Simplifying Life Through Laser Vision Correction

With Daniel Haddad, MD

My mornings begin with my three-year old daughter coming into the room, standing next to me as a lie in bed, and announcing she is “awake now.” I blindly reach for her, scoop her up and put her in the bed between my wife and me. She asks to watch Dora the Explorer, at which point I fumble reaching for the remote. I ask my wife what the time is, since I cannot see the clock without my glasses. I turn on the television, feel around the floor for my glasses while I simultaneously squint to try to see the recording for Dora the Explorer on the DVR.

Eventually, I either guess correctly and Dora comes on the television, or I finally find my glasses and am able to see the correct selection. After a few more moments of watching television, we get out of bed. I head to the shower and prepare for my work day. I try to see in the mirror while I shave in the shower, and hope I don’t miss any spots on my face.

Yes, seeing anything without my glasses or contact lenses is difficult. Once I get my contacts out of the containers, cleaned and into my eyes, I see the world clearly.

As I go through the day my eyes occasionally get dry. Since I am behind the wheel of the car eight or more hours each day, looking at the computer in between stops, I have to put wetting drops on my contacts to keep them moist.

In the evening I head off to play in my basketball league where part way through the game one of my contacts pops out onto the court. So, not only am I temporarily unable to see clearly, but the game is halted while we all search the floor for my contact. Once it is located, I run off the court to the bathroom to clean the contact and put it back in my eye.

I have worn glasses for 30 years and finally started using contacts about 15 years ago. What an improvement I thought it was when I was able to wear contacts. I only wore my glasses when driving, but when I played golf, or any other sport, I suffered the consequences of blurred vision until I started wearing contacts. Of course, I couldn’t swim under water anymore with the contacts. I had to be careful when water skiing.

Now, contacts have done well for me over the years and are one of the reasons I put off any laser correction surgery. Even as the technology improved, I felt I was doing well. It wasn’t until several of my friends began getting laser correction surgery and boasted about their new-found freedom that I began to regret that I was still wearing contacts.

I decided to do some more research on whether I was still a candidate for laser eye surgery. At 40 years old, I know that there can be limitations to the effectiveness of surgery. I discovered that I was a candidate. And, I discovered that my best results could come from CustomVue Lasik.

Unlike what I had heard on the radio, this technology and surgery is not available for $299 per eye. Advertisements for corrective surgery for that price are using older equipment, technology and techniques. It was very clear to me that if I was about to have my eyes surgically improved, I didn’t want an older technique or machine. I wanted the latest technology that would offer me the best results with the least downtime from work.

I chose Dr. Daniel Haddad of the Laser Eye Institute in Troy. He has performed numerous Lasik surgeries and was very skilled utilizing the CustomVue Lasik. My research revealed that Dr. Haddad has performed more CustomVue Lasik surgeries than any other physician in Michigan. Obviously, if I was going to trust my eyes to anyone, I wanted someone with experience. From my initial consult to each of the follow-up visits, I met with Dr. Haddad. He talked to me about the technology, the benefits I can expect, as well as any limitations I may experience.

My surgery went as I expected on a Wednesday and the following morning, I was able to drive myself to my follow-up appointment. When I took the vision test, I could read the 20/15 line on the eye chart! Amazing! After years of utilizing contacts and glasses to see clearly (which wasn’t always 20/20, I felt); I was finally free.

So, what did I say? The same thing every other person who finally gets Lasik surgery says, “I wish I had done this a long time ago.” My reasons ranged from the fear of having surgery on my eyes to finding the time to do it. However, with technology the way it is today and an experienced surgeon who took the time to walk me through the process, I felt comfortable getting the procedure. Not to mention, I only was “out of commission” 1 1/2 days.

I can’t say enough about how happy I am with the results. The morning after my surgery my daughter came into the bedroom and announced, “Daddy, I’m awake now.” I sat up, scooped her up into the bed between my wife and me; looked over at the clock, grabbed the remote and quickly located Dora the Explorer on the DVR.

Now I appreciate how laser vision correction surgery has simplified my life.

Questions To Ask Your LASIK Doctor

For peace of mind and to make sure you are fully informed before your procedure, here is a list of questions that may help make your LASIK decision easier. If you are not completely comfortable with the surgeon and staff after your initial consultation, visit a few providers to choose the LASIK surgeon that is right for you.

