Dr. Michel’s Pterygium Videos

I produced Pterygium videos so I could personally convey to you (almost) everything you’ll want to know about Pterygium and what to expect of me, your Pterygium removal surgeon. I talk about my background, the technique I use that results in recurrence rates less than 1%; I talk about what to expect during your initial Pterygium exam and, if I think you need Pterygium removal surgery, I explain the procedure and why I opt for glue instead of stitches. I conclude by offering a few Pterygium patient stories that I hope you find interesting.

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Pterygium Removal Surgery Video Transcription

Introduction
Hi, I’m Dr. Franz Michel and I’m effectively a cornea surface specialist. I call myself a two-trick pony because basically all I do is laser vision correction (LASIK) and Pterygium surgery. When it comes to Pterygium cases, the history behind that was I found myself having a lot of patients in need of help. And it’s something that most ophthalmologists shy away from.

They don’t want to deal with Pterygium cases. It’s been called the toughest thing in ophthalmology to treat and they’d rather deal with somebody with a heart attack or a retinal detachment than deal with the Pterygium because they can be very tough to deal with.

And, over the years, you modify your technique; you make little tweaks here and there and the next thing you know, all of these little adjustments that you make and suddenly you have great surgeries and you’re getting great outcomes. People are happy. And you do that for you know, well over 10, even 15 years out now. And we just have a wonderful streak and it becomes a sub-specialty niche. And now I’ve got docs who refer Pterygium patients to me basically from Los Angeles up to San Luis Obispo. So pretty much the Central Coast. And I have this very wide referral network of docs that refer to me. At the same point, you have the power of the internet. People are looking for things that they can spell and if they can spell Pterygium, they’re pretty motivated and they’re pretty far down that search pathway.

Pterygium Removal Surgery Technique | Stitches vs. Glue
Pterygium surgery is far more comfortable because Dr. Michel uses glue instead of stitches

Q: Isn’t the main difference (regarding comfort and success of the Pterygium surgery) the sutures, the stitches?

A: Oh, yeah. That’s the biggest difference. Use the glue. It’s infinitely more comfortable
It’s easier for everybody and I use the glue to so much and I use it to cover the eye as a liquid bandage and that’s very reassuring for people. And if people know you’re not using a stitch on their eye, it plays a role.

What Pterygium patients can expect in the initial exam and the factors that determine if surgery is warranted

Q: OK, talk to us a little bit about the Pterygium patient experience. What happens when they come to you with a Pterygium and what can they expect regarding the initial exam and the factors that determine if surgery is even warranted?

A: In the initial exam, it’s basically my job to make sure somebody is a good candidate for surgery and to basically pick and choose who needs surgery and is a good candidate and, at the same point, to filter out those who might have a smaller growth and really don’t need surgery. So, my saying is I have to have a good reason to do Pterygium surgery.

Most commonly (reasons to perform Pterygium surgery include) chronic irritation or something with some rapid growth. Other times it can be cosmetic, as well. Cosmetics are a big concern for (patients). Obviously, vision loss is a concern, as well. But initially, it’s actually pretty easy to just take a look under a microscope and take some easy pictures. I have an integrated camera system in my microscopes and we just basically take a picture and show people what they have. And then we go over the options there, as well. And we kind of get a look into the (patient) history, as well, and make sure there’re no other confounding variables such as multiple surgeries in the past or LASIK. LASIK flaps can be an issue with the Pterygium going over the flap. That can be a problem as well from a technical point of view. I’ve done a lot of surgeries where I removed Pterygium growth from LASIK flaps but I’d rather remove them before there’s actual Pterygium growth over them because the old saying is the flap will never heal.

What Pterygium patients can expect in the initial exam and the factors that determine if surgery is warranted

Q: OK, talk to us a little bit about the Pterygium patient experience. What happens when they come to you with a Pterygium and what can they expect regarding the initial exam and the factors that determine if surgery is even warranted?

A: In the initial exam, it’s basically my job to make sure somebody is a good candidate for surgery and to basically pick and choose who needs surgery and is a good candidate and, at the same point, to filter out those who might have a smaller growth and really don’t need surgery. So, my saying is I have to have a good reason to do Pterygium surgery.

