Vision Surgery: Give It The Twice Over

For 20 years, Valerie Carr wondered what it would be like to live without eyeglasses. She tried contact lenses but found the itching and irritation intolerable. Finally, 18 months ago, the 34-year-old Philadelphia-area insurance cost analyst underwent experimental laser surgery to correct her vision. She hasn't looked back. Says Carr: "Just think of one day putting down your glasses and not picking them up again."

After 16 years of expanding slowly in the U.S., corrective eye surgery is coming of age. Nationwide, nearsighted people can easily find ophthalmologists who do radial keratotomy (RK), using diamond-bladed knives to make wagon-wheel-shaped cuts in the covering of the eye, the cornea. Newer techniques, such as inserting a small plastic ring into the cornea to reshape it or surgically excising parts of the middle of the cornea, are being developed. And as many as 5,000 people have been helped by excimer laser surgery, which may win Food & Drug Administration approval for broad use by late 1995.

CAUTION. But as the number of techniques grows, so does the controversy. RK is notorious for being heavily advertised and hyped. Some medical experts argue that slicing into the eye can permanently weaken it and cause it to rupture if subjected to a trauma, such as getting hit by a ball. They caution prospective patients considering surgery purely for vanity reasons not to act hastily--especially since safer and more effective procedures may be around the corner. "None of this is medically essential," says Dr. Stephen Orlin, a corneal specialist at Philadelphia's Scheie Eye Institute. "It makes sense to err on the side of being conservative."

The laser, which vaporizes a thin layer of the cornea instead of slicing it, seems to offer clear advantages over RK. Because less tissue is removed, laser surgery leaves the eye stronger. And it doesn't typically cause a "starburst" effect--the appearance of halos around lights at night, which sometimes shows up with severely nearsighted people who have undergone RK. The technique has been tested in about 40 U.S. sites since 1991 but has been commercially available in Europe and Canada for several years. Says Dr. J. James Rowsey, chairman of ophthalmology at the University of South Florida: "The excimer will have a broader range of efficacy."

Even so, it is not expected to replace RK completely. At $4,000, the laser will cost $1,000 or so more than conventional surgery--no small factor, since insurers usually don't cover these procedures. Recovery of full vision from RK can take a few days, but some patients who have undergone the laser complained of blurriness for a month or more. What's more, the laser is more painful initially and leaves a hazy scar on the cornea, the long-term effects of which are not yet known. Says Dr. Christopher Rapuano, a surgeon at Wills Eye Hospital in Philadelphia who has used both techniques: "RK will survive."

THE RISKS. No matter which method you choose, you're apt to wear specs again someday, at least for reading. Both types of surgery accelerate a natural deterioration in close vision that comes on as most people age. Also, a fair number of patients--up to 30% with RK, less with the laser--need secondary operations or "enhancements." And permanent injury to the eye remains a small risk.

Curiously, some surgeons say the odds of success rise with age. The best candidates are in their 30s or older. Why? Younger eyes heal more aggressively and try to return to their poor-vision shape. On the other end of the age spectrum, there seems to be no limit to uho can be treated, so long as cataracts haven't developed. "The oldest I've done is 65, but I recently had an applicant [for RK] at 85," says Rowsey. The reason: Glasses interfered with her tennis game.

Balancing the risks of surgery with its rewards, many oculists say eyeglasses or contact lenses remain the top prescription. They correct vision more predictably, they're safer, and there's no painful post-op recovery. But if you're still leaning toward surgery, look twice before you proceed.

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