“It’s like putting a man on the moon kind of stuff” – Countering laser eye surgery’s scary reputation
“We could talk about the technology, I could talk about how incredibly sophisticated it is. We could talk about that,” says Professor Dan Reinstein, founder of the London Vision Clinic. Only he doesn’t want to. “Forget about what’s new in the technology – that’s currently not the issue. The issue is the misinformation out there about what it is.”
“You’ve got a technology which is so sophisticated to – as Arthur C Clarke says – ‘appears to be magic’, but the message is hijacked,” he explains. “The industry has been terribly unaggressive at counteracting the optometric community who lie – well, either they’re ignorant or they’re lying, but neither is consistent with being in an eye care profession. You don’t say ‘you can’t have it because you have astigmatism’, because it’s not true, but they do.”[gallery:1]
I’m sat in Professor Reinstein’s office, having previously gone through a few hours’ worth of testing to conclude that no, I don’t need laser eye surgery. It turns out my eyesight is in the top 5% of the population as a whole, but the two glasses-wearers on the team were too squeamish to consider the procedure, so I decided to volunteer. Running my journalistic career to the rules of Yes Man hasn’t caused me any problems to date, after all.
“The industry has been unaggressive at counteracting the optometric community who lie – well, either they’re ignorant or they’re lying, but neither is consistent with being in an eye care profession”
The procedure was time-consuming, but almost entirely painless. In fact, I go through the part that I’m told is the most painful section: anaesthetic dye is poured into both of my eyes. Imagine taking a tequila eye drop, and you’re in the right ballpark: unpleasant, but tolerable. I spend 30 seconds blinking until the feeling recedes and is replaced by one of slight fatigue.
Other than that, the pre-operative tests are pretty much exactly as you’d imagine, only far more thorough than a standard optician’s appointment. Unlike a test for contact lenses or glasses, which is really only interested in how well you can see and how thick the lenses need to be, laser eye suitability cares about a whole bunch of different metrics, from the thickness of the cornea to the pressure of the eye. In total, I stare into five different machines while an assistant gently instructs me on where to rest my chin and when it’s okay to blink. The majority of the tests involve looking at lights in one form or another, and a full picture of my eye is slowly coming into focus.[gallery:16]
“You have to understand that corneal refractive surgery – fixing vision – did not begin in the early 90s when laser eye surgery started. It started 40 years before that,” says Reinstein, who proceeds to show me the original keratomileusis kit gifted to him by one of the inventors, and explain it in grisly detail. “You see that bit that looks like a carpenter’s plane? That passes over the cornea to shave off a bit. You then have a bunch of curved dyes that you put on there, you put the cornea over the dye, and pass it again, evening off what’s sticking out to shave it off. You then sew it back onto the eye.[gallery:4]
“So this was being done already. Laser was added as a much more accurate way of removing the tissue – so laser eye surgery is not the invention, keratomileusis is the invention.” Reinstein shows me the original text by its inventor, Jose Barraquer – a name that Reinstein pronounces flawlessly (“I should hope so – I grew up in Mexico!”).
“Laser eye surgery is not the invention, keratomileusis is the invention”
You’ll be pleased to hear that the process is utterly unrecognisable now. Not least because of the keyhole surgery used by Reinstein and a couple of other clinics in the country. “Three minutes, you lie down, you see some lights, you wait a few hours, next morning you’re not blind anymore. A 2mm incision. Literally, you could have a karate lesson the next day and get whacked in the eye – you’ll have a retinal detachment, but nothing will happen to your cornea.”[gallery:6]
When the laser was first added to the surgery, the complication rate was around 5%, I’m told. “We say it’s now down to one in 1,000 – 0.1%,” says Reinstein before breaking off into a stage whisper to add that “actually it’s a lot lower than that, but we say one in 1,000”. Conventional wisdom, he explains, is that complications can’t be fixed, but that’s just plain wrong. “You want to talk technology? I’ll show you technology that’ll blow your mind about how we fix complications. It’s like putting a man on the moon kind of stuff – it’s that cool,” he enthuses.
