Q: What’s the Pterygium removal procedure like and how soon before patients can drive, or go back to work, or resume even normal activities?

A: For Pterygium surgery, we've made wonderful strides over the last 20, 25 years. The old school way of doing it was under general anesthetic. And basically, you put stitches in the eye to move the eye around to get access to the Pterygium. I'm a laser eye surgeon and I’m used to basically talking to people while I operate on their eyes. And if you give them some valuable equivalent, get them relaxed, you can actually do it and you can do it while you do great surgery and you can avoid all that (general anesthetic).

The other issue is a few, actually many years ago now, I had two patients back-to-back for Pterygium surgery. Both of them were not - you could tell they were not happy during the course of surgery - that they appeared kind of disturbed. And later on, they told me the eye surgery wasn't bad at all. But they hated the IV needle in their arms. So, after that, I basically stopped putting IV needles in people's arms unless, of course, I have somebody with some underlying medical conditions that the anesthesiologist says you've got to do this, which is incredibly rare.

Usually, if they're in bad shape from a systemic medical point of view, I probably am not going to touch them from a surgical point of view, I suppose. But nonetheless, we don't like to put in IV needles. Basically, we use a triple local with three types of anesthetic either on or around the eye or under the Pterygium and some Valium or equivalent under the tongue, as well. We get people relaxed and we achieve twilight anesthesia.

But at the same point, we don't have to take them down that much in terms of things and their breathing is still intact as well. So we don't have to worry about any issues. Like I said, we don't have an IV needle in their arms or a breathing tube down their throats. Forgive me, but there's no Michael Jackson medication, as well. Surgery itself will last 20 to 30 minutes depending on how extensive it is, how technical it is, and also sometimes I'll do both eyes at the same time if somebody wants it. I know I have a lot of people who do that. It's a little tricky with the insurance premiums and such, but usually anywhere from 20 to 30 minutes per eye for that. Again, surgery does not involve any stitches. And the glue, it's more efficient surgery and allows us to do what needs to be done and in an expeditious fashion. Now, the other thing for the surgery is that anxiety is a big issue. People are afraid of eye surgery. But if you basically give them a triple local (anesthetic), you don't stick needles into them and you basically don't use any stitches on them. And it's actually not bad at all. And basically, I usually tell people, hey, your job is to look after the side, listen to jazz music for about 20 or 30 minutes. And it's actually been called pretty easy surgery. We've simplified things a lot over the years. We've made it much more patient-friendly, as a result.

Other considerations, getting back to work and driving. Usually the surgery, if you use stitches, that can be a really tough recovery over the span of many weeks as well. Sometimes not. And there's nothing wrong with stitches and I’m not bashing that as a technique. That is an approved standard technique which is completely acceptable from a medical point of view. I personally, being somewhat of a boutique surgeon, prefer to actually have the glue instead for the reasons we discussed. It's more comfortable for people, it's smoother surgery. I don't have to take people down as far in terms of anesthesia and such. And then usually we can do our surgery, say, for example, on a Wednesday driving probably a couple of days I would. And then the first day out, they're still going to be some recovery process - it’s still taking a tumor off the surface of the eye. But basically, a couple of days in terms of driving, that's not a problem.

And then back to work a couple of days, if it's a Wednesday or Thursday surgery, usually back to work on Monday or Tuesday. So, a couple of days of recovery, not a few weeks.

About Dr. Franz Michel
Franz Michel, MD, a UCLA-trained cornea surface specialist, specializes in Pterygium surgery and bladeless, no-cut LASEK laser eye surgery.

With offices in Ventura County (Thousand Oaks, Oxnard) and Los Angeles, Dr. Michel is referred to by other cornea specialists as the "king of Pterygium" and has the largest Pterygium referral practice in the US. His Pterygium recurrence rates are less than 1%, a remarkably low rate compared to the 10-50% recurrence rates of other Pterygium removal surgeons. In addition, 100% of Dr. Michel's LASEK laser eye surgery patients have been able to pass the DMV vision test without glasses and 94% have enjoyed 20/20 vision.

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