Nervous Insomnia

It is no secret that I routinely have bouts of insomnia here and there. And lately I have been fighting insomnia of a different kind: Nervousness.

In less than 24 hours, I'll be heading into a surgical room with huge machines at the Northwestern Memorial Hospital. Procedure: elective LASIK surgery. Options: Intralase FS and Wavefront.

Here's a quick rundown of the steps involving LASIK surgery:
1. Cut out a thin, outer layer of flap on your cornea.
2. Reshape the exposed cornea with an excimer laser.
3. Replace the outer flap of the cornea.

Traditionally, for years surgeons have used a special scalpel called microkeratome for the first step. It is hand-held by the surgeon, which is used to scrap across your eye to create that flap. And it looks like this:


Yeah. Holy shit was what I said too. This has been used on millions of patients over many years since LASIK was introduced. Unfortunately, the use of such mechanical device which is controlled purely by a surgeon's hand is that 1% to 5% of patients will have complications resulting from this step alone, which may require additional surgery.

Since 2001, a new way of accomplishing the first step of the procedure has been to replace the microkeratome device with Intralase FS laser, approved by the FDA in 2000. Intralase FS laser is guided by a computer and can make the cutout of the outer layer of the cornea more precise and accurate. As of the middle of 2003, a study of 108 patients who had used the Intralase FS laser had no complications during the crucial six months after surgery.

Good news, right? I'll take that option. $300 extra an eye. I definitely don't want a miniature bug scrapper being used on my eyes! Nosireebob!

In late 2002, the FDA approved an improved LASIK procedure called custom cornea wavefront guided LASIK. This involves the second step as mentioned above. No one has perfect eyes, or perfect aberrations or irregularities in the eyes. So instead of applying a standard excimer laser to provide a specific set degree of correction in the eye, a patient will first undergo a wavefront diagnosis of the eyes to map out what irregularities exist. Think of it as fingerprinting of an eye.

With the fingerprint of the eye captured, the surgeon can plug that information into a wavefront laser machine, which will then ablate the cornea accordingly. In studies conducted by the American Academy of Ophthalmology, 90% to 94% of wavefront LASIK patients achieve 20/20 or better vision, as compared to only 80% of conventional LASIK patients. The US Navy also announced that its patients of wavefront LASIK had better distance and night vision than those of traditional LASIK patients. Better yet, a most recent but smaller study concluded that 88% of contrast measurements improved a month after wavefront LASIK surgery, as compared to just 40% for traditional LASIK.

Sounds great, right? I'll take that option as well. $500 extra an eye.

So why am I nervous, you ask? Well... For one, since its first use in 2001, only 108 patients had foregone the use of the microkeratome scalpel by 2003. That's not a whole lot. So far for the last five years, about a million people have undergone Intralase laser procedure. Compare that with the average of a few million Americans who chose LASIK on average since 1995.

Then there is the issue with the wavefront LASIK procedure. This procedure, albeit being approved by the FDA in 2002, is still relatively new. It has only become widely offered by surgeons in the country starting the end of last year, my surgeon included. Exact statistics, or approximate thereof, is still unknown, although I suspect my surgeon probably have read some new study not widely publicized yet.

And then there is the combination of having both Intralase and wavefront LASIK together. As far as I can tell, my surgeon has only performed less than 50 patients with such combination. Obviously I'm still a guinea pig.

Finally, there are only four companies that manufacture wavefront LASIK equipment: Alcon, Visx, Bausch & Lomb and WaveLight. WaveLight actually does not provide individualized treatment based on each unique patient's map of the eye, but rather that it is wavefront optimized. This much I know: My surgeon will be using a Visx equipment. Of the four companies, one of them has been sued and forced to remove its equipment from the market, and it is not Visx. That should be a sigh of relief, right? But what's to say that there isn't any serious defect in the design of the other manufacturers' equipment that has yet to be discovered as of late?

Yeah. So all that is floating through my head and causing me to toss and turn in bed. Despite the nervousness and lack of sleep, I am still committed to getting this done, and I cannot be more excited about it than anyone. It's just that I hate being the kind of person who wants to know as much as possible in the greatest details. Sigh!

So this will probably be my last entry for the rest of the week, until my doctor indicates I am all good to stare at bright computer screens. =)