• • What kind of laser do you use?
• • How often is your laser calibrated? (The Laser should be recalibrated at least every 4th use)
• • What kind of microkeratome do you use?
• • How often is the microkeratome incisor changed? (A new incisor should be used for every patient)
• • What financing options do you offer?
• • Are pre- and post-op visits included in the cost?
• • How many post op visits are included in the cost?
• • Are additional post op visits for emergencies free?
• • How many LASIK procedures have you performed?
• • What other state-of-the-art equipment do you use?
• • What kind of results can I expect from LASIK?
• • What kind of results have past patients had?
• • Do you have patient testimonials available?
• • What is your background and training experience?
• • How long have you been performing LASIK?
• • Do you offer Custom LASIK?

Some of these procedures and terms may seem confusing to you. If you feel as though you need more information on these laser vision correction procedures, or still have questions about choosing a LASIK surgeon, we encourage you to explore this directory’s in-depth pages for more information at www.the-lasik-directory.com.

Dr. Daniel Haddad received his medical degree from New Yor Medical College. He completed his ophthalmology residency at Kresge Eye Institute. He has been practicing in Michigan for 20 years.  Dr. Haddad is considered a leader in the field of vision correction by colleagues and his patients. Some of his noteworthy contributions to the field of Ophthalmology include his pioneering the custom RK procedure, astigmatism and his work on Laser Active Traker, and his election to president of the Michigan Kerato-Refractive Society.

Ask the Doctor: July 2007

Question: I have heard advertisements for Lasik Eye Surgery for $300 per eye. I thought it was more expensive than that. Can you get Lasik Surgery for $300 per eye? – T.M., West Bloomfield

Answer: Dear T.M. – Often patients ask me this very question, to which I reply the old adage “if it sounds too good to be true, it probably is” holds true. There is no such thing as $300 LASIK.

$300 LASIK (or any variation such as $299, $599, $699) is your classic bait-n-switch marketing technique that has been around for ages – with a twist. The idea is to offer an extremely low price to get customers in the door, and then once they have taken the bait, switch it with another higher priced package. Here it helps to read the fine print (which they usually won’t give you until you actually visit the office). Let’s take a look at the “fine print” on a popular LASIK center’s offer for $295 LASIK:

“$295 per eye offer is for –1 diopter of (sic) less prescription with no astigmatism on Nidek Excimer Laser only.”

The technical terms here can be confusing, but generally patients with less then –1 diopter of correction do not even require laser vision correction. In addition the laser included with this package, the Nidek, uses an out-of-date (1994) technology. Now that we have seen the bait, let’s take a look at the switch.

A recent patient of mine went to a center offering $295 LASIK. After all of the “add-ons” “upsells” and “extras” he walked out with a $3,600 price quote. Even worse, he felt like he was rushed through an assembly line. This is a far cry from the advertised amount of $295. Sadly though, most patients give in to this marketing technique and figure since they are already at the center they might as well book with them.

So the short answer to your question is No. There is no such thing as $295 LASIK. The best advice I can give you is to find a center that is upfront about it’s pricing and does not employ these bait-n-switch techniques.

Finally, when it comes to something as important as your eyes, do the right thing and shop around.

Dr. Daniel Haddad is past-president of the Michigan Keratorefractive Society and nationally recognized for his work on the laser tracker. Dr. Haddad is an expert on astigmatism and has performed more than 15,000 eye procedures including Lens implants, RK, AK, PRK, CK (Conductive Keratoplasty), LASIK and LASEK.

If you would like to submit a medical question to “Ask the Doctor”, please email your question to: askthedoc@healthandleisureonline.com

* Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Lasik: From a Patient’s Perspective – Part 2

The last machine is the glaucoma test. You know, it’s that annoying little machine that puffs air into your eye, makes you flinch, and helps make sure you don’t have glaucoma. Ann makes a notation on my chart and stands up, “If you would follow me, please?”

I follow Ann into the hall and into a rather small room with another machine. Ann walks around to the back of the machine and gestures for me to take a seat. She asks me to put my right eye to the machine.

