What feels like a lifetime ago, the pandemic was raging on and half my friends from college had taken advantage of work from home to move from Silicon Valley to Hawaii. Naturally, they all, along with everyone else with access, took up surfing as a safe-ish (at least from respiratory viruses) social activity. I received a text from a friend who had heard that we were performing a new procedure called SMILE that could help minimize any time out of ocean therapy and, of course, keep him surfing without losing his contacts after a wipeout.
For active people, that’s often the appeal of SMILE. Less time worrying about glasses and contacts, and more time focused on the activities they love.
The fact that losing his contacts was his biggest fear and not disgusting, bacteria-filled ocean water being held against his mucus membranes was a complete shock to me. I was horrified seeing surfers everywhere doing the same, going so far as recommending others on social media to just “squint your eyes” to keep contacts in. I pleaded with him to get refractive surgery done on the islands and not wait to come see me on the mainland so he could get out of his contacts ASAP, but to no avail. He insisted on waiting.
Swimming in contacts is like driving without a seatbelt
You’re fine until you’re not, and then you’re in big trouble! I trained at UC San Diego, seeing young people with corneal ulcers who didn’t know you shouldn’t sleep or shower in them. I saw middle-aged patients coming in with increasing contact lens intolerance and permanent damage from years of contact lens abuse. And now, as a refractive surgeon, I see patients with scars who were never even aware of their injuries and just got lucky the scars weren’t central.
Everything has risks, but we as humans are great at normalizing the ones we take day to day: staying in our contacts far too long, not cleaning them or replacing them as recommended, and falling asleep in them from time to time. The risk of a blinding, painful, hard-to-treat infection is not insignificant.
Luckily, he eventually made it and he was back in the water after his first post-op.
That’s what I love most about helping active patients. They rarely tell me they miss their contacts. They tell me they stopped thinking about their vision altogether.
One year later, his wife with chronic dry eye also came to see me. We went over how to optimize her eye surface before and after surgery, and while her dry eye is still there, it’s much better now that she no longer needs contacts. Because she was a candidate for SMILE, we were also able to avoid creating a flap, helping minimize disruption to the eye’s surface.
I’m getting “old” by now, approaching the age when I start needing reading glasses, and of course, so are my friends. The local surf crew start getting curious about SMILE too, and while I’m hesitant to do their procedures now since they’re all Type A engineers and are what some consider “too old,” they push me on it as well. We spend each surf session and hours in between setting expectations and doing trials to see what treatment would work best.
One by one, they all get SMILE until suddenly we’re at brunch and realize I’ve had the privilege of helping almost every single person present wake up and see clearly without reaching for glasses or contacts. Whether they’re surfing, traveling, working, or just enjoying a day at the beach, they have one less thing to worry about.
The rest of us either didn’t need a procedure to begin with, or had our procedures decades earlier.
Sometimes, the conservative path is surgery
While many may think of refractive surgeons as cowboys or risk takers, I’m not. I don’t like performing procedures when I’m not 99% sure of a patient’s happiness, let alone safety. Add that expectation for myself with seeing my friends, who are also my patients, at least once a week makes me feel especially lucky to have SMILE in my toolbox.
As overused as it was, I’m truly #blessed to be able to do this for the patients and community I care about, and my friends and family.
Cheers to clear vision. And cheers to the beach!
