Refractive Surgery | The Smarty Podcast with Dr. Wiley

CEENTA cornea specialist and LASIK surgeon Lee Wiley, MD, stopped by the Smarty Podcast with Charlotte Smarty Pants to discuss surgery options like LASIK, cataract surgery, implantable contact lenses, and more. Here the podcast episode below, read the transcript, and schedule your next eye appointment with Dr. Wiley at our Pineville and Steele Creek locations today!

Transcript of the Interview

Caroll Watson: Welcome to the Smarty Podcast series from Charlotte Smarty Pants, where we focus on all things parenting. For everything from education, health, travel, beauty, fashion and more, join in on the discussion at charlottesmartypants.com, The Smarty Podcast series is produced by Charlotte Star Room, Charlotte's premier boutique music, development, and corporate video production studio and the best parties in the QC, feed the pop star music video party and professional voice lessons in a studio and amazing content creation. Check them out at charlottestarrooms.com.

Jen Plym: This is Jen Plym with Charlotte Smarty Pants. Thanks for listening. Joining us today is Doctor Lee Wiley with Charlotte Eye Ear Nose & Throat Associates, also known as CEENTA. Dr. Wiley specializes in cataracts, cornea and corneal transplants, external disease and refractive eye surgery, including LASIK. Thanks for being here. So today we're talking about refractive surgery, options like LASIK, and some common myths to debunk. Let's start with a general overview of refractive surgery and why would patients choose vision correction surgery over glasses and contact lenses.

Dr. Lee Wiley: So, when patients want to get out of their contacts and glasses and become more independent from them, they turn to LASIK surgery. But there's such a wide variety of options for different patients. LASIK is the most common version of refractive surgery, but there is option known as pre-K SMILE, implantable lenses and even lens exchanges. So there's a wide variety and it's tailored by your surgeon for what the best option is for you and your needs and your situation. So it's become quite, quite customized.

Jen: Right. So how do you know? I feel like LASIK is marketed as a brand, is that the brand LASIK is?

Dr. Wiley: No, that's actually the medical term for.

Jen: It's not the brand, OK, it's the actual term.

Dr. Wiley: The procedure, yeah.

Jen: So yeah, so I feel like maybe how do we figure out what's our best option? I guess we just lean on you, right?

Dr. Wiley: Yeah, you go in for a LASIK evaluation. And generally, that is what we do. We do a LASIK procedure. And what we're doing there is we're sculpting the cornea or the window of your eye to help you see better. And by resculpting the cornea, we can apply your glasses prescription to the cornea. LASIK is a 2-step procedure where first we make a flap in the cornea, we lift the flap and then we resculpt underneath the flap and we put the flap back. Now, the reason why we do that flap is because you heal up very rapidly. You're seeing better that day or even if not the following day.

Jen: Right, like it's how isn't it? Like a twelve minute procedure?

Dr. Wiley: It is, yeah. And it is a “wow” moment. I've had patients that sit up on the table and just start crying. They're so happy that they can see. It's very rewarding for everybody. Yeah, but sometimes people's corneas are too thin and we don't want to make that flap. And you know the first question I asked myself. Well, there's two questions when someone comes in for an evaluation. One, “Is it safe?” And two, “Will it work?” so you have to check both of those boxes.

Jen: Right. And how long?

Dr. Wiley: You've already we've already decided that it's safe, but one of the safety profile things that we have to look at is how thick your cornea is. If it's too thin, we can do a procedure called pre-K which is the same as LASIK, just no flap. We just treat the surface of the cornea resculpt the surface of the cornea. That just takes a few more weeks to. Heal from so, but is the same treatment same long term outcome and for the right patient it's the safest option.

Jen: OK. Right. So are the side effects different at all for both or just a longer recovery for PRK?

Dr. Wiley: Just a longer recovery for PRK. It's a little uncomfortable in the post op period, but every now and then I'll treat someone who's like a prize fighter or like a wrestler or has needs where they may be worried about traumatizing the flaps. And although the LASIK flaps heal really strong these days, we do have to take the whole patient into account.

Jen: OK. Let's talk about SMILE, like LASIK versus SMILE. SMILE sounds like it's a new a new offering, so maybe let's dive deep into that.

Dr. Wiley: So SMILE is something that's newer. It is being done in certain cities in the US, and essentially what it is, is instead of doing the flap like a traditional LASIK surgery, we create a little pocket in the cornea with it. The pocket is made very precisely with the laser and then we just remove the tissue through a small 4-millimeter incision from that pocket, and that in itself by removing the tissue from inside the cornea, we're reshaping it that way instead of doing the laser procedure on the top.

Jen: So it's less invasive?

Dr. Wiley: It's a little. It's not quite as customizable right now as a LASIK or PRK is, but in the right patient, it’s a good option.

