Articles

09 vision

Difficult Decisions

Dr Marc Tay

Taiwan, 2000

I was woken up in the middle of the night - “Sir, Sir, we have an emergency,” said my medic.

I jumped out of bed and rushed to the infirmary.

A young 20-year-old 2nd Lieutenant was waiting for me in my office with a patch over his right eye. “What happened?” I asked him.

“Sir, I was on a field camp for a week, and I didn’t want to wear my glasses into the field. So I decided to wear my contact lenses for the whole week” he says.

I removed the patch and looked at his eye, it was red and angry. On closer examination, there was clear scaring on the corneal surface. He had developed a corneal ulcer due to the prolonged use of his contact lens and there hadn’t been suitable washing facilities for him to regularly clean his lens.

Here was a young boy who had his entire life and career ahead of him - a year away from entering Stanford University in California, and he may require a corneal transplant! I gave him a long lecture, and proceeded to refer him urgently to a specialist ophthalmology department in the nearby city of Kao Hsiong.

The above example highlights a situation that could have been avoided. Technology has come a long way; we can now do surgery on the eye to correct myopia and astigmatism.

The latest technology available does away with a flap on the cornea of the eye. Instead, a special laser cuts a lens-like disc within the cornea and then through a 4mm cut (instead of a 27mm cut with Lasik).

It leaves very little side effects previously common with Lasik such as dry eyes and night vision aberrations.

Evolution of Lasik

Why did I decide to purchase the Visumax?

After watching a member of my staff, Felicia take the plunge, I know it wasn’t an easy decision for her. We needed a volunteer to help us during a press launch of the Visumax and Relex, and Felicia volunteered. She watched as we completed over 30 patients in Aug 2015 one month plus after the installation of the machine. The outcomes were excellent with approximately 92% of patients obtaining 6/9 vision one week after surgery.

She went through with the surgery and the day after, she rested at home. Two days after surgery she was back at work and other than a little tearing she was back to her routine, alas with perfect vision.

I was jealous; I wanted to experience it too. I have been wearing glasses from 11 years old. From 17, I started to wear gas permeable hard lenses. So for over 3 decades when I took my gas permeable lenses off, I was legally blind. And wearing my think glasses wasn’t really an option.

I have always been very sporty, enjoying my various sports, swimming and running regularly. I golf year round and snow ski in the winter. Wearing my gas permeable contact lenses allowed me to enjoy my activities but not without occasional difficulties. Skiing in winter with contact lenses would leave my lenses feeling like “potato chips” by the end of the day.

This year, I am looking forward to the freedom of being able to see with my own eyes again.

I have never really considered Lasik - first of all my myopia was relatively high, so doing Lasik with high myopia requires quite a bit of corneal tissue. The excimer laser would have to work hard and vaporize quite a bit of my corneal tissue leaving me with a very thin layer left over.

I was never really a big fan of having a flap on both my eyes, particularly since I did such active sports. While the flap does heal it never really heals fully and this has the possibility of separating with blunt trauma to my eye. Not a great idea when you ski downhill at 80+km/hr.

So when I heard about Relex, I was intrigued. Dr Eugene Tay introduced this technology to me and he was very passionate about it. He felt that it had many superior attributes compared to the other available refractive procedures:

  • No Flap
  • Less Dry Eyes (less corneal nerves affected as no flap is cut)
  • Stronger cornea
  • One step

Hence I made the ultimate decision to proceed with my surgery on the 30th of Oct 2014

The day of my Surgery

The numbing eye drops didn’t feel like much. Once I was rolled into the theatre and positioned onto the surgical bed. Everything seemed to proceed like clockwork. I was positioned under the warm blue glow of the visumax machine.

Dr Tay moved the lens into position under my right eye and slowly lowered the lens onto my cornea. Once contact was made with my cornea, all I saw was a blinking green light. There was absolutely no sensation whatsoever. No pain, no discomfort, nothing!

You see a water mark slowly enlarge till it fills your vision and then suction is activated. Again nothing!

Dr Tay activated the laser and your vision gets increasingly blur till the blinking green light barely appears in the distant. All it took was approximately 20 seconds for me but it really depends on your degrees of correction.

Once the auction was disengaged, the lens retracts. I saw a bright light as Dr Tay uses his instruments to extract the lenticular. All you would feel is a gentle sweeping of the instruments on your eye. Again there was no pain, just a little discomfort. This was all over in another one to two minutes.

The whole process is then repeated on the second eye. All in all the whole process took around 20 minutes or so. I felt a little tense through the whole process but that is normal. It was difficult opening my eyes after it was all over. I tried to open them later when I was in the recovery area. Things seem a lot brighter. And my eyes were watering constantly. They applied the antibiotic eye drops post-surgery and I was sent home to rest.

Once I got home my eyes were throbbing. They started to hurt a little. It wasn't a sharp pain but more of a dull throbbing pain pulsating across both eyes. My vision was a little hazy but already I could see relatively clearly, better than without my glasses. The sleeping pills provided came in very useful. My suggestion is to start with one or just take both so that you can sleep immediately. Also, make sure there is someone to bring you home.

Three hours later I woke up from my nap and opened my eyes. The pain and throbbing had gone entirely. My vision was hazy but I could see relatively well. I had my surgery late morning, napped till about 5 pm and the rest of the day progressed without incident. I watched TV that night. It was a little blur but overall it was acceptable.

The next day I woke up and looked outside into the greenery. Everything was clearer than the day before but still a little hazy. I went for my eye check up got a all clear from Dr Tay. I proceeded to continue with my full day in the office. There was absolutely no pain or discomfort - I religiously applied my eye drops when required. By the end of the day I felt comfortable enough to get into the car and drive. There was no pain or discomfort. And there was certainly no halos or dryness.

My vision was slowly improving. I felt the most improvement in the first two days post-surgery. By the second-day post-surgery, I felt well enough to play a round of golf. I had no problems with the exception that I could not see my golf ball land in the distant.

All in all, the difficult decision proved to be one of the best decisions.

This article is written by Dr Beng Teck Liang, Chief Executive Officer of Singapore Medical Group (SMG).