Photos and text by Enzo Diaz

As I type this blog, it has been 15 hours from my LASIK surgery. My eyes are still a blurry but I am fully functional. The bring light coming from the morning sun still hurt my eyes but I am fully functional. In fact, in the evening of the operation, I was out having dinner with friends from 7:30 to 9:30; having some red wine in Bistro 101 with my old friends from 9:45 to 10:30 and played Texas hold ’em till midnight. I owe all of these of course through the expert handling of the doctors and nurses of American Eye Center.

Laser-assisted in Situ Keratomilieusis (LASIK) is a procedure used to eliminate or reduce near sightedness (Myopia), far-sightedness (hypertopia) and/or astigmatism. I had this procedure four years ago when my eyes had a grade of 2.50. Yes… thats right! It was not completely eliminated the first time around so I had to do the enhancement procedure again to clip down my 1.50/1.25 vision. And because of the lifetime guarantee of the American Eye Center, I didn’t shell out any fee (otherwise, a new LASIK procedure will cost Php 68,000 or US$1, 300.00 for both eyes)

Furthermore, during my first operation they don’t have Wavefront technology yet. This wavefront-guided LASIK is a variation of LASIK surgery where, rather than apply a simple correction of focusing power to the cornea, a spatially varying correction is used based on measurements from a wavefront sensor (from Wikepedia). In short, this new technology takes into consideration the uniqueness of your eyes. Hopefully this new procedure will not call for a third procedure down the road.

Pre-screening. Not All Can See the Light.
Are you a good candidate for LASIK Surgery? The only way to find out is to undergo the preliminary screenings. The screenings are given for free (except for the Retina test which cost around $12.00). The screening involves the following:

Automate Refraction Test — This is a test were the computer estimate the grade of the eye while you look at an asterisk or a “house” or a “truck”.

Corneal Topography– This generates a digital image (color map) of the contour or curvature of the corneas,

Specular Microscopy/ Pachymetry – The machine determines the status of the cornea in this test. The corneal cells are counted and the corneal thickness is measured. If your cornea is not that thick, you may not get the procedure.

Air Puff Tonometry — A small blast of air will be directed towards your eyes to determine your eye pressure. If your eyes don’t hold enough pressure, this might eliminate your chances.

After the machine tests, you will also undergo a manual Refraction (or manifest refraction). The optometrist will determine manually the grade of your eye by looking at those letters with varying sizes. This will confirm the results given by the machine.

The last test, and perhaps the most crucial, is the retinal screening. Eye drops will be instilled to dilate the pupils allowing the retina eye specialist to examine and look at the retina. If your retina has marked deterioration or determined weak, you may bid laser surgery goodbye. If you are going to have this test, your pupils will be dilated for four to six hours. If you are driving, you are strongly advised not to (so take this into consideration when you are going for the screening).

One final note on screenings: American Eye Center does LASIK surgery on Fridays and Monday and other kind of surgery on Tuesdays and Thursdays. As you can see from the pics, it can be quite chaotic with all the patents and their companions jamming the waiting areas. The best time to come is on Wednesday. But be sure to call first and ask if the Retina specialist is holding office for that day so that you can have all the test in one visit

Operation Day
As I said, it is quite chaotic during operation day. There are a lot of people up for operations. Along with them are two to three of their companions. Add to this, the people who are coming in just for the pre-screening and you have a scheduling issue. But be that as it may, the nurses are aware of your schedule and from what I can see they have a tight lid on necessary steps to be taken. You don’t feel you are wasting your time at all.

Before you go under the light, you will be subjected to another battery of test and orientation. My surgery was scheduled at 1:30pm and they requested me to be on site by 11:30am. Bascially all the test during the pre-screening are performed (except for the retina screen and the Air Puff test). They perform also what they call the Wavefront Diagnostic. This machine will read the unique properties of the eye to be used by the LASIK machine later during the surgery.

Another pre-op activity is the specular Microspy. This is done inside the operating room called laser suite using the same LASIK machine that will zap your eyes later. The patient will be asked to put on a light blue scrub, complete with a plastic head cap (like a shower cap) and shoe covers. You will be asked to lie on your back while the technician guide the machine to take a photograph of your eyes.

Prior to operation, the nurses will instill dilating drops in your eyes. They will measure the dilation and it should measure, at the minimum,7.0mm. This is where my eyes had a hard time. Instead of having the operation at 1:30pm, I had to wait for some two hours before my eyes reach the prescribed measurements.

Operation Time
You will wait for your turn inside the operating room. But before you enter the room, they will ask you to put on this blue scrub along with the plastic head cap and the shoe covers.

The operating room is basically divided into two. One part is the waiting room and the other part is the laser suite. The room is divided by red doors and a glass window. The glass window allows those in the waiting room to see how the drama unfolds. A TV monitor will show what is currently happening to the patient’s eye that went before you.

If you feel that you need your mom, dad or significant other to be in the operating room holding your hands and cheering you, you may request them to be present during the procedure.

Laser On
The consent form details what happens during the procedure:

“During the procedure, you will be lying on your back under the laser machine and you will be asked to fixate on the red blinking light. The eyeMD will then create a corneal flap with an automated instrument called a microkeratome. In some cases, the opening of the eye may be inadequate to accept the microkeratome and sure proper fixation. Your surgeon may opt to perform a relaxing incision the lateral aspects of your lids to allow the microkeratome to be positioned properly. Once the flap has been made the and eyeMD is satisfied with the position and the alignment of your eye, the laser will be activated and treatment will begin. You will see a faint flash of blue light and hear a clapping sound as the laser is operating. You will not feel the laser action, although you may smell ozone as the laser photodecomposes the corneal tissue. You will hear an automated voice from the laser that will countdown the remaining treatment seconds. The flap is then repositioned and allowed to adhere into place, without the need for stitches. Antibiotic drops will be placed to prevent infection.”

Recovery Period.
They will patch your eyes for 15 minutes after the LASIK procedure and ask you to sit this out in the waiting room. After your 15 minutes are up, the eyeMD will check if the corneal flaps are aligned. If everything is okay, they will then tape transparent eye shields on your forehead, transforming you into a psuedo bumble bee. These eye shields are to be kept in place overnight to prevent accidental rubbing of your whiles. Moreover, you will walk away with a kit containing your antibiotics, eye steroids, and eye drops. An instruction on how to use these medicines is also included inside the said kit.

And just like that, you are sent off to see the beauty of the world again– in this case, the beauty of the shops of Shangri La.

After thoughts
On the day of my operations, Channel 7 was at the center filming foreigners who travel to Manila just to undergo the procedures. The show, according to the crew, will be shown on Saturday night, during the Jessica Soho Reports. The topic: Medical Tourism.

Apparently, there are tour packages being offered to patients to travel Manila and undergo various medical procedures. Aside from Laser eye surgery, quite popular for the foreigners, and balikabayans alike, are cosmetic surgeries. Not only is the procedure very affordable compared to other countries (in Los Angeles, the same wavefront LASIK can cost you $3,000.00), the medical professionals are also top class. Hopefully this trend will continue to grow. This is probably what we need to tip the brain drain situation of our country.