JANE WEISS / Opthamology
Fixing a Lasik Enhancement
CRAIG MULCAHY PHOTOGRAPH
One of Dr. Jayne Weiss’ toughest cases was referred to her in order to fix a complication after Lasik enhancement. The patient had Lasik years earlier but then lost some of the effects, so she ended up having a touch-up enhancement procedure.
When Lasik surgery is performed, a flap is cut into the cornea and lifted up in order to be able to correct a patient’s vision. The flap is then put back into place and smoothed down.
During this particular procedure, there were a few complications.
The original flap tore, so there was a piece of the original flap that was separated. Then the patient’s vision ended up decreasing because of cells that grew underneath the original flap.
Coming out of Lasik surgery, the patient was looking for vision without glasses to be pretty close to perfect, but instead the vision with or without glasses was so poor she couldn’t see the large letters on the eye chart.
“These cases are very difficult because the actual flap is probably around 180 microns, which is tenths of millimetres ... it’s teeny-tiny. It’s like a sliver of cellophane; really thin. The individual was referred to me because it was such a complex case.
“I have the opportunity to consult other doctors from around the world, but no one had one good answer for this case. So basically, it was, ‘you can try this, you can try that,’ but there was no definitive answer. Even the top people in the world who are colleagues of mine didn’t have one answer.”
The patient opted to go ahead and do the procedure that Weiss recommended, even though the surgery was risky and there was no guarantee that it would work. If even a small sliver of the patient’s eye flap came off during the procedure, the patient wouldn’t have been able to see with or without eyeglasses.
The surgery was going well until Weiss discovered pieces of the old flap that had come off in the patient’s eye. Weiss judged that it would be better if she stopped the surgery rather than continue and risk the patient’s vision.
“Quite fortunately, I was able to smooth the flap down and leave it in place before any damage was done. There was more that I wanted to do – take out more cells and such – but sometimes in eye surgery, the enemy of good is better,” says Weiss.
“You can walk to the edge of the cliff, but if you go too far, you fall off. That’s where experience and judgement of the surgeon comes in. I always tell patients that there are three things that get a good result: one is my skill, two is you listening to me, and three is something we can’t predict. You can’t predict everything in eye surgery. So at that point, I realized I had gone far enough and if I did any more it would be too risky.”
The day after the surgery, the patient was seeing better and was pleased. As time went on, Weiss saw the patient periodically and thought that she must be doing fairly well because Weiss hadn’t heard from her. Two days before they were scheduled to have a big family event, the patient came into the clinic, and Weiss discovered that her vision with glasses or contact lenses was close to perfect.
“I was boggled. It was really amazing and the patient was very happy and thankful. I was very happy and also surprised, because I couldn’t get any other doctor to tell me of such a wonderful result with a patient they had had before.” She and her family were so grateful that they invited Weiss to their family event.
“I had seen them when they were having problems and it was such a trial, and then to see them at such a happy occasion, and see the patient doing so well ... it’s why you become a doctor. It was very rewarding. It’s why I do what I do.”