Perceptions
Exploring Uncharted Territory
A pioneering surgeon and an adventurous presbyope make inroads. 
BY BARRIE SOLOWAY, M.D., NEW YORK, N.Y.

Talking to so many LASIK patients about reading glasses, and realizing that I, too, would soon need them started me on a search for a method to reverse presbyopia.

In 1998, I traveled to Canada to learn about a technique that couldn't be taught yet in the United States. At the Presby Corp seminar on scleral expansion bands, I was intrigued by the differences between the Schachar theory and the century-old Helmholtz theory, which I'd been indoctrinated in since residency. I left with such enthusiasm that later that year I took my entire surgical support staff from the New York Eye and Ear Infirmary to another seminar at the Academy meeting.

After I purchased the surgical instruments and implants, all that was left was to find a willing patient. I had always wondered how surgeons did this. It seemed impossible. The thought of being my first patient, or one of the first patients in the world to have the surgery, or having to travel to Mexico because it wasn't permitted in the United States put off most New Yorkers.

Then Bob came in for his 1-year LASIK post-op exam. Bob was one of those patients who had traveled thousands of miles in the early 1980s to have cryokeratomileusis to get out of his "Coke-bottle glasses that everyone wanted a drink out of" when he was younger. I performed LASIK on him in 1997 to finally help him accomplish that goal. He looked much younger than his age, but still complained that he wasn't getting any young-person acting roles because his reading glasses always gave him away. When I told him I'd be traveling to Mexico in 3 months to perform presbyopia surgery, his first question was, "Why can't we go sooner?"

So, I had my first patient. But while in Mexico, I started having doubts about the surgery. Although some surgeons were reporting excellent results, others were reporting that the surgery didn't work at all for them. I started to worry about what I'd do if we came all the way to Mexico and ended up without any improvement in Bob's near vision. But I thought back to the patient I had seen in Toronto, who was reading without glasses post-op, and we forged ahead.

The Saturday-morning surgery lasted about 45 minutes. I knew from performing LASIK on Bob that his epithelium didn't tolerate surgery well, so we agreed that he would be patched and spend the first 24 hours post-op on Percocet for pain.

The next morning, we both went to the hospital for his 1-day post-op exam. I removed the patch. He looked great at the slit lamp. Then, it was time for the moment of truth. I gave him a near card that was marked on the 20/100 line, the smallest he had been able to read without glasses the previous morning. I asked him if he could read the card. After a long pause, he shook his head and said, "No, it's not quite there yet."

My heart dropped as I thought my fears had come true. I pointed to the large top numbers on the card and asked him if he would guess. "Oh, those are no problem. I can even read this line," he said, pointing to the 20/25 line. "But the bottom line is just too small. Can I bring it closer?"

I told him to hold it wherever he wanted, and when he zipped through the bottom line at 8 inches, I realized that he was reading better than I could. What a great feeling! 

Dr. Soloway is the Director of Vision Correction at the New York Eye and Ear Infirmary, where he is the principal investigator of surgical reversal of presbyopia and automated lamellar therapeutic keratoplasty. He's an Assistant Professor of Ophthalmology at the New York Medical College, and specializes in cornea and vision correction surgery, including LASIK, LASEK, Intacs, phakic IOL, surgical reversal of presbyopia, and augmentation keratoplasty. You can contact him at bsolowaymd@pol.net.