I see a bunch of really bright concentric circles making it look like a tunnel, similar to one of those crazy spiral effects they use in the movies when someone is falling into a dream world.

In the center of the tunnel is a red icon that, to me, looks like a drawing of a computer mouse. Ann tells me that this is the WaveScan (you may have also heard it referred to as WaveFront) machine and she will be taking several scans of both of my eyes. These scans are what the doctor will use to program the laser to best correct my vision.

I spend several minutes with my face pressed against this contraption, with Ann politely asking me to open my eye wider and wider and to keep looking “through” the little mouse-looking icon.

By the time I’m done with both eyes I feel like I’ve been trying to push my eyes out of their sockets from the inside. Oh well, Ann says she got good scans, and I guess that’s what really matters.

Next we go around the corner to another room; this one though would be familiar to anyone who has been to the eye doctor anytime in the last century. In the room is a reclining chair and a stand with a phoropter hanging from the end.

It’s the thing that looks like a mask with the little lenses that they constantly adjust and ask you “better/worse.” This test always gets me because usually the difference is so slight that I’m never sure which of my answers is right.

Ann runs me through the whole sequence of “better/worse” to refine the results of the previous tests. She then gets up and tells me that Dr. Haddad will be in to see me in just a minute.

This is where I actually get to talk to the guy who is going to take care of my eyes! I know he isn’t just seeing me because I’m writing an article about him; I can hear him going up and down the hall talking to all the patients.

In fact, Dr. Haddad pops his head into my room and tells me he is going to be back in a few minutes, but he just wants to finish up with another patient. I can hear him in the next room answering all of this patient’s questions. From her tone and shear number of questions, I can tell she is just as scared about getting her eyes done as me.

A few minutes later Dr. Haddad whips around the corner and settles on the stool next to the examination chair. As charming as the first time I met him, he chats me up like we are old friends as he goes over the results of the tests I did with Ann. He then proceeds to give me the whole “better/worse” exam again with the eye chart and the lens machine (hey, you can never have too much data to work with). Next, he pulls out the printout from the WaveScan machine and shows me exactly what is wrong with the optics of each of my eyes and how he is going to program the laser to correct them.

He says that he could just plug a few numbers into the machine and have it set up a correction plan for me and the VISX CustomVue system would do a “good” job. This is common practice. But, Dr. Haddad explains that he took additional scans allowing him to program a specifically designed program for my eyes which will do the “best” job.

On top of that, he also has all the data from my iris so that he will be able to use the Iris Registration system to ensure that the laser stays focused and aligned exactly where it needs to be. This system will also correct itself with even the slightest movement of my eye. Pretty cool stuff, eh? I’m still scared, mind you.

Another tech comes in to help Dr. Haddad with the next battery of tests. They put in the drops that will dilate my eyes so that they can check my retinas; also they put in some numbing drops so that they can use a device to measure the thickness of my corneas. This last test is funny because she puts this little clear plastic pen right on my eye, and I can’t even feel it. She reads off the results to Dr. Haddad. He says that it is just a bit thicker than he estimated, but this is good because it’s always better to work with more cornea tissue than less.

Dr. Haddad checks to see if I have any questions (Yeah, my conscious says, can I push this back to like, oh 2010?). I ask a few questions, but I don’t ask near enough to make a dent in my anxiety level. I’m trying to put on a brave face though. I’m also too busy taking notes for this article (it’s getting harder to write as those dilating drops kick in).

Dr. Haddad knows I’m nervous. I think he would be surprised if I weren’t nervous. He looks me straight in my fully-functional albeit nearsighted eyes and tells me everything is going to come out just fine, and he will see me tomorrow afternoon. With a final smile, he zips out the door and into the next room where he starts all over with another patient. Okay, I feel a little better.

Ann leads me down the hall into another room and tells me that Jennifer will be in to see me in a minute. Jennifer comes in, cheery as ever with a lilting South African accent, and proceeds to tell me all the things I have to do to prep my eyes for my surgery the next day. This entails using the antibiotic and steroid drops that they are going to prescribe for me, and to clean my eyelids before I go to bed that night.

Jennifer then takes me to the room that is on the other side of the fish tank wall and sets up yet another video for me to watch. This one is at least a 15-year old video and is less about LASIK and more about the legal stuff you hear at the end of drug commercials. Only this time, it isn’t quick, and they do not mince words.

