An exciting program for people with quadriplegia provides LASIK surgery to qualifying candidates at no charge.
By Lori A. Wood
Dr. Robert Maloney consults with Courtney Henrichs. |
Wearing glasses or contact lenses can be bothersome to anyone, but especially to quadriplegics, who may not have the manual dexterity to keep lenses clean or to place contacts on the eye. Thanks to the Focus on Independence program, which provides free LASIK surgery to eligible people who are quadriplegic, many are now able to turn an eye toward freedom.
“The program is for quadriplegics who have significant impairment in their ability to use their arms and hands,” explains Robert Maloney, MD, ophthalmologist and director of the Maloney Vision Institute, (www.maloneyvision.com), located in Los Angeles, California. “We’re really excited about doing this for quadriplegics. For most ambulatory people, glasses and contacts are a nuisance, but for quadriplegics, they’re a real limitation. If their glasses fog up, they can’t reach up and clean them off. If glasses slip down their noses, they can’t reach down and push them up. If they want to be able to see something in the middle of the night, they can’t reach for their glasses. Having to wear glasses or contacts really undercuts their independence, and that is really the motivation for this program.
“But there are health exceptions, and part of evaluating people for LASIK is doing a comprehensive examination of their eyes,” Dr. Maloney continues. “We talk to people about why they want the procedure, and what the benefits are for them. There may or may not be enough benefits to make it worth it. We have a frank discussion about the risks. At the end, people are comfortable with their decision about whether or not to have the procedure. It turns out that most people are candidates if they’re wearing glasses and want to get rid of them.”
Reshaping the Eye
What does the LASIK procedure entail? “It involves peeling back the outer layer of the surface of the eye, reshaping it with a laser, and then replacing the outer layer,” Dr. Maloney says. “The outer layer just sticks all by itself. There are no stitches, no needles and you don’t have to be put to sleep, since no general or intravenous anesthesia is needed for the procedure. Instead, we use eye drops. The procedure takes about five minutes per eye, and it’s painless. You’re usually a good candidate for the procedure if you have healthy eyes and are tired of wearing glasses or contact lenses.”
An excimer laser is used in the procedure, which removes tissue from the eye without burning or heating. “It’s a cold laser, and it has revolutionized our ability to correct vision. The lasers that we used before were hot lasers, which heated or exploded. That’s just not a good thing to do to the surface of your eye. If you heat it, it cooks it, and it turns hazy. If you use an explosive laser, it creates divots in the surface of the eye and blurs vision. The excimer laser, which was first applied to the eyes in the 1980s, turned out to be a really wonderful way to reshape the eye and correct vision. The way to think of it is like sculpting a contact lens right onto the surface of the eye. It’s just like wearing contacts, except you don’t have to take them out and clean them. It gives you a much greater degree of freedom.”
Making a Difference
Dr. Maloney and his colleagues at the Institute are now making such freedom available to quadriplegics. “Last year, this idea was conceptualized by Barry Elbasani, the first patient to benefit from the program. He had LASIK performed by Dr. Dan Durrie, a colleague of mine, and he thought that this would be a really great option for quadriplegics. Dr. Durrie was excited about it and got me involved, so together we’ve set up a growing network of surgeons around the country that can do LASIK surgery for quadriplegics. It’s a way of giving to people in whose lives we can really make a difference.”
As beneficial as the LASIK procedure may be, it can also be expensive. Therefore, Dr. Maloney and his colleagues offer it to quadriplegics at no charge. “I charge $5,600 for both eyes, and the average around the country is in the $4,400 range,” he says. Most quadriplegics have very limited financial resources, because it’s hard for them to work. Many of them wouldn’t be able to afford this procedure any other way. Our commitment is to have a surgeon within an hour of any quadriplegic patient in the country and, so far, we’ve been able to live up to that commitment with all of our patients.”
Still, the LASIK procedure can have certain side effects. “First, your vision may be good, but not perfect. Second, you may have some glare around lights, which may make it harder to drive at night, which is unusual nowadays with our newer methods of custom treatment. Third, your eyes may feel drier afterwards. These conditions can be permanent.”
When performing LASIK on quadriplegics, conditions like autonomic dysreflexia and spasticity may have to be taken into account. “That’s something that needs to be handled differently for each patient,” Dr. Maloney explains. “Quadriplegic patients are both similar to, and different from, our other patients. If a person is on a respirator, we adapt for that by placing the wheelchair right next to the operating chair. The respirator can cause some head movement, but we have lasers that can track the eye as the head moves. The patient also needs help transferring from their wheelchair to the operating chair, but these are minor differences. We have treated a number of quadriplegic patients without any difficulty at all.”
Recovery from the procedure takes four to six hours. “It’s the same for quadriplegics as it is for anyone. Typically, a patient experiences mild discomfort for a couple of hours after the procedure, but then it goes away. Within four to six hours, most people’s vision is almost 20/20.”
Dr. Maloney finds a great deal of satisfaction in working with quadriplegic patients. “For me, the most gratifying thing is that the patients we take care of are so grateful,” he declares. “The second most gratifying thing is seeing how the surgeon community has responded. I’ve personally invited about thirty surgeons to participate in the program, and every single one of them has been delighted to join. We’re asking surgeons to spend their own time and money, because there’s a lot of cost in doing the surgery, and there hasn’t been a moment’s hesitation in their willingness to give of their services to quadriplegic patients. It’s just been so gratifying to me to realize what wonderful colleagues I’m privileged to work with.”
Lori A. Wood is a regular contributor to Action.
