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  Beijing Scene

Beijing Scene, Volume 6, Issue 6, November 19 - 25

The Kindest Cut
Laser Eye Surgery in Beijing
by David Richinger

It may sound terrifying, but repairing vision defects with laser surgery is becoming increasingly common, especially in China. The operation is surprisingly affordable, and increasing numbers of patients mean that Chinese surgeons are more experienced than many of their Western counterparts.

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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