Departments
Health Matters
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Week of 9 January 1998 |
Vol. I, No. 15 |
Health Matters
To see or not to see
I have had poor eyesight for years. Recently I have been hearing about laser surgery that corrects vision. Is this the cure it is touted to be?
If you meet a few basic qualifications, laser surgery can help reduce dependence on glasses. According to Santiago Villazon, M.D., two new surgeries, photorefractive keratectomy (PRK) and laser in-situ keratomileusis (LASIK), can dramatically improve vision for people with myopia (nearsightedness) and astigmatism (image distortion). "These surgeries will not always produce 20/20 vision, but most people will be able to drive and perform basic activities without glasses," says Villazon, who is assistant professor of ophthalmology at the Boston University School of Medicine and director of refractive surgery at Boston Medical Center.
Candidates for the surgeries should have maintained the same corrective-lens prescription for more than a year -- thus, people in their 20s, whose vision is still changing, should probably wait. Individuals with diabetes, organ transplant recipients taking antirejection medications, people who do not heal well, people who are monocular (have only one functioning eye), and individuals with very thin corneas are not candidates. A consultation with an ophthalmologist or optometrist will clarify your status.
PRK involves sculpting the cornea back into the shape of a soccer ball by removing tissue on the front surface of the eye with a special laser strong enough to destroy the targeted tissue while leaving neighboring tissue undisturbed. The procedure takes several minutes, and vision should improve within a few weeks. Sometimes, however, the eyes need further correction, so you may need to return for a second session.
By contrast, in the LASIK surgery, a thin slice of the cornea is cut and lifted. The laser sculpts the corneal tissue beneath, and the flap is replaced, becoming a protective cap. The healing process is typically faster with LASIK, but the risks are higher as well. Because the cornea is cut, LASIK can lead to some complications. "The most common complication, which occurs in about 1 percent of patients, is that their eyes don't improve from the surgery, and may even worsen slightly. However, we can possibly correct this with a follow-up surgery. The risk of blindness or retinal detachment is extremely unlikely," Villazon says.
Which technique is right for you? Your eyes may hold the key to that answer. According to Villazon, people with a moderate to high level of myopia or astigmatism may gain greater benefits from LASIK because the amount of haze and regression (the chance of the eye going back out of focus) is lower. However, PRK or LASIK can have similar results for patients needing only mild correction.
The treatment is expensive. Operations can cost several thousand dollars, and most health insurers do not cover them. If you are interested, one option to consider is checking with your employer about setting aside "health dollars," which can be used to pay for the procedure tax-free. "Don't trust ads touting remarkably low prices," Villazon warns. "There may be hidden costs for services necessary for safe treatment, such as initial consultations and follow-ups. Make sure to discuss every expense the fee covers."
Keep in mind that optometrists (who are not licensed to perform surgery) are different from ophthalmologists (who are medical doctors specializing in eye disorders), although their recommendations, as well as their pre- and postoperative care, are often the same. Consider getting several opinions -- including from former patients -- before choosing a doctor. You may want to contact the companies that make the lasers, Visx (800-246-8479) and Summit (800-880-4582); they maintain a list of qualified ophthalmologists who perform the surgeries.
While Villazon says the new treatments will revolutionize eye care, he adds that they don't help all vision distortions: "Those who use reading glasses won't benefit from PRK or LASIK -- and eventually, we all need reading glasses. But they'll help many others."
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information about laser surgery for improved vision, or other health matters, call 800-682-2862.