Journalist Al Ruechel knew his vision correction posed special challenges. "I started wearing contacts when I was nineteen years old," says the popular Bay News 9 news anchor, "...hard contacts," he emphasizes, "because I had such a pronounced astigmatism. Soft lenses just couldn't correct for it. After more than twenty years of that kind of abrasion, the corneas of my eyes were really misshapen."
Five years ago, he tried gas permeable contacts, but they caused his eyes to dry out. "No matter how many enzyme tablets I used on these lenses, I couldn't keep them clean enough. By three o'clock every afternoon, I was looking through a haze."
Eyeglasses weren't an option. "The glare from the studio lights would be too harsh in the camera lens," Al reminds.
Al had followed advances in laser refractive surgery, and he realized his high degrees of myopia (nearsightedness) and astigmatism meant he was not a good candidate for PRK (photorefractive keratectomy). A relatively new procedure, LASIK (laser-assisted in situ keratomileusis), caught his attention, especially after he saw the good results enjoyed by several co-workers.
The procedure sounded good, but Al's professional needs created special concerns.
"My eyes were already experiencing presbyopia," he notes, "so, in addition to being very nearsighted, I was now experiencing the difficulty with close vision that comes with the territory in my age group. In my work, I have to be able to read a monitor on the desktop and, without a pause, switch to reading the TelePrompTer on a camera ten feet away. I had to be very careful about any procedure I selected and the surgeon who would perform it."
Al found his eye surgeon - in his dentist's office!
"I was reading a copy of Florida Health Care News while I waited for my dental appointment," he relates, "and there was a story about one of Dr. Behler's patients who was very pleased with the results of LASIK. From reading the article, it was obvious that Dr. Behler takes whatever time is necessary to ensure the best results, and that is exactly what mattered to me."
Scott C. Behler, MD, is a board certified ophthalmologist, a highly skilled practitioner of state-of-the-art refractive and cataract procedures, and founder of the Behler Eye & Laser Center in Belleair.
"Dr. Behler isn't in this for personal glory," Al comments. "He loves the science, the challenge of solving a problem with the right skills and tools. I have always believed that the best doctors are the ones who are artists, as well, and it didn't surprise me when I discovered that Dr. Behler is also a concert pianist. He understands the nuances of sound, just as he understands the nuances of sight. My visual needs, because of my work requirements, required an appreciation of those nuances, and Dr. Behler realized that and assured me he would help design the right solution for me."
Careful Planning
Dr. Behler recalls, "After reviewing Al's ocular health, and the degree to which his prolonged use of hard contacts had affected his corneas, I explained the procedures that are currently being used to correct myopia and astigmatism. I want every patient to be fully aware of the techniques which are available, the facts about them, and, then, the basis for my recommendation as to the best surgical technique for each individual case.
"One of my important roles as the ophthalmologist is to offer the most appropriate and safest choice of procedures based upon the needs of my patients.
"Until recently, the only methods for surgically correcting refractive error were RK, PRK, ALK, or refractive lensectomy," continues Dr. Behler. "However, there are different degrees and types of refractive error and not all cases could be properly corrected with these procedures. We are able to better address the correction of myopia, and now also hyperopia, even in the presence of substantial degrees of astigmatism, with LASIK.
Dr. Behler uses the VISX Excimer Laser, which received government approval for correcting higher levels of nearsightedness and astigmatism than were possible with PRK. It has also been approved for the correction of hyperopia. Up to twelve diopters of nearsightedness, up to five diopters of astigmatism and up to six diopters of farsightedness can now be addressed with this advanced laser. LASIK corrects nearsightedness by carefully removing tissue from the inner corneal layers, thereby flattening the curvature of the cornea and allowing images to focus more sharply on the retina.
Aggressive approaches to LASIK sometimes result in over-correction, and a nearsighted person could leave surgery with hyperopia (farsightedness). Dr. Behler takes a conservative approach, removing the least amount of corneal tissue to yield the best results, and enhancing that improvement with a secondary procedure only if it is necessary. He counseled Al that his need for good near and distance vision, coupled with his presbyopia (aging eye), meant that increased care would need to be taken to prevent overcorrection.
"What I appreciated about Dr. Behler is that he explained everything to me thoroughly and didn't rely on 'quick and easy' answers," states Al. "I've reported on medical procedures before, and I want the whole story. Dr. Behler gave it to me, telling me the science and the art of what had to be accomplished, letting me know what kind of improvements I could expect, and when."
LASIK Procedure
Before making a suggestion about the most appropriate procedure for any patient, Dr. Behler conducts a thorough exam which includes taking a medical history, testing refraction (determining the degree of visual impairment) and measurements of the cornea to determine its health and exact curvature. Computerized corneal topography provides a colorful three-dimensional map of the cornea, which not only identifies abnormalities, but also is an important part of the treatment plan, especially for patients who have astigmatism.
In performing LASIK, Dr. Behler uses a microkeratome to elevate a very thin flap on the surface of the cornea. This flap allows the VISX Excimer Laser access to the underlying corneal tissue. The strength of the patient's eyeglass prescription determines the amount of microscopic tissue that must be removed to compensate for the untreated eye's refractive deficit. The procedure creates a flatter corneal surface, creating improved, natural vision. Once the corneal tissue is treated, the flap is put back in place to protect the newly reshaped cornea.
The procedure takes about ten minutes and involves no stitches. Because only the surface layer of the cornea is raised to allow access to the inner corneal tissue, the healing process begins as soon as the corneal "flap" is replaced. Most patients can return to work or resume normal activities on the day following the procedure.
Quick Recovery
"The whole thing was pretty amazing and painless," attests Al. "Dr. Behler assured me the anaesthetizing eye drops would keep me comfortable, but I expected some discomfort... there was none!
"By the morning after LASIK, my vision was completely clear, and within a few weeks even my night vision was stable. After my second procedure, to 'fine tune' the corrections, I'm seeing better than I even imagined I would. I'm astounded," he continues. "I love it!
"At first, it was just being able to see things clearly - the individual leaves on a tree, the numbers on my alarm clock. I coach soccer, and now I can even see the kids' expressions when they mumble about running laps! What I'm really appreciating now is the freedom from my contacts and eyeglasses.
"Best of all, Dr. Behler did exactly what he planned in providing me with modified monovision. My brain has already made the adjustment to use one eye for distance vision and one eye for near, and I'm able to do my studio work without a hitch.
"Friends have asked me about LASIK, and I've told them about my success with Dr. Behler. The important thing is to find a surgeon who will take his time with you and give you realistic expectations. Dr. Behler did that, and everything he told me to expect happened just as he described.
"Dr. Behler restored good clarity for me, without any drawbacks, and without that 'three o'clock haze' that was so aggravating. I couldn't be more pleased."