Most commonly (reasons to perform Pterygium surgery include) chronic irritation or something with some rapid growth. Other times it can be cosmetic, as well. Cosmetics are a big concern for (patients). Obviously, vision loss is a concern, as well. But initially, it’s actually pretty easy to just take a look under a microscope and take some easy pictures. I have an integrated camera system in my microscopes and we just basically take a picture and show people what they have. And then we go over the options there, as well. And we kind of get a look into the (patient) history, as well, and make sure there’re no other confounding variables such as multiple surgeries in the past or LASIK. LASIK flaps can be an issue with the Pterygium going over the flap. That can be a problem as well from a technical point of view. I’ve done a lot of surgeries where I removed Pterygium growth from LASIK flaps but I’d rather remove them before there’s actual Pterygium growth over them because the old saying is the flap will never heal.

The Pterygium Removal Procedure

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.

Special Pterygium Patient Experiences

Q: Do you have any special Pterygium patients you’d like to talk about?

A: Oh, there must be hundreds of them. Off the top of my head. I can probably give you three cases that I thought were really kind of outstanding and remarkable. Number one, I had a guy who was a helicopter pilot. It turns out that when they go to repair power lines, they don’t have the guys climb up the power lines. They lower them down with a helicopter. He had a Pterygium in he left eye and it was affecting his vision. And he’s basically driving his helicopter, piloting his helicopter, looking off to the left. He’s got high powered power lines basically right nearby within 100, 200 feet, whatever it is. And he’s lowering either equipment or men on ropes down to the structures to basically repair things, as well. So, he’s a very high functioning guy who couldn’t see well. So, we did his case and he noticed his vision improved beautifully. It was a lot easier for him to fly. That was a fantastic case. Very remarkable in terms of how functioning it was, His vision wasn’t all that bad, but that subtle improvement, the vision made a big difference in his being able to do his really cool job.

OK, the other biggest aspect of a Pterygium that is very, very poorly discussed is the effect on people’s self-esteem and self-perception, as well. A Pterygium is a, has a terrible psychological effect on people, as well.

And nobody really understands that except for people who have a Pterygium. They have disfiguring look to the eye. They’re typically red. They have friends or family or workers, co-workers, even police, asking if they’re using drugs. And I’ve had people dragged from DWI checkpoints to the hospital to be tested. I had one poor guy who had his car ripped apart because an officer thought he was actually using marijuana. And after a four-hour traffic stop with drug sniffing dogs, they didn’t find anything and they let him go. It was something innocent. I think he had just had like a taillight out, for example. And for that, he just wanted to have surgery and didn’t want to go through it (the police experience) again.

I did have a lady drive from the Bay Area and I think was a five- or six-hour drive down. Had her case done. And for her, she sent me this text message about a year out and she said to the effect of:

“This is my 11th month since surgery. I just wanted to thank you. I spent most of my adult life never looking people in the eye. The Pterygium negatively affected my self-esteem.”

And for her to have this powerful impact, improvement in her quality of life and also her self-esteem and to send me this about a year later, that’s really powerful.
And I will add one final case. I had a young man – college age, twenty, twenty-one or so – who was taken care of through a major university down in Los Angeles. And he had a bad Pterygium, it was affecting his vision. It was very disfiguring; his eye was red as can. He was a handsome guy but he just had this disfiguring mass on his eye. They wouldn’t touch him at one of your major universities. And finally, he got in the internet and found me and I said, yeah, sure, we can do this one straightforward case. He was a little young but that the only risk factor he had for recurrence.

I did the case and about two months out, I saw him and he was a new guy. He just had more spring to his step. He sat up straighter. He had more presence. You could tell he had this psychological burden lifted off of him. And that was just very, very powerful stuff. And he was basically a young guy getting ready to obviously move on with the rest of his life and he had this, suddenly the world was his oyster again, as well.

So, I think that the psychological aspects of Pterygium, the psychological toll that it takes on somebody’d mind cannot be underestimated. It really takes a toll. And the cosmetic aspects are actually the more powerful stories for me. It’s a good thing if an ophthalmologist takes somebody who’s basically blind or can’t see from the Pterygium and makes their vision better. We do that all the time anyway, based on my LASIK surgery. It’s great. Like I said, it never gets old. But at the same point, the psychological aspects of the Pterygium and taking a disfigured red eye, which is irritated and such, and giving them a normal look, the normal surgical look to the eye. You make the eye white quite again. For people, it’s priceless.