For the myopics among us who dream of waking one day to actually read the alarm clock without glasses, there’s something new on the horizon, the living contact lens. Using a simple surgical procedure called, not so simply, epikeratophakia, an ophthalmologist removes the epithelium, or outer surface of the affected eye. and makes a groove in the cornea. Then, cor-neal tissue from a donor, pressed, frozen, and ground to the proper prescription, is sutured into that groove.
Living contacts, nicknamed “epi’s,” were first used as a last-ditch effort to help children and adults who. after cataract surgery or because of certain rare eye disorders and injuries, were unable to gain satisfactory vision with glasses or contact lenses. Before the procedure was developed at the Louisiana State University Eye Center in New Orleans in 1979, premature infants, who are especially likely to develop cataracts, often went blind because no intra-ocular lens existed that could help maintain their vision after the cataracts were removed.
Among the epi’s biggest supporters locally is Dr. Thomas Marvelli, a thirty-four-year-old ophthalmologist who was a resident physician at LSU. Although he is quick to admit the surgery is not a panacea. Marvelli predicts that within five to ten years, the epi will be as common as the contact lens. He does an average of one of the surgeries a week and says that almost everyone with a significant near-sightedness or farsightedness is a candidate for the procedure. That’s 30 million people nationwide.
Unlike radial keratotomy. a controversial and permanent vision-altering refractive surgical procedure. epi”s can be replaced with new corneal tissue ground to another prescription. Marvelli says thai 90 percent of his patients can see without glasses or contacts within six weeks, and that no donor tissue has yet been rejected. The hour-long procedure, for which the surgeon’s fee is about $3,000 per eye, is frequently done on an out-patient basis with a local anesthetic.
Among Marvelli’s satisfied customers is Jane Goode, a new recruit to the Fort Worth police academy. Before epikeratopha-kia, she was ineligible for the Fort Worth force because her nearsightedness was too severe. Now she’s preparing to take the vision test again and feels confident she can pass without glasses. Another of Marvelli’s patients is Scott Kopp. a real estate developer who damaged a cornea at age six and had lived with severe double vision. One month after his surgery, he says, “I could see better than I’ve ever seen in my life.”
Fewer than ten ophthalmologists in Dallas/Fort Worth perform the operation, and most of those who do reserve it as a last resort. Drs. R. Wayne Bowman and Mary Beth Moore, assistant professors of ophthalmology at Southwestern Medical School, have both performed the surgery successfully, but they warn that the epi’s are new and unproven and they recommend caution in using them electively.
“The real significance of epi’s remains to be seen five years down the line,” Bowman says. “No operation is risk-free; this one has its place now only among contact lens failures.”
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