“There’s an eye-tracker that notes the position of the eye in six dimensions, it repositions the firing 1,000 times a second, so every single spot has four positional photographs to know where that eye was at that time. There’s a billionth-of-a-second pulse that moves a billionth of an inch of cornea per pulse. It does it exactly in the place that we’ve designed, and you can reshape the cornea and correct complications.”[gallery:5]
This technology has existed since 2004, so it’s more than a decade old, which is why Reinstein is so frustrated that scare stories persist. “It’s a chicken-and-egg problem. Because it’s not having to be used very often, most surgeons can do the surgery without knowing how to fix complications. We all generate complications – I do – but I like to sleep at night, meaning I generate one, and I fix it. Then I sleep.
“There are very few complications now that can’t be fixed. We can measure to within a hundredth of a hair in 3D. We can therefore measure a lot of things before surgery to prevent them happening.”[gallery:3]
London Vision Clinic’s equipment is particularly strong, and the surgery has been known to take on customers rejected by other clinics. “There are six lasers on the market, three of them in the first class and the other three in the… eighth class. There’s a gap in between because they didn’t do anything with their technology for ten years.
“We all generate complications – I do – but I like to sleep at night, meaning I generate one, and I fix it. Then I sleep”
“For the layperson it’s very annoying, because they go to a website of someone using the eighth-class laser, and it says ‘ours is the laser that was approved by NASA’. But it doesn’t say with an asterisk, ‘only because in the US the other three lasers that are the best ones aren’t approved, so this is the only one that could be approved by NASA, so we’re stuck 15 years behind the rest of the world because of the FDA’.”[gallery:14]
So where does that leave a layperson like me, when choosing between clinics? When I put this to Reinstein, he pauses for the first time since I met him. “I cannot give a PhD in physics to everyone who wants to have laser eye surgery. I only do 1% of the surgery in this country and I’m very busy – all I say to people is ‘do your homework’. Go to more than one clinic. You will see the difference.
“So where does that leave a layperson like me, when choosing between clinics?”
“Forget about the technology for a moment and just look at who’s operating it and how they manage appointments. The amount of testing that people get pre-op is a great telltale.”[gallery:9]
“For Boeing planes and airbuses, there is a minimum standard required to run the damned planes. Well, we ain’t got that in refractive surgery. You qualify from medical school, you become an eye surgeon – you take a weekend course from the sales rep after you’ve given them $500,000 to buy your laser and you’re a laser eye surgeon.”
But even with all these problems, the chances are that you’ll be fine. “The problem with laser eye surgery is that it’s so incredibly safe. Even without the regulation, and even though there are three lasers in class eight and three in class one, and even though, even though, EVEN THOUGH – the thing is damned safe.” This means that, according to Reinstein, some operators don’t go through all the correct preparatory steps, and complications emerge – which are so rare that the surgeons don’t understand how to correct them.[gallery:11]
“Those patients get told there’s nothing that can be done. They become an angry – justifiably –- frustrated, depressed, suicidal source of information on the internet, for understandable reasons, even though they’re wrong. Because they didn’t know that it can be fixed. They trusted the guy – he’s a doctor – and they told them it can’t be done.”
We’ve been talking for around 45 minutes now, and the clinic manager has come in to speed things along, as Reinstein has patients to see to. “I haven’t really given you what you wanted, have I?” he says apologetically as we rush to finish the interview.[gallery:7]
While he is understandably angry about online scaremongering, he does understand that people might be concerned about any kind of eye medicine, but he tells me the story of a memorable patient of his. It involves a high-power executive who wanted the surgery but “couldn’t have anything go near his eye”. It turns out that he’d had a foreign body removed from his eye at the age of three when he was physically held down by doctors. After a larger-than-average dose of sedatives (“two would put a big fat guy to sleep… five would put a horse to sleep”), he became the perfect client. “He was like a pussycat. He looked at the light, we did the treatment. ‘I didn’t feel anything.’ I know, we told you wouldn’t feel it. ‘I know, but I thought you were just saying that.’ No, we weren’t just saying that.”[gallery:18]
If this man could cope with the surgery, then there’s hope for anyone in the right hands. “No-one wants to be blurry. ‘Oh, I like blurry, because it separates me from the world and I can meditate.’ What!?
“The reality is that virtually every single person who has refractive surgery says ‘it didn’t hurt, it was easy, it wasn’t scary, it was no problem. I healed in three hours and now I can see, I wish I’d done ten years ago.” Even though I wasn’t a candidate for the surgery, my takeaway eye scans above are testament to how, if I had, I’d have been in very safe hands.