Jen: I mean, I did LASIK a long time ago. And I can vouch for it is life changing like it is. I was almost legally blind. I was a dive scuba diver. I was scared of like, what happens when I'm 100 feet down and my contacts came off or my mask comes up. You know, all the emergency planning that you do. And I'm like, I wouldn't. I wouldn't be able to navigate, so it was. It really was life changing for me.

Dr. Wiley: And same here. I actually believe in this technology so much I had LASIK too. My trigger was that I was wearing contacts as a medical resident and I was over wearing. And I was putting myself at risk for infection the way I was wearing them and also my patients were coming in all happy.

Jen: Right.

Dr. Wiley: And I'm sitting here with dry eyes. In my contacts.

Jen: Alright, you're like “I need this.”

Dr. Wiley: And I just eventually got jealous and ended up going for it. And it really was the best decision I ever made because people don't realize it. But wearing contacts, you are at risk for infections.

Jen: Right.

Dr. Wiley: And so, if you're sleeping in them, if you're not taking them out, if you're not doing proper hygiene. I mean you have a very high risk of infection. With refractive surgery, it's like less than 1% chance. It's incredibly rare, so I just took that chance once and I never looked back, and it's changed my life.

Jen: Same, I can say it's one of the best decisions I've ever made in my life and now I'm at the point where I need readers a little. That and my vision – so my vision went from almost legally blind. And then I had my surgery and then I was 20/15, which is like, I was like an eagle. And then recently I was like, I can't even see anymore. And I’m 20/20. It’s so funny. I'm like, “I gotta remember what I used to be like.”

Dr. Wiley: And it's been a really long time, right? Like it's been.

Jen: I'm not gonna reveal the number.

Dr. Wiley: I won't ask.

Jen: Just when my oldest was a baby. I got it done.

Dr. Wiley: It is a stable procedure. People think that changes, but honestly, it's gotten so good that it really isn't considered permanent. People are so afraid of changing but it really does not.

Jen: Yeah, and I think and I'm, you know, I'm not the medical expert, but I think when I went to have my eyes checked to find out that “Oh no, I'm 2020.” He said that because I had LASIK my readers won't change that much. Like I barely need readers. Is that true? Did I misinterpret that? I'm not sure.

Dr. Wiley: So basically the laser vision correction is really geared for distance vision. OK, now the cornea works with the lens inside our eye as a two-part team. So we are reshaping the cornea to give you clear vision. But as we get into our 40s, the lens hardens and stiffens, so our body changes around us. And so as that happens, the lens inside the eye loses its flexibility and we do require reading.

Jen: So maybe it was the vision part because I got progressives. Maybe I was, like, worried about that. He said that for sure it's not gonna get way worse.

Dr. Wiley: With or without LASIK, the lens changes. This is not a lens procedure, but that happens in our 40s. Even then, you still retain the good distance vision. It's just the near vision that you start to need reading glasses as we have more birthdays. That's just the way it is in life.

Jen: Right. I mean, it's not the worst thing. It's I've been lens free for many, many, many years. Is there ever a situation where any of these are not an option for someone?

Dr. Wiley: So you know when once again that first question is it safe? That's the number one thing. Our success rates are so high because we screened people so more effectively. Now we have such good technology. It's kind of equivalent like. Flying in an airplane. Right. Putting yourself in a tube, taking off 30,000 feet above the ground. Sub zero you know degrees. It's not really. And and we're sitting there reading a book or falling asleep because it's like we know it's safe and LASIK has become the same way. It's like, yes, we're doing surgery. The success rate is so high, we want it to be equivalent to that of what the airline industry is essentially so.

We always we and the way we keep it safe is we only do candidates that are that qualify, right. So if your cornea is too thin to do a laser ablation or to reshape, then we can do a lens-based procedures going back to what I was saying about the lens inside the eye, working with the cornea. So, for example, if you're like a -10. Or a really strong prescription.

Jen: I can't believe people are minus 10.

Dr. Wiley: We probably won't recommend laser, but we can do what we call an implantable collamer lens, or some people call it the implantable contact. So we can slide a lens just into the eye between your lens and your cornea, and that can provide you all the correction you need, including astigmatism. So that can be a very safe option.

Jen: Are there different long term like, retinal detachment things like dry eye down the road that vary for each of these procedures? Or you just kind of generally maybe at risk for?

Dr. Wiley: Those are great questions. So anyone who's incredibly nearsighted, like minus 10 or like minus nine, you know, you're going to be at a higher risk of retinal detachment. Just walking down the street in the general population.

Jen: OK.

