Medical Mystery: Preparation for surgery revealed cause of deteriorating eyesight

Silvia Bacot had devised a strategy for coping with her steadily worsening eyesight.

As she walked down the hall of the suburban Maryland federal building where she works as a medical researcher, Bacot would say, “Hi, how are you?” to everyone she passed, worried that if she didn’t she might inadvertently snub someone she knew but couldn’t see. She always sat in the front row at lectures and close to the screen in movies. At crowded scientific meetings she tried to seem unwaveringly approachable, peering and squinting at name tags when their wearers got close enough.

  • ( OWEN FREEMAN FOR THE WASHINGTON POST / ) -
  • ( BILL O'LEARY / THE WASHINGTON POST ) - Silvia Bacot attributed her failing eyesight to the routine effects of aging.

( OWEN FREEMAN FOR THE WASHINGTON POST / ) -

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“I would feel like an idiot,” she said, referring to her practice of universal greeting. “At scientific conferences you want to make connections, and if you can’t see people, it’s bad.” Luckily her work was unaffected by her inability to see at a distance because as a bench scientist she focused on objects at close range.

Bacot was frustrated that her ophthalmologist had been unable to correct her severe nearsightedness and the distortion known as astigmatism that often accompanies it. She assumed that her deteriorating eyesight was an inevitable result of aging; her eye doctor offered no other explanation.

It wasn’t until the summer of 2010, while undergoing a work-up for laser eye surgery, that Bacot, now 38, learned that her visual problems were not caused by the normal progression of myopia, but in fact indicated something far more serious.

“I turned white as a sheet of paper,” Bacot recalled, after corneal specialist Roy Rubinfeld told her that lasik was out of the question. “I didn’t even know I had anything wrong with me.”

Beware of lasik

The first time her eyesight caused problems, Bacot was 6 and had just started school in her native Costa Rica. She could not see the blackboard and began suffering from severe headaches, which her grandmother dismissed as fiction, saying that “children do not get headaches.” But after the pain persisted, Bacot was taken to a doctor, who determined she was nearsighted and prescribed her first pair of eyeglasses. The headaches disappeared, and for years she saw well with glasses.

In 2004, Bacot noticed that the vision in her left eye seemed unaccountably blurry. Her eye doctor strengthened her prescription, but she soon noticed that her vision was fuzzy again.

“I figured it was the best they can do,” she said, noting that the pattern of visits to the eye doctor occurred every six months or so for six years, as her vision deteriorated and her prescription got progressively stronger. “I settled for it because of my own ignorance.”

She tried wearing contact lenses, but they were uncomfortable and her vision was poorer than with glasses. Driving, especially at night, became more difficult. At times her eyes felt swollen, and Bacot developed headaches, just as she had as a child.

Fed up, Bacot thought laser eye surgery might be the answer. She was impressed by the experience of co-workers who had undergone lasik, which uses a laser to reshape the cornea, sharpening vision. In July 2010, midway through the preoperative evaluation in Rubinfeld’s Chevy Chase office, she met with the corneal surgeon.

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