David C.

I'm only 27, but for years I've been bothered with glasses, particularly when I go to the gym but also at the office where my brand of science requires me to sit at a computer all day. For many months I had been tempted nightly by a billboard advertising LASIK on my way home. When I finally started my own search for a surgeon I used the web to find three in southern California that I would go and speak with.

The first had done thousands of procedures, mostly LASIK, and could boast numerous celebrity clients. The surgeon's residents took my measurements, and the immediate conclusion was "thick corneas and a prescription that's right in the middle of the range... you're a dream candidate." I asked how much improvement I could expect, and one resident replied, for someone like you, we could even afford to do an enhancement, so I'd expect 20/20 if not better." The recommendation was for custom wavefront LASIK. I asked about the PRK alternative procedure, and was told that yes, PRK was an option, and that indeed, the only downside was a longer healing time, but that in my case there was no reason not to opt for the more convenient LASIK procedure. It was a very exciting visit--even though the time I had with the surgeon was a bit rushed and I had to consider afterwards that I had gotten nearly as much face time with the secretary hearing anecdotes about patients who had gotten the surgery as I had spent with the surgeon's residents talking about the technical side of things.

I wanted to get a second opinion, so I went to Dr. Nahl's office. It was very different, but not just because she did most of the tests herself. Juxtaposed with Dr. Nahl's warm and lively manner, the visit itself was much more moderated and sobering. She presented extensive information on laser eye surgery, even pointing out where the underlying assumptions are open to debate. I never heard her say "you're a great candidate" or imply that any procedure was a slam dunk. When she began looking at my scans the first thing she pointed out was the asymmetry of my corneas and her concerns about it. In school I was always the one grubbing for a high grade, so I pointed out to her that I had very thick corneas. "Yes, I know," she replied, "you've got that going for you. But, I'm more worried about this asymmetry. No, I would not do LASIK on you." She then explained about the possibility of developing keratoconis, a debilitating progressive thinning of the cornea, that could result if I had LASIK. She offered that although LASIK would be a risk, PRK would be safe for me. She did all of the pre-operative tests for free--other places charged between $80 and $250 for the dilation tests--and she explained everything that each drop she administered was going to do. I elected to take the 24-hour dilation drops she preferred to use, rather than the 4-6 hour variety, to give her better readings. I was very impressed with Dr. Nahl, but with two conflicting opinions I didn't want to make any commitments.

I got my third opinion from one of the most experienced physicians in the world. When I uttered the word keratoconis over the phone with the doctor's secretary, she replied immediately, "Then I can tell you right now, if you have keratoconis, there's no way we're doing any procedure on you." The need for validation kicked in again: "No, she says I don't have it, but that it would be a risk." The secretary paused a moment and replied, "Well, if there's a question about this then you need to talk to someone as experienced as my boss." I got in the very next day--the surgeon's residents were able to use the tail end of Dr. Nahl's dilation drops to do their own glaucoma screen, and by that point I was just listening to the numbers they rattled off to get a feel for the tolerances on modern machines (they're pretty tight). When the surgeon came in to speak with me my dilemma was already well known. "So," the doctor began, "you went to Dr. ---, who said 'LASIK', but then you went to Dr. Nahl and she said 'No. PRK.' And, you want me to arbitrate between them." Yup. "Well, I side with Dr. Nahl. It's like, you have the gene for keratoconis, and somewhere in the process your cornea said 'No, stop.' and now you're stable. But, if we did LASIK, we might start that in motion again. However, the PRK procedure, so far as we can tell, doesn't make a difference for cases like you. The outer layer of the cornea is the strongest, and it seems that the fibers over the periphery of the iris are the most important in holding off a condition like keratoconis. With PRK, all of those fibers remain intact, but with LASIK, they'd get cut, and you'd have a 1/300 to 1/2000 chance of developing keratoconis. It's a small risk, but the condition is so devastating that it's not something you'd want to do. As for the other doctors, I can say as much as Dr. Nahl's great, and the first one you visited is also very skilled. We'd love to have your business, but it's your decision." The surgeon glanced wryly at the secretary: "See if you can beat Nahl's price."

The third physician did beat Dr. Nahl's price by about $700, but it was really even dice. I needed PRK, and any of the surgeons I went to could have provided world-class care. Another thing I was considering was that the surgeon herself wasn't going to be firing laser beams into my eyes with crosshairs--the result hinged on the appropriateness of the laser machine's program for my case. I opted for Dr. Nahl because she, rather than a resident, had done so many of the tests, to catch any subtleties in the results and think about those as she designed the laser pattern. Another factor that I felt would affect the results was my comfort level during the surgery. Out of all the surgeons I spoke with, I felt I would be most comfortable in the O.R. with Dr. Nahl.

I'm glad I did--just four days after getting my custom PRK procedure my eyes were not irritated, I was no longer taking any pain medications, and my vision was approaching 20/20. Within a month, my vision was 20/15. Whenever anyone asks me about LASIK, I strongly recommend the PRK procedure over the LASIK surgery, not just because of my particular case but because it truly is so much less invasive. Some of the people I've spoken with who have had LASIK are barely aware of the alternatives and the risks in each case. I tell people, "It's your vision. If you're going to spend $3000-$5000 be willing to spend 3-5 days recovering." I'm very glad that Dr. Nahl felt the same way.