“Lost flaps usually will occur in the operating room where the microkeratome just made too superficial a cut,” Dr. Geggel said. “Surgeons have to be comfortable knowing how to take the microkeratome apart, because the lost flap is usually going to be somewhere within the machine.”

A 45-year-old woman came in for routine LASIK. I’m doing my LASIK, I hand off the keratome, and they blow out the keratome. And suddenly there is no flap. Now we’re looking for the flap, but we can’t find it. And all of you know how to find out if spaghetti is done. You throw it against the wall. If it sticks, it’s done. And that’s exactly what happened. The cornea ended up against the wall. We find it, but now it’s been sitting on the wall for about 5 minutes.

After about an hour in the dark after her surgery, someone told Steward she could go home for the day, but to come back the next day for the standard post- operative followup check of her eyes. Davis tried to reassure her, Steward recalled, suggesting the extreme blurriness she was experiencing should clear up by the next morning.

She was given no explanation of what had happened, no hint of any glitches, even though Davis said he realized what had happened soon after the procedure was over. He just decided to keep it to himself for a while.

"I was absolutely in shock when I found out," he said. "I was going to tell her immediately, and then I consulted with another physician, who said the result 'may not be as bad as you think, so wait a little while, let it settle down. Fit her with contact lenses and make sure she's seeing well, and then talk about it.' "

"That was my big mistake," Davis said. "I should have told her right away."

Steward, unaware, didn't know enough to ask why she wasn't given a name tag to wear. Because she couldn't see the road, much less make out street signs, a friend drove her home, where she spent most of the day in bed, feeling her way around when she had to get up.

Her father took her back for the follow-up exam the next morning. She was more than a little upset. Even though she had been warned to expect some cloudy vision to persist for a while after the surgery, something just didn't seem right.

"My dad had to lead me by the arm into the doctor's office," Steward said. "He examined me, and said I had had an adverse reaction to the procedure. It was just something in the way my body reacted. He wouldn't explain it to me beyond that. He wanted to have me fitted for contacts. He just said the optometrist would fit me for contacts to try to get me to see better."

Davis knew exactly what had gone wrong. But he said he was hoping that Steward's eyesight would improve over time, or that another operation might be able to fix any residual defects.

Sometimes, a situation that looks like disaster may look much different as the eyes heal and the cornea gradually changes contour. Sometimes, even big overcorrections with a laser have a tendency to ease back toward normal on their own. And sometimes, even the stopgap measures don't work: Steward's eyes were in such bad condition it proved impossible even to make contact lenses work properly anymore.