Dr. Wiley: OK, so that's because your eyes longer, you're righting inside the eyes on stretch. And so that's just a risk. However, some of those people still have needs, like they need to see or they have like they want to be pilots or they want to, you know, enjoy a better quality of life, in which case the rate is still incredibly low, that the refractive surgery is really geared for those folks.

Jen: Right. Right.

Dr. Wiley: But the rate is incredibly low of any of those issues happening. And of course, your surgeon monitors you to make sure that things go well, and if there is a problem that. Arises it's fixed rapidly.

Jen: Yeah, that makes sense. Well, but I think we can now talk about like maybe some of the popular myths that people think about later when they're scared to come in, how do you want to start there?

Dr. Wiley: Oh, there's so many out there, yes.

Jen: Let's start with it's not safe. We probably already touched on that, but it is.

Dr. Wiley: It's incredibly it's incredibly safe. So safe that I had it done myself. So I think the biggest thing about safety that changed for me that made me want to get it is. When we do that flap, when we create that laser flap we now use a laser. It used to be done with a blade and that that did increase the risks of issues, but now that it's made with a laser, it is so precise and it heals in so strong that it's just incredibly safe in that respect.

Jen: Right.

Dr. Wiley: It's very rare to have issues with that flap these days, and so that is very safe. You know, the success rate and the risk, I should say, of complications from LASIK is probably in my hands far, far less than 1% from what I've seen so it's very right.

Jen: And it's been around a long time now. So it's not like it's brand new.

Dr. Wiley: And it's still studied and researched and constantly. And so it's gotten so sophisticated now that if you're under the laser, it tracks your pupil and if you look away in the middle of the treatment, it'll just stop. And it'll pick up right where it left off when you look back. It is just amazing the technology that these engineers have put into these devices.

Jen: That's really cool. We've already talked about a couple of the other ones already. How about “All LASIK is the same”?

Dr. Wiley: So going back to what I was saying about the blade, LASIK versus laser versus laser-made flaps with LASIK.

Jen: Do we still do blade LASIK?

Dr. Wiley: It's out there and that is that is a way that some centers will cut costs. So it is cheaper to use a blade to do the LASIK flap. So if and when you go get your procedure ask “Are you using a blade or a laser to make the flap?”

Jen: Right.

Dr. Wiley: There's a little more expense to doing the laser flap, but I am 100% a proponent of it just because of how precise it is. And also, once again going back to like the LASIK first PRK versus SMILE, I mean your surgeon is customizing the treatment for you. Choosing the right procedure and then your surgeons deciding “Do we need to treat astigmatism or not? Do we need to treat irregular stigmatism, or is there some sort of, you know, scar on the cornea or something else going on that we need to look into so these treatments are all customized for each patient?”

Jen: What do you think is the best age to do this?

Dr. Wiley: That is a great question. You're going to find a lot. If you ask five doctors, you get five different answers for that. In my opinion, though, usually people are over after age 25, and once again between age 25 going up into the 40s where you start to need reading glasses. It is probably the best time because you're going to get 100% glasses independence. However, I find that a lot of patients, once they start to need reading glasses, is when they start to want LASIK because they're like, “OK, now I can't see distance or near” and they're like, “I want one. I want one back.”

Jen: Right, which is so nice. Can you do both? With the surgery.

Dr. Wiley: That we can. So what some people do is opt for monovision. We call it where we make one distance. We leave one eye just a little near sighted and that can give you glasses and dependents again, because your two eyes, your brain gets your two eyes working together, but you're able to see distance. That's not an option for everybody.

Jen: What if it doesn't work? Like is there ever a spot where you're like “This is too wonky for me” or no?

Dr. Wiley: I will trial the contact lenses in the office first to give you a simulation of what that feels like so that you're not surprised.

Jen: OK.

Dr. Wiley: I don't want to put that on you permanently without you trying it first, but it is something that patients tell really well and if not, we can at least correct the vision for distance.

Jen: Right.

Dr. Wiley: Still after age 40 the reading glasses are necessary if we go that route.

Jen: OK, what if you've had LASIK me and then now you're starting to need reading glasses. Do you do a secondary surgery?

Dr. Wiley: You can consider the monovision approach, so we could correct one eye for you if we tried in the office and you liked it or, you know, 3 glasses are an option.

Jen: Do you have?

Dr. Wiley: We can, you know, exchange the lens in your eye for a multifocal lens implant that gives you distance in your vision. But that's kind of a separate realm that falls more under like cataract. But we do what's called a refractive lens exchange because once again, the cornea works with the lens in the eye. So we can work on the cornea, or we can work on the lens. There are lens implants now that give you distance in your vision again, but you would have to be screened to make sure you get candidate for that.

Jen: How old are you typically when you need cataract surgery? Like way old, right?

Dr. Wiley: Usually like 50s to most people in the 60s, to be honest with you. But I've done cataracts as young as 14, as old as a four.

