Nothing to fear but fear itself

It was not that long ago that in the American West where we now reside, patients were given something to bite on, like a soft bullet to reduce the pain of surgery.  Modern anesthesia has made remarkable advances in that while unconscious patients can be treated oblivious to their surroundings.  It is a different matter for LASIK vision correction.  Here we need the patient to cooperate and to fixate on a lighted target in order to properly perform the procedures.  We also have advanced in that there are eye trackers, all laser procedures, and much improved technology but in the end we require an awake and cooperative patient to perform this procedure.

One of the benefits of having a surgery center as opposed to an office environment is that we can confidently give our patients a mild sedative knowing that we can reverse the medication or support them as necessary if they get too sleepy or have any untoward reactions.  Without discussing the specific formula, we have customized how we sedate each patient in addition to customizing their laser vision correction.  We take into account allergies, sensitivities, past experiences, medical history, and personal preference in formulating a safe and effective plan and the patients are carefully monitored by our registered nurses during the entire time they are in our facility.  This is amazingly comforting to most patients who may become slightly anxious, but in general most find the experience of having laser vision correction anywhere from highly tolerable to actually pleasant.

Another key ingredient is the talking therapy.  Patients all meet with a nurse who takes a history related to their overall medical status, performs baseline blood pressure and other readings, and describes in detail the step by step experience that they will undergo.  The greatest fear is that of the unknown and by education we have found that confidence is greatly enhanced.  Next the patient is seated in our pre-op area where they are surprised to find themselves comfortably seated in a Lazy Boy recliner watching a flat screen monitor with their choice of popular videos.  Usually I find that there is a music video playing softly and it is sometimes difficult to get their attention from the show while I go over the plan with them and review any last minute questions. What we are doing is our final preoperative planning as well as waiting for the medications that were given to be at an optimal level for the treatment.  Patients are always able to walk to the treatment room, where someone escorts them and continues to explain what is going to happen over the next fifteen minutes.  When I arrive we talk again and I tell the person everything that will happen before it does so that there are not surprises.  Mostly it is reassurances like, "you will see a green flashing light but not feel anything during the next 15 seconds."

Upon completion of the treatment, there is usually tremendous relief that it is over, almost always a spontaneous admission by the patient that it was not nearly as bad as they expected, and a sense of delight that they can already see so much better than they did just a few minutes ago.  I will personally perform another eye exam at the slit lamp, review the treatment and the findings and impart some instructions that will be expanded upon both verbally and in writing by our nursing staff.  After fifteen minutes to half an hour in our recovery area, again in a Lazy Boy recliner just like the one in the pre-op area, the patient is escorted out with their driver to take go home and rest for a few hours.

I find that people in general have two fears.  The first is that they will not be able to cooperate properly and will somehow interfere with their treatment and harm themselves.  The second is that the process will become uncomfortable physically or mentally and therefore are afraid that they will not be able to complete the process.  As to the first, we have in almost 50,000 cases been able to coax everyone through the procedure so it is extremely unlikely that this will present a problem.  As to the second, since the treatments are so quick and painless, most patients do not even realize that we have started when we are virtually done. 

Our goal is to make having laser vision correction a safe and easy undertaking as well as being an effective one.  One of the newer features we have begun to offer is a tour of the surgical facility prior to the actual day of the procedure.  We have found that by making a return visit, much of the fear factor is removed.  I guess FDR was right, it is all a matter of attitude.