The phrase “catastrophic vision loss” is mentioned as well as several other complications that probably aren’t as bad, but sound that way. Did I mention the catastrophic vision loss part? Yeah, my anxiety just hit a new high! After the video, I have to fill out an industry standard questionnaire stating I understand everything in the video, and that I’m aware that this is an elective procedure, and Dr. Haddad cannot guarantee me anything about the results of my surgery, including whether or not I will even be able to see afterwards.

I tell myself that the video was made several years ago when this technology was brand new, and they have made tremendous advances in technology since then (and they really have).

This makes me feel a little better. I sign the document.

Finally, my eyes are so dilated that I can barely see, and they take me in for my final test. They check my retinas to see if they are up to snuff and then confirm with me that the appointment for my procedure is the next afternoon. I will need someone to drive me to the appointment and back home. With that, I head out into the painfully bright sunlight and spend the day worrying about everything that can possibly go wrong with my procedure, Yea!

The next day I arrive for my appointment and I seriously want my mommy. I don’t even get to sit down before they call me back! With more bravado than I really feel, I follow the tech back into the office. In a little room right next to the procedure room, the tech gives me a dose of Valium to help calm me down (yeah, good luck with that, have any horse tranquilizers?). She then proceeds to clean the area all around my eyes. This all happens very quickly, and I hear someone in the procedure room say that they are ready for me. Not even 10 minutes have passed since I walked in the door (the rocket sled has left the tracks and is entering orbit)!

The room is very open and bright, and they have nice music playing. Dr. Haddad is there with a few techs all dressed in scrubs with masks and he jokes he is going to put on some Rap music for me. I politely request a bit of jazz, not that I don’t appreciate a little 50 Cent now and then.

The Visx machine is a rather large contraption with a reclining chair, an arm with the lasers, and what looks like a binocular microscope positioned over the headrest. I sit down and they recline the chair back. A tech uses a little U-shaped pillow to steady my head and neck under the laser.

Next, Dr. Haddad tapes my left eyelid back with a few quick, practiced motions (my right eye is covered with a little cup to help me focus on the laser). He then puts in what I consider the worst part of the whole procedure, the eyelid speculums (these are less than comfortable). I can imagine that I look like Malcolm McDowell in “A Clockwork Orange,” and I mention this to Dr. Haddad. He says he actually has the soundtrack. At this point I’m glad he is not playing it, because that is a really messed up movie.

My eye is all watery from my own tears and all the eye drops. I can’t see a thing other than a little blurry yellow light where I assume the laser is positioned. Dr. Haddad tells me that I will hear a little high pitched whine as they test out the microkeratome (the blade that will make the flap in my cornea). Next, he puts a suction device down on my eye. I can’t feel anything here since they have numbed my eyes completely. He tells me my vision will go out on me for a few seconds. I hear a bunch of different sounds and all of a sudden my vision goes completely BLACK.

I find out later that the little suction device increases the pressure in my eye above that of my blood pressure in that area, thus the blood is forced away from the optic nerve and hence, you don’t see anything. It’s probably a good thing that you lose your vision for this part since that is also when the microkeratome cuts the flap in your eye.

With the flap pushed back, my vision is quite blurry, like looking through Vaseline. I can still see the little yellow light above me, and Dr. Haddad asks me to focus on this light and to try not to move my eyes (the system will take care of the little movements and will actually shut down the system if I move them too much). Next, I hear him make a few adjustments to the system and he tells me that I’m going to have an eleven second burst, and it will be done. I focus as hard as I ever have on that little yellow light, and the laser starts up. I can actually see it “zap” little bluish wedges all around my eye and before I know it, the laser powers down.

There is a faint scent like that of burnt hair (or maybe I’m imagining it), and Dr. Haddad begins to irrigate my eye with a lot of fluid all the while pushing my cornea flap back into place.

The entire process is repeated for my right eye, and since I already know what is going to happen, I’m a lot less anxious about it.

It is about then that I realize that we had gone so quickly from the prep-room to the procedure room that I don’t think the Valium has kicked in yet! Hey, I made it through all of this with just my own nerves of Jell-o! Actually, it speaks volumes to Dr. Haddad and his entire team. They kept me so well-informed on what was going to happen each step of the way that I never really got all that nervous.