Jen: OK.

Dr. Wiley: So there's a wide range, but I would say the majority of people around retirement age generally.

Jen: Oh wow, OK.

Dr. Wiley: So that is another opportunity to get out of the readers.

Jen: So maybe that's a time to combine. Then maybe that's going to be my plan. OK. As a candidate, we already went over, “Oh, you can go blind.” Here's a myth that, which is silly, but people think that.

Dr. Wiley: I mean, yeah, you've seen that. Some people have seen that scene in Final Destination where the girl gets stuck under the laser and it doesn't. But it's like I said, once again it is so safe. The risk of true blindness is close to 0.

Jen: Yeah, I don't think I've ever heard of anyone I know a lot of people who've had this procedure over the years.

Dr. Wiley: It is incredibly, incredibly safe. It's all about proper screening and our screening is so good now. You're just going to be very confident going into your procedure.

Jen: Right. And the last one, “It hurts.” I can vouch it doesn't. It is a little of a weird sensation, you know. But it's literally for a 10 or 11 minutes.

Dr. Wiley: So during the procedure it doesn't hurt at all. The LASIK when we put it back down and you go home, you feel like a little burning a little bit, but honestly, a few artificial tears and a nap is usually all it takes to get that to go away.

Jen: Yeah, I'll I remember vividly looking out.

Dr. Wiley: Patients tolerate really well.

Jen: So I took the nap and my, you know, your doctor's call and check on you. I took my nap and when I opened my eyes, now I have, I still have probably this clock, but I have the largest digital clock you can ever have, like, because you can't see the numbers. And my husband had moved a small clock in my view to the baby's room. and when I opened my eyes I could see the tiny time I was like, “Oh my!” I started crying. It really was unbelievable.

Dr. Wiley: That's the wow moment I love. The wow moment.

Jen: It's a wild moment and you know, I've just. It's just been an incredible experience and I highly recommend it for everybody. OK, I guess my last questions are: “Are any of these treatments ever covered by insurance, or is there a creative way to save for a procedure?”

Dr. Wiley: Yeah, so currently no. It's usually an out-of-pocket elective procedure with insurance companies.

Jen: Which is crazy.

Dr. Wiley: Well, I know like, I don't know who decided that eyes and teeth aren’t part of medicine.

Jen: I know, and I think some of it is covered with glasses, but not, you know.

Dr. Wiley: I mean, it's just a cheaper option when it comes down to it for the insurance companies generally. Now I will say this one solution a lot of my patients have used is Care Credit. So that is a company that will finance elective medical procedures. And I have had some patients use that, but you know it is unfortunate that if you're born nearsighted or farsighted, you have to pay a tax on that by buying in a way by buying corrective lenses your whole life, contacts and glasses.

Jen: Right.

Dr. Wiley: I mean, you could spend hundreds of dollars a year on contacts or glasses, especially when you're changing them. That adds up quite rapidly. The majority of other LASIK is about, you know, $2500 per eye or so, that's ballpark. And paying it up front, you know, there's a lot of studies out there showing that it does save money in the long run when you're paying hundreds a year already and taking the risk of infection and slight detriment to the quality of life.

Jen: Yeah, I would say.

Dr. Wiley: If you're not wanting to wear corrective lenses so you know in the end it for me it turned out to be a good investment.

Jen: Right.

Dr. Wiley: I think for most people it would when you really crunch the numbers.

Jen: I think so too. I mean, I think it sounds expensive. The younger you are, right? But you know, maybe the older you are, don't go on a vacation or, you know, you use your company matching.

Dr. Wiley: It's just what you value.

Jen: You know, there's a lot of things you can do to.

Dr. Wiley: Save exactly like my goal here is to improve quality of life. You know, if patients like their contacts and glasses, I let it be, you know, it's not broken. Don't fix it. But if it's something that, you know, you want to look into and you're nervous, I just want to try to alleviate those fears for folks who get LASIK and are good candidates.

Jen: Yeah, I would agree with. Well, thank you so much for joining us today and sharing your knowledge. CEENTA offers comprehensive adult and pediatric eye and ENT care and nearly 20 locations in the Carolinas. If you'd like to make an appointment with Doctor Wiley or any of the doctors at CEENTA, you can call 7042953000 or visit their website ceenta.com/appointments. That's C-twoE-N-T-A.com/appointments. You can find us daily on charlottesmartypants.com, Facebook and Instagram at Charlotte Smarty Pants and Twitter @charlottesmarty.

Caroll: Thanks so much for listening to our Smarty podcast. You can always join in on the conversation at Charlottesville Jams. The Smarty Podcast series is produced by Charlotte Star Room, Charlotte's Premier boutique, music development and corporate video production studio. Check them out at charlottestarroom.com.