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It's been many years since I've seen
my feet in the shower. This is not because I can't say
no to second helpings, but because I'm functionally
blind without corrective lenses. Since childhood my
myopia (shortsightedness) has worsened. The technical
reason is increasingly domed corneas which cause light
to focus in front of my retina rather than directly
onto it. To compensate, I've had to wear progressively
stronger glasses and contact lenses.
The cost and hassle of glasses, contact lenses and prescription
sunglasses compelled me to look into corrective surgery.
The procedure is becoming more and more common in many
Western countries as well as in China. An increasing
retinue of satisfied customers encouraged me to visit
the Eye Hospital (Tongren Yiyuan) at Chongwenmen to
check it out.
"But it's your eyes!" cautioned squeamish
friends and relatives - especially my mother who probably
bequeathed me the defective eye genes in the first place.
Some were surprised that I wanted to have it done in
a developing country, but there are at least half a
dozen places in Beijing to get corrective laser eye
surgery and the standard of surgery is high.
Chinese friends assured me that Tongren is among China's
best hospitals and has a strong reputation for ophthalmology.
They have performed laser surgery on almost 8200 patients
since 1993, about 50 of whom were foreigners (not including
overseas Chinese). The hospital itself is in desperate
need of basic management. They don't take appointments
so people wander in and out of doctor's offices and
pace impatiently. Patients jump queues rudely, there
are many lines to stand in, and a maddening litany of
small fees to pay and pieces of paper to have stamped.
(All expatriate managers should be required to go to
a Chinese hospital to understand why local employees
need a full day for simple procedures there).
Of greatest importance to me, however, was not the behavior
of administrators and bureaucrats. I focused on the
equipment and the surgeon using it. I wanted the most
modern laser equipment on my eyes. Tongren uses two
types: an American VISX Star laser with a field upgrade,
and a German Schwind laser. These lasers utilize more
advanced technology than anything in use in the United
States, where surgeons are one step behind due to cautious
FDA approval requirements. The surgeons at Tongren claimed
that both lasers were of equal quality.
My surgeon, Dr. Lu, gave me final
reassurance. She exuded confidence and friendliness
in the stressful and resource-strained Chinese hospital.
The four surgeons at Tongren probably pass as many people
under their lasers as any clinic in the world. Quantity
does not necessarily translate into quality, but at
least these surgeons are experienced. They also charge
a fraction of what their colleagues in the West charge.
My entire operation came to RMB10,000 (the rate for
foreigners and Chinese is the same). I have heard of
places in Canada performing the operation for less,
but experienced surgeons command a premium.
When I asked Dr. Lu how myopic readers interested in
the procedure could contact her, she cautioned with
a giggle: "Of course we will help anyone and foreigners
are welcome, but please don't bring so many!" She fears
floods of foreigners because there is no shortage of
Chinese patients to keep her busy, and communication
- about what to expect, the risks, and appropriate behavior
- is a very important part of the treatment. They are
surgeons and not linguists: "We're not set up to provide
proper service in English; I'm afraid they might misunderstand
something and later be disappointed and complain."
The Big Day
On October 26 I tripped into Tongren
to go under the laser knife. They called us in groups
of five into a small room outside the operating theatre
where we donned shoe covers and plastic gowns with matching
shower caps. The nurse applied local anaesthetic and
then washed out our eyes and disinfected our faces.
One by one we went into the operating room to get zapped.
Almost all of the other patients that day were Chinese
women and as they came out of the operating room, the
queuing patients would ask if it hurt. "It didn't hurt
at all!" each one would insist. Dr. Lu says her typical
patients are young Chinese women, and she often operates
on athletes, actors, and aspiring soldiers and pilots.
A few minutes later I was on the
operating table myself, wondering if my pain threshold
was lower than the average young Chinese woman's because
it was hurting me! Overall, though, it was less painful
than a bad trip to the dentist. Extreme discomfort would
best describe the sensation. As I lay there I remembered
reading about how many North American eye surgeons give
their patients a little Valium to smooth the process
and I started to wonder if paying five times the price
would have been worth it after all. I was just losing
myself in the Muzak theme from "Rocky" piped into the
room when the surgeon chuckled in my ear and joked with
the others in attendance about how my big nose was getting
in the way of her equipment. Besides her amusement at
my proboscis, the other thing I remember about the surgery
was the audible staccato bursts of the laser beam.
