With the bounty of correc-tive surgical techniques available, eye surgeons and ophthalmologists can now transform the way people see. From radial keratotomy to the excimer laser to the implantable contact lens, technology indeed promises to grant better vision.
Nearly 25 percent of North Americans suffer from myopia, or nearsightedness. This common eye condition occurs when an irregularly shaped cornea-the clear, outer layer of the eye-causes incoming light rays to fall short of the retina. The eye thus registers close images but cannot decipher distant ones.
Previously, people with myopia could turn only to glasses or contacts for treatment. Now, however, there are several procedures that can eliminate or reduce the need for artificial lenses by altering the surface of the cornea. Originally developed in the former Soviet Union during the 1970s, radia] keratotomy now ranks as one of the United States’ most popular corrective procedures-primarily because of advances in the past few years.
The operation involves making tiny spokelike incisions with a diamond-ripped blade to flatten the surface of the cornea. The modified shape causes incoming light rays to fall directly onto the retina, thus reducing the blurred vision typically associated with myopia. Physicians caution that RK produces the best results in patients with low levels of nearsightedness.
Patients also might look to photo-refractive keratotomy (PRK), a new surgery that uses a cold laser beam-known as the excimer laser-to shave microscopic layers of cells from the surface of the cornea. Physicians increasingly recommend PRK as a primary operation and turn to RK for fine-tuning. Most patients boast 20/40 vision after PRK-eyesight good enough to obtain a driver’s license without lenses. About 80 percent even gain 20/20 vision after surgery,
Still, these procedures aren’t cure-alls. Surgery can restore natural vision, not necessarily perfect vision. Even patients who undergo corrective treatments might need reading glasses when they turn 40. As part of the aging process, the eye’s lenses lose their natural ability to focus, which results in a condition known as presbyopia.
As with any surgery, both RK and PRK involve some cautions. Recovery times can vary from two to 10 days, depending on the procedure, and patients sometimes wait several months for vision to stabilize. Light sensitivity, hazy vision or a starburst effect number among potential side effects.
Once vision stabilizes, the patient must monitor his progress. RK patients experience fairly high levels of regression, and roughly one-third of patients require follow-up enhancement procedures. PRK produces less regression-only 3 percent Co 10 percent need fine-tuning-but the procedures aren’t necessarily foolproof.
Other eye conditions, including cataracts, benefit from recent technological advances as well. After age 65, almost everyone’s eyes develop some degree ot cataracts, a clouding of the lens that obstructs vision. Not all cataracts require treatment, however, and specialists prefer to surgically remove them only when the patient complains that his vision has become intolerable.
Previously, cataract correction came only through thick glasses that inhibited peripheral vision. Now, physicians can perform sophisticated no-stitch cataract surgeries on an outpatient basis. The most common type removes the clouded lens and replaces it with a flexible plastic lens inserted through tiny 1/8-inch incisions in the eye. The new “taco lens”-so named because it is folded like a taco and then unrolled when placed inside the eye-restores clear vision. Although the procedure also involves small incisions on the side of the eye to help guide placement of the new lens, they heal naturally. Patients should notice clearer vision the following day.
LOOKING TO THE FUTURE
Current treatments present vast improvements over those used in past decades, but new ones offer even more promise for a wider variety of conditions. One of the most well-known cutting-edge procedures combines the excimer laser with traditional RK treatment to provide a quicker recovery. The Laser Assisted In-Situ Keratomileusis (LASIK)- popularly known as “flap and zap”- involves cutting a flap into the surface of the cornea and then using the laser to shave microscopic layers from the portion of the cornea beneath the flap. After the corneal tissue has been reshaped, the flap is placed in its original position.
“Patients experience virtually no discomfort during the LASIK procedure,” says Dr. Harvey Carter of the Carter Eye Center. “Because the procedure alters only the inside of the cornea, recovery time is minimal and since neither the corneal epithelium or Bowman’s layer are destroyed, the possibility of stromal haze is almost completely eliminated.”
Perhaps the most enterprising treatment option, the implantable contact lens, eventually might correct all types of vision problems. This surgery inserts a contact lens directly within the eye. Among its advantages, the surgery is reversible, which allows physicians to change lens prescriptions. Don’t expect to schedule the surgery soon, however. Final FDSA approval might take as long as 10 years. The sheer scope of vision treatments should grant eye care’s increasing presence in the medical field, experts agree.
