Who Can You Trust Your Eyes To?
"Who can you trust your eyes to?" is the tag line of a radio advertisement promoting laser eye surgery (Lasik). Implied is the idea that there are few things more valuable than one's sight, and that these doctors can be trusted to do quality work. Vision correction surgery, both by laser and traditional means, is changing almost daily. Tremendous progress is being made, and it is very popular, according to eye specialists.
"Even though refractive surgery is booming in the community, people should remember that it's still in its infancy. I fear that the public is being led to believe that the new technology can eliminate their need for glasses forever, and restore their eyesight perfectly," according to Majid Moshirfar, M.D., professor of ophthalmology at the University of Utah and director of the Moran Eye Center.
"While it is true that refractive surgery-whether shaping the cornea with a laser to allow light to focus more directly on the retina or surgically implanting a lens-is a major advance and can benefit many people, it is not yet for everyone. We, as eye surgeons, need to better educate the public about the benefits and the dangers of these procedures," he said. "There needs to be a word of caution."
"Based on scientific literature, chances of obtaining 20/20 vision with laser surgery is between 45 and 65 percent for various ranges of nearsightedness," Moshirfar said. "Patients should understand that just because their corrective lenses may allow them to achieve 20/20, there is no guarantee that laser correction will achieve the same result."
"Much of laser surgery's effectiveness depends on the patient's individual condition, the type of laser used, and the training and experience of the surgeon. The field may be moving a bit too fast," Moshirfar said.
The excimer laser, which produces a computer-controlled ultraviolet beam of light, was first used in the early 80's to treat nearsightedness. Now, a variety of lasers are used to surgically correct nearsightedness, farsightedness and astigmatism.
"Incredible progress has been made in the use of lasers in eye surgery; new lasers and new procedures are being introduced practically every day. But, the public needs to be cautioned that it is not appropriate for everyone, that optimum results are not obtained in every case, and the technology is changing so fast that there may be something better next year," Moshirfar said.
The university eye surgeon emphasized that computerized laser surgery is not an exact science, that judgments still must be made by the physician. He also cautioned that the long-term results of some of the procedures are not known, and that Lasik cannot prevent the natural aging of the eye. Laser surgery also cannot prevent the later development of cataracts, and may even complicate their treatment. Nearly 500,000 Americans underwent laser eye surgery last year. It is estimated that vision was improved in about 70 percent of them. "Lasik is new. It is changing very fast. Performed by skilled and experienced surgeons, it helps most people. But, there are risks of irreversible damage. If patients are comfortable with their glasses or contacts, I suggest that they not undergo the surgery, that they wait for the next development," Moshirfar said.
The Moran Vision Center is also one of the 20 sites nationwide involved in the clinical investigation of a contact lens-like device surgically implanted in the eye, which is believed to correct myopia, or nearsightedness.
The lens is about a fourth the size of a fingernail and is surgically attached to edges of the iris. Called the Artisan lens, it was developed during the past 15 years in Holland and is thought to offer hope to the extremely nearsighted. Using the Artisan lens, however, leaves the cornea intact, so the surgeons can remove it or perform laser surgery later if the patient's needs change, according to Moshirfar, the study's principal investigator.
Other cornea specialists on the university vision correction team are Drs. Maureen Lundergan, Mark D. Mifflin and John B. Fassio.