When I got up from the table a few minutes later my
vision was cloudy: almost like it would have been with
my contact lenses in a Turkish steam bath. The nurse
scotch-taped some pieces of plastic over my eyes and
told me to keep them on until I came back the next morning.
After I stood in another line to pay RMB 5, I somehow
groped my way outside to a taxi queue and headed home
to bed.
After I got home my eyes started to water and ache as
the local-anesthetic drops wore off. I began to think
they had botched the operation and I was considering
going back to the hospital for help when a friend who
had the operation a few months earlier called. She reassured
me that tears and discomfort were normal, and for about
two hours I writhed and whined about the stinging while
my eyes watered prodigiously. Eventually I fell asleep
for an hour and when I woke up at about 8 pm, the pain
was gone.
The Aftermath
I went back to work the following
day and for a few days my eyes felt as though I'd been
sleeping with daily-wear contact lenses. A week later
all discomfort was gone; my vision improved daily and
my distance sight was pretty much perfect.
Three weeks on I still have problems with reading and
night vision. The night vision should correct itself
over the next year - lights have large spiked halos
and, in a fluorescent-lit room, my vision is not very
sharp. The reading is something I hope will improve
much sooner.
For updates
on David Richinger's vision, email him at richinger@canada.com.
The Eye Hospital (Tongren Yiyuan)
is located at 2 Chongnei Dajie, Chongwen District .
Open M-F, 8:00am-12:00pm, 1:00 - 5:00pm. For information
call 6512-9911. Appointments must be made in person,
and will not be made by phone. The Eye Hospital does
not have special services for foreigners - so 'caveat
emptor'.
Laser Eye Surgery - How It's Done
Laser eye surgery has been practiced
for about 20 years, but there are constant advances
in technology and technique. There are a number of different
procedures that have been or are being used (e.g. RK,
ARK and PRK, LASIK) to "sculpt" the eye into the desired
shape for better vision.
LASIK (Laser in Situ Keratomileusis) is the state-of-the-art
technology in corrective eye surgery, and the procedure
most commonly used at Tongren Hospital. The part of
the eye that is too curved or pointy is basically vaporized
and the patient is left with eyes more ideally shaped
to refract light properly onto the retina. The advantage
of LASIK over older procedures like PRK is that the
membrane covering the eye, known as the Bowman's layer,
is left intact. Before the laser zapping begins, the
surgeon peals this protective skin back and then replaces
it later. By sparing the Bowman's layer LASIK has a
recovery time of days instead of weeks, less post-op
pain, and greater stability of correction.
The actual operation consists of the surgeon making
a very shallow circular cut around the Bowman's layer
(imagine a knife peeling a flap of skin off of an orange)
and folds the flap to the side to expose the cornea.
Second, the laser "sculpts" the cornea tissue by rapidly
heating unwanted cells to extremely high temperatures.
Since the cells are mostly water, they are vaporized
in an instant. Finally, the surgeon replaces the flap.
The whole procedure takes about 10-15 minutes for both
eyes.
The flap-making stage of the procedure lasts about 20
seconds. A suction ring is used to make eye movement
virtually impossible. The eye is kept open while a doctor
uses a second instrument to position the eye as desired.
Since the eye is anaesthetized, this is not painful.
As with any surgery there are significant risks. It
is crucial that the Bowman's flap is given time to heal
properly, so swimming, bathing, and vigorous sports
have to be postponed until a month after the operation.
Complication rates quoted at the Tongren Hospital (consistent
with Canadian figures) are about 2-4 percent. Most of
these are post-op infections, but more serious mistakes
(such as a loss of the corneal flap, an incision made
too deep or too shallow, etc.) also occur.
Laser vision correction can treat a very broad range
of vision problems including nearsightedness, astigmatism,
and farsightedness. Doctors claim that even patients
with severe vision defects can be treated.
For an animation or video of the
procedure and a persuasive presentation from a for-profit
organization, check out http://www.lasikprk.com.
The risks of laser eye surgery are well documented
at a website called
"I Know Why Refractive Surgeons Wear Glasses" at http://members.aol.com/eyeknowwhy.
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