After putting stylish little clear eyecups over my eyes, (which I open just enough to keep from running into things) they take me to another little room to give me some simple directions on what to do for the rest of the day.

They tell me I should try to rest my eyes as much as possible (sleeping is the best). I can’t take a shower that night, and I should put in my antibiotic and steroid drops every few hours. Other than that, they say that I can take off the eye cups in the morning and will be able to drive myself in for my follow-up appointment at 9 a.m. the next morning. I shuffle out into the waiting room, and my ride is there waiting to take me home. From the time of my drop off to being picked up… forty-five minutes!

I get dropped off at home, and I make my way into the house and to the bedroom. My eyes are all watery and my left eye feels like I have a grain of sand under my eyelid (too bad I can’t rub it). It’s about that time the Valium kicks in, and I drift off to la-la-land.

I wake up several hours later and put in my eye drops. I then lay in bed and listen to the TV, peeking out through my eyelids every now and then. What I see looks promising, but it’s uncomfortable to keep them open very much and eventually I drift off to sleep.

The next morning I wake up and stumble my way to the bathroom. Standing in front of the mirror, I take off the eyecups and clean gently around my eyes with a tissue. It is then that the WOW factor kicks in. Everything is sharper than I ever remember them looking. It’s almost like the world got upgraded to high-defintition while I was asleep. I get dressed, grab my sunglasses (everything is very bright) and head out for my appointment. As I’m driving down from Rochester Hills to Troy, I’m marveling at just how clearly I can see – much better than I ever did with my glasses or contacts.

I pull into the Laser Eye Institute’s parking lot with a huge grin on my face, and I head inside. I’m led back to the very first room where I did my initial work-up. I look into the autorefractor again and the tech takes the printed slip and puts it in my chart. I ask her if everything is “okay,” and she says that it looks fine.

Fine? I was feeling like it was stupendous!

Next, I’m led to a regular eye exam room and I’m given the whole eye chart test again. I read all the way down to the next to the last line on the screen.

That is when the tech smiles at me and tells me, “Congratulations, you have 20/15 vision.”

20/15! That’s better than perfect!

I would have been happy with 20/20, but I’m ecstatic with 20/15. That would explain why everything was so sharp.

Dr. Haddad comes into the room and does a quick check-up on my eyes to make sure that the flap was still in place and healing well. He says everything looks great and he congratulates me on my 20/15 vision.

I shake his hand and thank him very much for helping me get 20/15 vision and for making it so relatively painless. The scratchiness is gone and my eyes just feel a little bit sore like I had been staring a computer screen for too long. Dr. Haddad says that is just a leftover from the eye pressure change, and it will go away very soon (it does a few days later).

With that, he flashes me another smile, which I’m sure is a reflection of his pride that he has yet another very happy patient. He makes his way down the hall to give another patient their good news.

I head up to the front desk and they give me my instructions on how to care for my eyes for the next several weeks. It’s all pretty easy stuff. I schedule my next appointment for the following week, smile at the girls at the front desk, and make my way outside to my car.

It is a beautiful brisk February morning, and as I drive away I slip on my sunglasses. A huge broad grin breaks out on my face as I think about seeing the world through all new eyes.

LASIK: From a Patient’s Perspective – Part 1

The waiting room is very nice. Trust me, I’ve been in enough bad ones to really appreciate a nice waiting room. Jennifer, the office manager, comes out and tells me that she has a quick video for me to watch. She directs my attention to the large plasma television on the wall touting the greatness of LASIK.

You would have to be in a cave to not have heard about LASIK; on TV, the radio, newspaper, and so on. The video I’m watching has people claiming how they wish they had done it sooner.

Then, at the end of the video, the fear that has kept me from getting LASIK sooner jumps out from the video: “The doctor can’t guarantee any results from the surgery and a small percentage of patients have negative results including the possibility of permanent vision loss.”

Now, of course, the rational side of my mind tells me that the complications are very rare and I have yet to meet anyone who has had a bad experience with LASIK. Then my rational (but much more paranoid) mind tells me that someone had to have had these bad results at some point. And, I really don’t know all THAT many people who had LASIK, so my scientific ‘study’ has a woefully small sample size.

