导试验已经由国家眼科研究所在进行了。

回头来看,我觉得我的手术医生和咨询过的那些医生都没有将手术的缺陷明确告诉我,比如,干眼症状实在是让人烦恼,就像Belmont医生说,或者是,每天睁着眼睛的时候,都会感觉有凡士林抹在眼睛上,那种感觉会让人抓狂。

但也许,不同的观念来源于个人对于成功的定义。

53岁的Barbara Berney说,有人会说,你再也不用戴着厚重的眼镜了,但除非你体会到我的感受,你是很难正确评价的。他在2001年接受了Lasik手术,现在的他每天忍受着干眼症状、夜盲、视力下降、光圈感和飞蚊症的痛苦。

心情郁闷的Lasik手术患者,有些人的经历甚至比我还要糟糕(有一名患者需要进行角膜置换),这些人已经建立了12个网站,与我交流过的12个人有着和我一样的感觉,就像看煤气灯一样朦胧。他们不止一次和手术医生抱怨说看不清楚,他们的医生也就重复回答,说你们可以的。

有少数几个医生说他们可以治疗我的干眼,但是我担心他们只会建议我再做更多的手术,所以我后来再也没有去看过他们。也有几个医生说,可以给我配置特别的镜片让眼睛感觉湿润些,我正在考虑接受这个方法。

还有,今天我路过了眼镜店,我真是希望我能够进去。


  LASIK术后容易得干眼征啊
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