Karen van Kampen
Dr. John van Westenbrugge of Gimbel Eye Centre has performed about 24,000 surgeries.
It's 4 p.m. and Dr. John van Westenbrugge has operated on 13 pairs of eyes. His last patient of the day walks into the dimly lit operating room wearing jeans, runners and a grey hoodie.
The 27-year-old lies down on a leather recliner that resembles a dentist's chair. She crosses her feet and laces her fingers together across her chest.
A bright light illuminates one of her pupils. Van Westenbrugge's blue eyes peer down at her.
"Your job is to look at the red light for the whole procedure," he says, referring to the laser.
The surgeon's gentle voice tells her exactly what he's doing, so there are no surprises. First, van Westenbrugge uses a metal instrument to hold the eye lid in place.
"Blink as you normally would," he says. He administers anesthetic drops to freeze the eye.
The surgeon tells his patient she will feel some pressure on her eye. He pushes down gently onto the eye with a circle marker to outline the area he will be working on.
"Is the pressure OK?" he asks.
"Yes," the woman replies.
Then it is time to remove the outer surface layer of the cornea by rubbing it away with an instrument. Within a few days, the protective layer will regenerate.
Van Westenbrugge calms his patient with some chit-chat. "Where do you work?" he asks.
The Calgary woman does accounting and marketing for an oil and gas company and spends most of her day staring at a computer. A close up of her eye stares down at us from a large screen.
The woman's tense shoulders begin to relax. Van Westenbrugge is known for his kindly manner. He speaks calmly and methodically. Now, it's time for the laser treatment, he says.
Van Westenbrugge positions the laser, which vapourizes a small amount of the eye's stromal tissue. The stroma, which is the interior section of the cornea, does not regenerate. The laser treatment permanently changes the shape of the cornea, correcting a person's vision.
There is a zapping sound that resembles an overactive air purifier, followed by a burning smell that wafts through the operating room.
Twenty-one seconds later, the laser treatment is complete.
Van Westenbrugge inserts a contact lens that acts like a bandage, comforting the eye. The woman will wear the lens for the next four to seven days.
Four minutes later, the surgeon repeats the procedure on the woman's right eye. Another four minutes pass, and the surgery is complete.
The woman can see immediately after the operation, even though objects are quite blurry. Healing will take a week. Four to six weeks after surgery, she can expect side-effects that include light sensitivity, dry eyes and halos or glare from bright lights at night.
Before she walked into the operating room, the woman was nearsighted. Staring at the clock across the room, she says excitedly, "I can read the time."
"You did very well," assures van Westenbrugge. The woman smiles, thanks the doctor and walks out of the operating room.
Van Westenbrugge used photorefractive keratectomy (PRK) on the 27-year-old. The first PRK surgery was done in Berlin in 1987. In 1990, Gimbel Eye Centre, where Van Westenbrugge works, was the first to perform the surgery in Canada.
This type of laser surgery is ideal for low to moderate nearsightedness and astigmatism, or if the cornea is too thin for
LASIK.
Laser-Assisted In Situ Keratomileusis (LASIK) cuts a flap in the cornea, leaving a hinge at one end. Folding the flap back, the stroma is exposed. As with PRK, a laser vaporizes a section of the stroma, and the flap is laid back down.
LASIK is ideal for people with low to moderate farsightedness, low to high nearsightedness and low to high astigmatism.
Prices vary at different clinics across Canada, but at Gimbel, PRK and
LASIK cost $995 an eye and up, depending on your vision. IntraLase, a new
LASIK corneal refractive procedure, costs an additional $400 per eye due to the expense of operating the machine.
Instead of using a surgical blade to create the flap during
LASIK surgery, IntraLase uses pulses from a laser. The surgeon then lifts the flap to operate on the stroma. IntraLase can create a very thin flap, enabling patient with thin corneas to have the
LASIK surgery.
Gimbel, which opened its doors in 1984, began doing
LASIK surgery in 1995. Van Westenbrugge, 52, has been with the clinic since 1985, and has performed refractive surgery on approximately 24,000 eyes.
A lot has happened since he entered the field. Surgeons began using laser surgery for simple nearsightedness. Then, they used the technology to correct astigmatism. The optical zones have increased, says van Westenbrugge, allowing surgeons to work on a larger area of the eye.
The halos that were once characteristic of night vision are now almost a non-issue, says the surgeon. With the improved quality of the laser beam, healing response has quickened.
However, according to the U.S. Food and Drug Administration, people should still carefully weigh the benefits against the risks of
LASIK before undergoing the surgery.
The FDA states the treatment can cause patients to lose lines of vision on the vision chart that can't be corrected with glasses, contact lenses or surgery.
Patients may be undertreated or overtreated because of surgery. Some will still require glasses or contact lenses after surgery and, in some cases, additional treatment is not possible.
Dry eye syndrome is a risk of LASIK, according to the FDA. This causes discomfort and possibly reduced vision, and may be a permanent condition. According to the FDA, the long-term safety and effectiveness of this relatively new procedure remains unknown.
Gimbel doesn't promise patients perfect vision for the rest of their lives.
"Nothing is guaranteed forever," says surgical assistant Pamela Donnelly. "Our eyes are always changing. As we age, our eyes can worsen or get better."
If a person's prescription changes, they will need to have another surgery. It's the same as requiring a new pair of glasses.
"Some can go six months, some can go eight to 10 years," says Donnelly.
If an enhancement is needed within 18 months of surgery, Gimbel covers the cost.
Yet this doesn't seem to deter Gimbel's patients. Laser surgery is so enticing because it frees people of the daily hassle of glasses or contact lenses.
Today's 27-year-old patient is excited by her newfound freedom.
"I can't wait to start swimming again," she says.
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