Once again I find myself asking, ‘Why, exactly, am I doing this?’ These are my eyes we’re messing with! If I had to pick any of my senses to lose, my eyesight would be the last one I would pick.

I have toyed with the idea of getting LASIK for years. I always thought it would be cool to get rid of my glasses and contacts and see the way I did when I was a little kid (I’ve worn glasses since I was thirteen).

After looking into the different procedures available, and talking to a couple of the eye centers in the area, I always talked myself out of it. I usually told myself that I was going to wait another year or two to see if they come up with some better technology. But, as you can imagine, this went on for several years because you can ALWAYS wait another year for advancements that will come around.

The cost of the procedure was never really a concern since I’m not one to squabble over something as precious as my sight. What had always held me back was fear.

Okay, so now that I have explained why I haven’t gotten LASIK for the last several years, you may be wondering why I am sitting in a waiting room now? For that, I have to go back a few months.

Back in October of last year, Clark Young, our managing editor, and I were promoting the magazine. Clark had an appointment with the Laser Eye Institute of Troy’s director, Dr. Daniel Haddad. We met with Dr. Haddad and discussed with him our vision for Health & Leisure Magazine. We talked about how our publication could help him grow his business.

Dr. Haddad then proceeded to share with us his vision (pun intended) and how he practiced at his Institute. Sixty minutes later, Dr. Haddad had given us a full tour of his facility and equipment, as well as a detailed education about LASIK eye surgery.

He told us about the research he has performed over the years and what he has learned from performing thousands of procedures. Now I’m not easily impressed, but I quickly picked up that Dr. Haddad was well-versed in his craft.

This was my first experience actually meeting with a physician who would perform my surgery, so I was impressed with the time he took to explain the process and technologies.

Now to further explain why I’m sitting in Dr. Haddad’s waiting room the day before I’m to have a high powered laser etch my eyes to perfection (hopefully); I must go back to shortly before we launched the magazine in early January.

Clark and I were talking about future articles for the magazine. We had the idea of doing an article on LASIK surgery. However, we wanted our article to cover the whole process from the patient’s perspective.

We would follow a patient from the first exam, through the procedure, and the follow-up exam. I couldn’t think of a time when I had seen a first hand account of the surgery, and I’m not even sure how much my friends who had had the surgery told me.

Clark and I decided one of us should get the surgery and write the article. Now the only question was who was going to do it, Clark or me?

I didn’t want to do it because I thought Clark should have the ‘honor’ of doing the article – in other words, I was still scared. After all, he is the managing editor. But, Clark pulled rank (I think he was a bit scared as well – more than a bit!) and it was ‘decided’ that I would do the article.

My appointment was set, I would have my initial exam and final evaluation exam together on the same day and I would go under the laser the next day. I wasn’t easing my way towards perfect vision, I was barreling towards it on a rocket sled.

Oh yeah, did I mention I’m scared out of my wits about getting my eyes lasered? ‘Oh well’, I tell myself, ‘suck it up.’

Now back to the waiting room.

“Jeff.”

I keep looking at the magazine in my hands and telling myself that any of the other four guys in the room could be named Jeff. Anyway, my appointment isn’t for another ten minutes.

“Jeff Lockwood.”

Okay, very little chance that one of the other guys shares my exact name. I look up and wave to the woman who just called my name. ‘That’s me,’ I say. She holds out her hand and tells me “Hello, my name is Ann and I will be doing your testing today.”

Ann leads me to a very nice room with beautiful paintings of brightly colored fish, and a live fish tank in one wall. On a counter shaped like a boomerang, there are three devices that are obviously the first round of tests.

The first test checks my glasses prescription and she notes that my prescription is not too bad (I’m about 2.0 diopters in both eyes; not blind as a bat, but pretty nearsighted). I look in the eyepiece of the next machine, an autorefractor, and after a few seconds it gives a pretty good analysis of the severity of my vision. This is called the refractor error.

The last machine is the glaucoma test. You know, it’s that annoying little machine that puffs air into your eye, makes you flinch, and helps make sure you don’t have glaucoma. Ann makes a notation on my chart and stands up, “If you would follow me, please?”