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A Sight For Poor E More People Turning To Surgery To Liberate Themselves From Glasses And Contacts

Sun., Jan. 29, 1995

Admit it. You’ve always hated your glasses - from the time your parents first bought you the tortoiseshell number and you became known at school as “Four Eyes.”

And you contacts users: You may love being glasses-free but how many of you really clean those $300 babies every night just as the doctor told you?

Well, no wonder so many people with refractive vision problems - such as the farsightedness and nearsightedness experienced by 35 percent of all Americans - are turning to eye surgery to free them from glasses and contacts.

The option is clearly gaining in popularity as various types of vision correction surgeries emerge and as studies attest to their safety and effectiveness.

Here’s a look at some of the latest advances.

Radial Keratotomy: Developed in Russia, RK began generating equal amounts of excitement and criticism in the United States in the early 1980s. The procedure corrects mild to moderate myopia - nearsightedness - by making tiny incisions in the cornea in a spoke-like, or radial, pattern. The cuts change the curvature of the cornea by flattening it and vision is corrected.

Critics of RK - and there were many - predicted complications and poor results. But those dire warnings simply haven’t panned out, says Dr. Robert Maloney, an ophthalmologist at the Jules Stein Eye Institute at the University of California, Los Angeles.

The 10-year study showed that after surgery, 85 percent of patients had 20/40 vision without glasses - the requirement for a driver’s license - and at least 70 percent did not wear glasses or contacts for distance vision. Only 3 percent had poor distance vision and none had catastrophic problems.

The study did show, however, that RK patients may need reading glasses sooner than they would have without surgery. Most people find they need reading glasses about the age of 40. But RK may speed up this progression to farsightedness.

This shift to farsightedness has made some eye doctors reluctant to endorse RK.

“This is a significant problem that occurs in about 40 percent of patients,” says Dr. Lawrence J. Schwartz, an ophthalmologist with Cedars-Sinai Medical Center in Los Angeles.

Still, because of rapidly improving results, Schwartz says he will start doing RK.

Anyone considering RK, however, should be counseled on possible side effects and complications.

Vision sometimes fluctuates from morning to evening, even long after surgery. A minority of patients also see a glare or “halo” around lights at night. And, if the surgery is not precise enough, additional surgery may be needed to sharpen vision.

RK takes about 30 minutes per eye. Patients are given eye drops to anesthetize the cornea and can usually return to their usual routines in two days. The second eye is corrected about two weeks after the first.

Like other refractive eye surgeries, RK is not covered by insurance. It costs about $1,500 per eye.

Automated Lamellar Keratotomy (ALK): Less wellknown than any of the other refractive eye surgeries, ALK also is gaining converts.

The surgery is for people with higher levels of nearsightedness, beyond what is recommended with RK. This is noteworthy because these people cannot see even a few feet without glasses or contacts.

In ALK, a layer of the top segment of the cornea, only 1/200 of an inch thick, is lifted up as a machine called a microkeratome glides across the cornea. To treat nearsightedness, a precise amount of corneal tissue is removed. The cap is then placed back on without stitches. Because some tissue has been removed, the cornea is flattened, reducing or eliminating nearsightedness.

The technique also can be used to make the cornea steeper and correct low levels of farsightedness.

“ALK is correcting farsightedness beautifully, but only in small amounts,” says Dr. Efraim Duzman, an associate clinical professor of ophthalmology at the University of California, Irvine, who adds that ALK is “taking off like a rocket in popularity.”

Most ALK patients improve enough to function without glasses or contacts, Maloney says. Glasses may still be needed for driving or watching TV.

The costs are similar to other refractive eye surgeries.

Photorefractive Keratectomy (PRK): The long-awaited excimer laser that is used in PRK may receive approval from the U.S. Food and Drug Administration within two years to correct nearsightedness. And, while highly touted, it, too, has its pros and cons, says Maloney, who began testing the laser in 1989 with government approval.

According to the government panel that recommended approval, 78 percent of the patients gave up glasses or contacts despite vision that wasn’t perfect. The panel estimated that 3 percent to 7 percent of patients still had vision problems after surgery.

The panel said that doctors must be specially trained, and that patients must be warned that only moderate to mild conditions can be helped and that certain risks are involved, such as some vision loss and glare problems.

Since the correction of vision via glasses and contact lenses is a “multibillion-dollar industry,” the advent of surgical correction could throw the marketplace into a frenzy as each sector lobbies to attract consumers, says Dr. Daniel Sigband, a Huntington Beach, Calif., ophthalmologist and contact lens expert.

Adds Dr. Efraim Duzman, an associate clinical professor of ophthalmology at the University of California, Irvine: “It’s a hot topic.” At a recent meeting of ophthalmologists, he says, close to 40 percent of the information had to do with refractive surgery.

Los Angeles Times

xxxx Visions of the future Two recent events have generated a high degree of enthusiasm for vision correction surgery: In October, a 10-year study on the controversial eye surgery radial keratotomy found that 70 percent of the RK patients still did not need glasses to correct their nearsightedness. The procedure also was found to be safe. Also in October, a government advisory committee recommended that the U.S. Food and Drug Administration approve the first laser device - the excimer laser - to correct nearsightedness, a procedure called photorefractive keratectomy. The excimer laser may prove to be more precise than RK, but is still experimental until final FDA approval.

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