Millions of nearsighted Americans have had their vision corrected through a cold-laser procedure. Now the same equipment has been approved by the U.S. Food and Drug Administration to correct farsightedness.
Dr. Andrew Lyle, founder of the Eye Institute of Utah, performed his first surgery for farsightedness (hyperopia) two weeks ago, using a laser created by Visx Inc.The results, he said, were terrific.
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The Moran Eye Center took part in the clinical trials. And last month the laser it has been using, from Summit Technology, received FDA approval at the same time the Visx laser did.
The cold-laser surgery is called Laser Assisted Intrastromal Keratomileusis but is generally referred to by the acronym LASIK.
Nearsightedness, or myopia, results when the eye is elongated and the cornea is curved too steeply. Light rays entering the eye focus in front of the retina, making objects in the distance appear blurred or distorted.
With hyperopia, the eye is too short, so that the cornea is closer to the retina and light rays focus behind it. Despite the name farsightedness, objects at a distance are apt to be blurred as well as objects that are close. So the hyperopic patient usually has to wear bifocals.
To perform LASIK surgery, the surgeon cuts a thin flap -- thinner than a split hair -- in the corneal tissue and folds it back from the eye's surface. Prior to the surgery, the eye is anesthetized with drops, and the eye is held open with an eye speculum. Once the flap is opened, a cool beam of laser light is applied to reshape the cornea. A suction ring holds the eye steady, and there's no risk that the patient will move the eye and cause an injury, Lyle said.
In the case of myopia the cornea is flattened somewhat by applying the laser in the center of the cornea. With hyperopia, the cornea is made steeper by using lasers on the sides of the cornea.
While the doctor operates, a technician monitors a computer screen that shows exactly what the doctor is seeing. He also counts off the time remaining on the laser pulse before the preprogrammed results are achieved.
For both hyperopia and myopia, the flap is then put back in place, where it sticks immediately. No needles. No stitches. The natural suction of the eye holds it in place, and within 24 hours the cut is undetectable.
Most people return to normal activities the next day. And many report 20/20 vision within a few hours.
Total time for the surgery is between four and five minutes for each eye. Cost, which includes the eye exam to determine if LASIK will help, ranges from about $2,000 to $2,400 per eye.
Insurance policies don't cover the surgery. But many of the doctors who perform it (and there are many in Salt Lake County alone) offer financing.
If surgery doesn't get the desired results, a doctor can perform "an enhancement" about three months later.
But Lyle said the need for follow-up surgery is very rare -- only about 3 to 5 percent. The most sophisticated older method required enhancements almost one-third of the time.
LASIK surgery is much less painful than the older surface laser procedure, which meant removing the surface cells of the cornea and then applying the laser beam to reshape the underlying cornea. The eye then has to be bandaged and pain drops are needed. Recovery from surface laser surgery, called PRK, can take several weeks.
LASIK can also be used on a broader degree of vision impairment.
But the surgery isn't for everyone. It's contraindicated in a condition called keratonconus, where the cornea bulges steeply because its not predictable. And those who are pregnant or have a serious disease of the eye, including infection, are not candidates at the time.
Some patients choose an option called monovision, which helps patients avoid bifocals later in life when the muscle that provides "easy focus" gets tired and gives out. One eye is used for seeing at a distance and the other for reading. And, odd as it sounds, people who've had it done swear it's easy to adjust to.
The laser used by Lyle and a number of other area doctors, which is housed at the Eye Institute, 755 E. 3900 South in Salt Lake City, and owned by ClearVision, was the first in the country to be outfitted by Visx Inc. with the software upgrades needed to perform laser surgery for hyperopia. The surgery for myopia (nearsightedness) and astigmatism has been around for more than two years.
The Summit laser used by Moran Eye Center and other doctors is owned by Visions Correction Centers. In both cases, eye surgeons receive special training on using the equipment, then contract with the company that owns the laser for time to do the procedure, said Moran's Julia Jeffery, medical assistant.