Every carpenter knows the phrase “measure twice, cut once,” but Dr. David O’Brien, who works in a different profession, goes much further, measuring thousands of times before making an incision.
O’Brien does his cutting on something far more precious and infinitely more delicate than any stack of two-by-fours. As a fellowship-trained refractive surgeon, he operates on the human eye and in the newest generation of “laser assisted in-situ keratomileusis” – or Lasik – surgery, his specific target is the eye’s cornea: the clear covering on the front of the eyeball.
Lasik surgery is performed to correct vision problems, including nearsightedness, farsightedness, astigmatism and presbyopia.
With the help of the newest generation of the FDA-approved “WaveLight Topography-Guided Custom Ablation Treatment” software and the “Allegretto Wave Eye-Q Excimer Laser System,” O’Brien now measures the curvature of the cornea at 22,000 different locations on the eye.
Earlier incarnations of Lasik surgeries measured the cornea at only 160-200 locations.
O’Brien’s face lights up as he continues to explain. “Think of the cornea like a mountain,” he says. “It falls off at a certain rate. In other words, there’s a certain steepness to it. That shape is called the prolate and that prolate shape allows people to have excellent night vision when it’s idealized.”
However, in previous generations of Lasik surgery, stretching back to the 1990s, O’Brien explains, “When we made incisions in the cornea, it would allow the cornea to splay open and flatten really aggressively in the center. The optics of that weren’t very good, frankly.”
In fact, O’Brien continues, “when the pupil would dilate, people [with flattened corneas] would get these aberrations. Light rays would come through at different angles causing a lot of scatter. Lights would have tails and halos and starbursts.”
Those problems were widely publicized and as O’Brien admits, earlier Lasik procedures “didn’t address all of the nuances of the cornea.”
The newest topography-guided approach is, he says, “simply a much better way of measuring the whole corneal surface” and it is producing some remarkable results by keeping or maintaining the cornea in its optimal shape.
“I’ve had it done myself. My wife has had it done. Multiple family members and most of our staff [at New Visions] have too. We believe in this.”
New Visions Eye Center invested some $1.2 million in the hardware and software needed to perform these new topography-guided Lasik procedures. The first ones were done here in early May.
In that first week, O’Brien performed nearly a dozen such surgeries. (In total, he has performed more than “11,000 Lasik procedures.”)
Jon Mann, a 34-year-old Port St. Lucie resident who works in Vero Beach at Treasure Coast Computer Services, was one of O’Brien’s first patients after he began using the new equipment.
Mann suffered from nearsightedness or myopia. The National Eye Institute reports that upwards of 30 percent of the U.S. population may now suffer from myopia and many NEI doctors feel the condition may be aggravated by the eye fatigue brought on by being in front of computer screens for too many hours each day, so Mann’s problems may have been work-related.
Whatever the root cause, Mann is enthusiastic about the results so far. He had the procedure on a Thursday and by Saturday he was driving again. By Tuesday he was back at work with Treasure Coast Computers. “During the process, I didn’t feel a thing,” he says.
O’Brien says, “the magic number” for complete post-surgical recovery is about three months but he adds that “generally speaking, people will see well enough the next day to drive to their post-op exam.”
Despite O’Brien’s enthusiasm, he cautions this particular technique is not for everyone. He firmly states that screening would-be patients is “the most important thing” he does.
People with highly irregular corneas, those who’ve suffered serious eye lacerations or those with cataracts, he says, are not usually good candidates.
“I get a lot of referrals from area doctors,” O’Brien confides, “because I’m not afraid to tell a patient: No, you’re not a good candidate for this.”
The rewards for those who have the procedure, however, can be “life-changing,” according to O’Brien.
Many people think of 20-20 as “perfect” vision but O’Brien says otherwise. He cites baseball’s legendary home run hitter, Roger Maris, as someone who “could see the stitches on a fastball and how it was spinning” as it approached the plate and speculates Maris’ vision was likely 20/12 – and it seems topography-guided Lasik may be able to help some people achieve that type of vision.
Then there’s the matter of money.
“I charge $4,800 total. That covers your pre-op examination, your surgery and your follow-up for a year,” says O’Brien – which may be something of a bargain.
“The average patient,” O’Brien says, “will have paid for their Lasik over the course of about seven years [by eliminating] the cost of glasses, frames and contacts over that period.”
“From an infection standpoint, surgery is safer than contact-lens wear,” he adds. Many contacts-wearing patients “abuse them,” he says. “They sleep in them. They don’t care for them. They wear them too long, and they wear them at inappropriate times.”
After a successful Lasik procedure, patients don’t have to deal with any of those issues anymore.
Dr. David O’Brien is with New Visions Eye Center at 1055 37th Place in Vero. The phone number is 772-257-8700.