Nearly 150 million adults wear prescription lenses, and that ever-growing number demands eyewear that provides not only clear vision but also comfort and beauty. Innovative materials and design techniques now make seeing well-and looking good-surprisingly easy, as both glasses and contact lenses provide comfort, convenience and beauty. “The marriage of new technology in prescription lenses with sophisticated styles oi new eyewear designs have made glasses into a fashion accessory,” says Dr. Linda Price of L’Optique.
A far cry from the heavy nickel frames of old that left wearers with semi-permanent nose indentations, today’s glasses boast more lightweight designs. Titanium and cobalt alloys remain strong but easy to wear when crafted into thin frames. “Rimless and semi-rimless frames are very fashionable right now,” says Valerie Barrett of Tom Barrett Optical, “New lens prescriptions and lighter metals allow frames to be thinner, lighter, stronger and more comfortable.
Glasses increasingly have become essential wardrobe components. Like other fashion accessories, today’s frames are more unique. “Unisex frames are giving way to more masculine or feminine designs, and plastic frames are also making a comeback,” says Barrett. Bob Schreiber of American Eyewear has noticed that geometric and severe shapes-such as cat’s eyes, diamond and octagonal-are replacing round and oval shapes in terms of popularity.
Many wearers collect different styles to use for work or for social occasions. Others trade contacts for glasses in hopes of attaining a more credible image. “Young people right out of school or just starting in the workplace want to look older, smarter and more professional. Glasses can help them get the look they want,” says Schreiber.
Previously, people would own one pair of glasses for seeing better, but now they have several pairs for simple variety. People often want a certain look for business and more formal occasions and another look for more casual times.
Contact lenses remain a popular option for people who don’t like the look of glasses or the loss of peripheral vision. In some cases, the products can improve vision more than glasses. People with high levels of correction often notice less distortion with contacts. By covering the entire pupil, lenses can also correct faulty peripheral vision. “Contacts have changed tremendously during the last 10 years. Many people who didn’t like contacts in the past are now finding them to be more comfortable, safer, and easier to maintain,” says Dr. Lisa Calaway-Batky.
Astigmatism can be corrected with soft lenses, although in certain cases, vision can be best corrected with gas permeable rigid lenses. New technology in specialty lenses, such as bifocal soft and rigid, are extremely important for patients who require both distance and near correction.
Contact lenses used today, both soft and rigid, are permeable, allowing oxygen to reach the cornea. Better eye health has been the result of this technology.
Similar to conventional lenses, disposable contacts gain a wider following because they require very litde maintenance. Worn for one day to one week, disposables boast5 the same comfort of traditional lenses, but allow wearers to forgo cleaning and discard them after use. With a larger variety of lenses, in terms of curve and diameter, almost anyone can wear contact lenses, says Dr. Calaway-Badty.
Whether people choose glasses or contacts, finding a reputable eyecare professional remains key to good vision. Incorrect prescriptions can lead to eye strain, while ill-fitting contact lenses can cause serious corneal ulcers, which are blisters on the surface of the eye that can cause blindness if not treated. Physicians recommend that everyone, especially those who wear contact lenses, undergo an annual eye exam to spot changes in vision. Even people with relatively good eyesight should consider scheduling an appointment to identify potentially serious conditions.
Vision problems sometimes extend beyond the eyeball itself. Drooping eyelids can obstruct sight or cause watery eyes, while misdirected eyelashes can irritate lenses. Fortunately, these conditions often can be corrected.
EXCESS EYELID SKIN
Diagnosis: Heavy folds of skin atop die upper eyelid cause the lid to droop from the added weight. Because the skin partially obstructs the eye, people with this condition cannot see when they look up or to die side, Heavy lids also prompt fatigue, particularly when reading or driving.
Treatment: The treatment of excess eyelid skin called Blepharoplasty can be performed in two ways: with lasers or by surgically removing skin in tiie creases of the lid. “Both procedures can by done in about an hour, and neither is very painful,” says Dr. David Martin. “Because the recovery time, is short, many choose to have die surgery on Friday and go back to work on Monday.”
Laser treatment uses the C02 laser to resurface the eyelids and tighten the skin. “This procedure is often preferred over a face lift because it allows for better healing and less bruising,” says Dr. Forest Brown of Consulting Dermatologie Specialists.
Surgically removing the excess skin restores a full field of vision. Surgeons carefully measure the amount of skin to remove, because extracting too much could cause the eye to close improperly, resulting in corneal damage or vision loss. Stitches are removed two to seven days after the surgery.
Diagnosis: Although diis condition often accompanies excess lid skin, a drooping eye