Vision Quest The Future is Seen at the Hagerstown Laser Center

by Nathan Oravec


It’s 3 p.m. on Monday, February 24, and John has arrived at the Valley Mall to purchase a new pair of eyes.

It is the day of his LASIK surgery and, following prior visits determining his eligibility, he’s come to the Hagerstown Laser Center in hopes that he will soon see the world more clearly.

At approximately 3:40 p.m., after a brief round of standard pleasantries and a routine eye examination, we sit in a preliminary waiting area directly outside the door leading to the laser that will perfect John’s sight, correcting his lifelong nearsightedness, as well as astigmatism.

Elastic capped and booted, a precaution taken by everyone setting foot near the majestic, corrective laser machine, he considers the operation that will occur in mere minutes, and that amazingly, will be performed in even less time than that. “It’s funny. I’ve worn glasses all my life, and now, in twenty minutes, I’ll never have to wear them again.”

At 3:47 p.m., we’re welcomed into the laser suite. Three minutes later, under the direction of Dr. John A. Stefano, M.D., FACS, John takes his position underneath the LASIK device - this formidable man suddenly dwarfed by this formidable machine.

According to Allison Combs, Hagerstown Laser Center Coordinator, LASIK (Laser In-Situ Keratomileusis) Eye Surgery - the most technologically advanced procedure in the field of vision correction today - works underneath the surface of the cornea to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. Two main instruments, she explains, are used during the operation. The first and foremost is the laser - a VISX Star S2 excimer model at the Center’s Hagerstown office - without which, Combs says, “you can’t do much.” The second device is known as a Microkeratome, used to create a protective flap on the cornea, allowing the laser to do its job. Once the eye is held in place via a pressure ring and numbed with a local anesthetic eye drop, the protective flap is created - taking a total of 30 seconds - and the treatment area is exposed. It is then that the laser, a cold beam of ultraviolet light, begins to remove minuscule amounts of tissue from inside the cornea, in essence, reshaping it. “With each pulsor tic,” says Combs, “the laser begins to change the way light is focused on the retina.” Pre-programmed specifically for each individual patient, by removing corneal tissue in the shape of a lens, the prescription is virtually built into the eye itself. Approximately eight minutes are spent on each eye individually, with an actual treatment time, dependent upon the patient and his or her prescription, varying from 15 to 60 seconds.

John’s right eye appears simultaneously on two tiered computer monitors, hovering about the VISX Star S2. Larger than life, the dual images shift and center on screen, directed by Dr. Stefano, who controls the device’s camera via a console joystick flanking his wheeled chair. Seated at John’s head, his face pressed against the LASIK’s viewfinder - a microscope/binocular hybrid extending from the laser - the doctor intently peers downward, eye to magnified eye. Three lab-coated, masked assistants surround the surgeon; two to his left - passing him his tools; one to his right, her eyes are trained on both monitors, her fingers inputting various commands on an attached keyboard. The pressure ring is applied, and John’s eye bulges from underneath its lid, threatening - in this guise - to burst from the screen. Little is said as three small incisions are made on the surface of the eye. These, it is explained, will later be used to line up and reposition the protective flap, which is made deftly with a tiny blade as a gelatinous sliver flips and uncovers the cornea. Glowing red crosshairs appear on the monitors and the joystick steers them over the black nucleus of the brown eye, targeting the troubled spot. It’s not television, and we’re not at the movies, but the images here are something straight out of a Learning Channel meets “Minority Report” amalgam. It is then that you realize - the future is now.

One of the first doctors to perform laser vision surgery in the region back in 1995, and with over 1,500 LASIK procedures under his belt, Dr. John Stefano is considered a leader in his trade, and has been perfecting patients’ sight for over two decades now. Last year, he was named one of the LaserVision ® 2002 Top 100 Surgeons for excellence in refractive surgery. Launching his practice in the Winchester area and the Eastern Panhandle of West Virginia, he expanded to Hagerstown, MD with the office at the Valley Mall in July of 2002. In addition to his work with LASIK vision correction, Dr. Stefano routinely performs cataract and corneal transplantation surgery, and has consulted patients for other doctors.

While Dr. Stefano, using the LASIK procedure, can treat approximately 95 percent of patient prescriptions - aiding the near and far-sighted and those with astigmatism - there are, notes Combs, certain conditions that must be met by potential candidates. These may include age, dependent upon prescription-type, as well as general health and an absence of pre-existing eye conditions, diseases, or problems, such as an irregularly shaped cornea. Those who fulfill the requirements and proceed with the procedure are said to feel “elated” and “excited” directly afterwards, and are promised to never see the world in the same way again.

Nearly twenty minutes after stepping inside the laser suite, John’s LASIK experience has come to an end. As he is welcomed to rise and open his new eyes for the first time, Dr. Stefano asks him what time a clock mounted on the wall reads.

“About a quarter after four,” he replies.

Following the laser surgery, Combs notes, patients are kept at the office for at least fifteen minutes, seated in a dark room to allow their eyes to rest, before they are sent out on their own. Thanks to the human eye serving as a natural suction, no stitches are necessary, and healing time is minimal. Patients are informed that for the rest of the day after the procedure, they will be extremely sensitive to light, and are sent home in sunglasses. An antibiotic is given to the patient to protect against infection, and a steroid is used to relieve inflammation. Lubricating drops are also used to treat discomfort.

Slight discomfort, Combs says, is normal for the initial hours after LASIK, and further rest is prescribed. For the first night, patients are not permitted to watch television or read. “We want the eyes to be as inactive as possible for the first twenty-four hours,” says Combs. For the remainder of the week, a number of related stresses are to be avoided, such as aerobic activities for three days following surgery; dirty or dusty environments for five days; and chlorinated water in swimming pools and hot tubs for seven days. Patients are not permitted to drive themselves home, and are actually not legal to drive until okayed by Dr. Stefano at their one-day follow-up.

Patients generally notice a difference in their vision immediately. The evening of the procedure, Combs explains, things may be blurry, but this is said to pass in time. According to the Center, during the follow-up appointment, many patients see at least 20/40, with others having been known to have improved as much as 20/20 or better.

“When I went in there, I was really worried about holding still and not flinching,” says John, two weeks following his LASIK procedure. “But it was easy, easier than going to the dentist.”

“I don’t wear any glasses at all now,” he continues. “It’s the first time since I was six years old. It’s interesting - you wake up in the morning and roll over, and it’s like you see the alarm clock for the first time in your life.”

For more information on Dr. John Stefano, M.D., FACS, and his practice at the Shenandoah Laser Eye Center and the Hagerstown Laser Center, 17301 Valley Mall Road in Hagerstown, visit www.seeclear.com or call 301-582-6127. E-mail info@seeclear.com.