In addition to glasses and contacts, there are
several surgical solutions to vision imperfections, including radial keratotomy,
laser surgery and the newest, cornea implants -- small rings surgically inserted
around the cornea to correct its shape. Here to discuss these options is Dr. Herbert
Kaufman, director of the Louisiana State University Eye Center, the head of ophthalmology
and Boyd Professor of Ophthalmology and Pharmacology and Experimental Therapeutics
at LSU Health Sciences Center School of Medicine.
Q: There have been all kinds of developments
over the past few years for improving vision, such as radial keratotomy, laser
Lasik surgery and now cornea implants. Why the move away from glasses and contacts?
A:
It's not that contacts and glasses are bad, but to see normally and not need
anything is wonderful. Now, with technology, it only takes a few minutes and
you don't have to deal with glasses anymore. The cost is down, and the downtime
is reduced, and the benefits are great.
Q: Let's discuss the newest development,
Intacs cornea implants, recently approved by the FDA. Is this better than the
other surgical treatments?
A:
No. I have significant experience with Intacs. I don't think they have anything
to offer over Lasik. I don't think the risk benefit and the cost ratio is worth
it. I don't do them anymore. I feel the other procedures (make the corrections)
with less problems and less expense.
Q: What are the drawbacks to radial keratotomy
and using a laser to flatten the cornea to improve nearsightedness?
A:
Radial keratotomy is hardly ever used anymore. If you're nearsighted, the cornea,
the clear membrane in front of the eye, is too steep or too curved. One way
to improve vision is to make it flatter. ... If you envision it as a dome, one
way to do this is to make slits in the dome so the sides bulge and the top flattens.
It's far less predictable and less reliable than laser surgery. ... Most ophthalmologists
don't do radial keratotomy anymore. It's not that it's bad, just that the laser
procedures are better.
Q: What about farsightedness? Are there
more permanent treatments than glasses and contacts?
A.
There are three treatments for farsightedness. When you're farsighted, it's
because the cornea in the front of the eye is too flat. The best treatment is
with the laser, to remove a little tissue from the outside to make it steeper.
A second possibility is to put little burns on the outside of the cornea, which
causes the cornea to shrink and makes the dome steeper. The third possibility
-- which I'm enthusiastic about, but it's just in clinical trials now -- is
to make a flap like you would with a laser, put in a little lens, and put the
flap back. The advantage with the lens is that you haven't removed tissue, so
you can take it out (if needed).
Q: Can these other procedures be reversed?
A:
When laser surgery was just beginning ... the incidence of having night dazzles
or stars around light and those types of problems were higher than now. Even
now, occasionally patients see dazzle at night and don't get perfect vision
with the laser. Occasionally, the flap that's put on with the laser, if they
rub their eyes or squeeze them real hard, they get wrinkles in the flap. We
can go in and correct that. Overall, the risk is very small and the benefits
are very great.
Q: What factors would make a person a bad
candidate for surgery and one who should go for glasses and contacts instead?
A:
Well, there's risk to anything, but the risks (in these surgeries) are very
small. Normal dry eyes are OK to do these kinds of surgeries on, but if someone
has severe dry eyes or some other general medical diseases, it might not be
appropriate to do this kind of surgery. There are some connective tissue diseases
where healing is defective where surgery wouldn't be appropriate.
Q: What do you think about the contacts
that people wear purely for aesthetic reasons, such as changing their eye color
or the ones that look like cat eyes?
A: I
think they're kind of a gas. Everything you do carries some risk, and contact
lenses carry a little risk, but I think they're kind of neat. If they just put
them on for special events, I think this is kind of fun.
Q: What is the infection factor with this
type of device?
A: That's
the risk. If kids put them on with dirty hands, wear them overnight, these are
the risk factors; this is the responsibility. Just like driving, it carries
some responsibility with it, but if they do it responsibly, it is fine.
