It wasn’t so long ago that the only correction available
to individuals with less than 20/20 vision was glass
lenses or discs professionally ground to a specific prescription
from an optometrist or an ophthalmologist. These would compensate for refractive errors like nearor
far-sighted vision.
These lenses were placed in a “frame” that stretched
across the bridge of our nose, then back, over and around
our ears. These “glasses” could be very heavy, causing little “nose pad” indentations. Or they would slide down our
nose or fall off when we’d look down or bend over to pick
something up.
Playing sports – no way! Of course, you could wear
one of those wide colored elastic bands around the whole
head to hold them on. These fashionable accessories
barely registered on the geek-o-meter.
More recently, a variety of enhancements have improved
the comfort of eyeglasses – lighter-weight metals
and plastics, thinner frames, half-frames or perhaps just a
little something over the nose bridge and earpieces. The
attractiveness of frames available today is almost eye-popping.
Get some jeweled frames, or wear some with someone
else’s initials or name on them. Maybe tinted lenses.
Or, if you’re a musical star named Elton, go crazy!
Some people can just grab really inexpensive glasses
off a rack at the grocery store. These lucky people are
those only needing some help when reading or sewing or
clearer vision at a movie, usually for short periods of time,
as opposed to those who can’t see without their glasses.
Contacts — the beautifying of the sight-challenged
Contact lenses — what a wonderful development for
those who need correction to see nearer or farther away.
These tiny clear hard concave things float on your eyeball.
But you can wear one on your left eye to see things close
by and one on your right eye for distance clarity to replace
bifocal glasses. This technique, called monovision, is often
used to balance the vision.
Clear lenses were followed by colored contacts — a way
to make green eyes greener, blue eyes bluer, or to really
change your looks by using brown or other dark-colored
lenses. Just think of it — a wardrobe of colored contacts.
A little more research produced a bifocal lens and
ways to correct for astigmatism. Want more comfort? No
problem — soft contacts. Want reasonable prices and
less trouble? Sure — lenses you can throw away after
limited wearing.
The next step: corrective surgery
The first time I heard about radial keratotomy (RK), a
colleague at work went to Austin for the procedure. As my
face contorted at the thought of a sharp, knifelike implement
near my eye, he said the procedure had already been
routinely used in Russia for over 20 years!
In RK, the surgeon uses a blade to make a series of incisions
from the center of the cornea outward. This procedure
failed to stabilize in most of the patients, so they
ended up with blurred vision, whether it was for near- or
far-sightedness.
On the other hand, photorefractive keratotomy (PRK)
became the first laser procedure approved by the U.S. Food
and Drug Administration (FDA) and, according to their Web
site, it still gives excellent results. Using this method, the
surface skin is first removed, and then a laser is used to
make the correction on the underlying layer. A “bandage”
contact lens is placed on the eye for protection until new
surface skin grows back.
A more recent procedure is known by the acronym
LASIK. The name of the procedure is in situ keratomileusis,
meaning to use a laser underneath a corneal “flap” to reshape the cornea (the transparent front covering
of the eye).
How do they do that?
The eye surgeon affixes a vacuum ring
to the eye, then cuts a layer of the cornea,
leaving it attached or “hinged.” Next, the
surgeon uses a special ultraviolet eximer
laser (the same type of laser used in PRK)
to send pulses of light to reshape the cornea
so that it matches the patient’s prescription — flatter for nearsightedness, steeper for
farsightedness. This outpatient procedure
takes a very short time to perform and is
said to be painless.
The main difference between PRK and
LASIK is the way the outer layer is removed.
In PRK, the outer layer is rubbed
off or taken off with alcohol, whereas in
LASIK, the outer layer is cut off with the
computerized device.
There are other options available to reshape
the cornea that are not being covered
in this particular article. One of these
is thermokeratoplasty, where heat is used
as the laser. Another uses corneal ring
segments inserted directly into the cornea.
A specially made contact lens, usually
worn at night, is used to temporarily reshape
the cornea.
As with any surgery, along with high expectations,
there are risks involved. It’s
good to ask friends and others for eye surgeon
recommendations, but you must
make an effort to check the credentials of
any ophthalmologist you might consider.
Give careful consideration to both the
benefits and the risks when meeting with
the surgeon to ascertain if you are a good
candidate for a procedure. Some things
you might discuss are:
• Past and present medical and eye
conditions (glaucoma, eye injuries, surgeries,
inflammation).
• Medications you are taking, including
those purchased without a prescription
(over the counter).
• Allergies you may have, particularly
any reactions to medications.
• Risks and benefits of your surgery and
any alternative procedures.
• What to expect before, during and
after the surgery.
• Costs and what is included in the
quote. Are any “tweaking” procedures included?
If so, does the quote include
charges for the operation facility? This is
important because medical insurance plans
do NOT pay for laser surgery.
You’ll probably be screened for inflammation
in the eyes or any crusting on
lashes. You’ll be examined for enlarged
pupils, thin corneas or dry eyes. You’ll be
asked if you have had RK, PRK or LASIK in
the past.
Your homework should include taking
the time to evaluate the pros and cons. Go
to the FDA Web site, where you can find indepth
descriptions of the surgeries plus
warnings not to let yourself be pushed into
the procedure.
They give cautions about “slick” advertising
or deals that “sound too good to be
true.” Red flags should include statements
such as “20/20 vision or your money back” because there are no guarantees with surgery.
On the Web site, they urge you not to
let cost be the deciding factor and to read
carefully the materials you should receive
at the initial meeting with the doctor.
One surgery or two?
You’ll want to balance the convenience of
surgery on both eyes at the same time versus
the wisdom of a waiting period between
surgeries. Yes, the doctor might let you decide
to have LASIK on both eyes on the
same day, but this is riskier than having two
separate surgeries. For one thing, you can’t
see how the first eye responds to this surgery.
Another disadvantage is that both eyes
may be blurred until the healing process is
over. If you do decide to have one eye operated
on at a time, the doctor will decide how
long to wait before the second surgery.
By the way, the monovision technique
used with contact lenses, where one eye is
corrected for close sight and the other for
distance vision, has greater consequences
when done surgically. Since the eyes no
longer work together, the quality of the vision
is poorer and depth perception is decreased,
particularly in low light. Statistics
show that many recipients of monovision
by laser cannot tolerate having one eye
blurred at all times.
You are NOT a good candidate
for LASIK if:
• You are under 18 years of age.
• You have certain diseases that could
affect healing — lupus, diabetes, rheumatoid
arthritis — or if you’re taking steroids or
retinoic acid.
• You participate in contact sports.
• You have dry eyes. Laser surgery aggravates
dry eyes, so this condition must be
treated before any surgery is done, with eye
drops and oral medications. Dry eyes are
most prevalent in women, especially postmenopausal
women. Of course.
• You might experience halos and glares
from lights.
Other serious risk factors could arise
from equipment malfunctions or complications
after the surgery that may require additional
treatments.
New versions of lasers and new procedures,
like lens implants, are developing
rapidly. A great deal of information can be
found on the Internet, in books and
brochures. You might even see a procedure
on one of the medical channels on TV
(the “real life” channels, not Dr. McDreamy
and crews).
Why not visit the FDA Web site, as I did,
for more in-depth information about this and
other health-related questions you might
have? There, you’ll find a glossary of terms
relating to the eye and eye surgeries and a
comprehensive LASIK surgery checklist for
each stage of the decision-making process.
See ya.
