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BEYOND GLASSES:THE LATEST LASER EYE SURGERY
Still, there are naysayers. "I just can't recommend this procedure to my patients," insists ophthalmologist Cynthia MacKay, associate clinical professor at the Columbia University College of Physicians and Surgeons. She puts the "need" for such surgery right up there with that for liposuction and is appalled by the risks. "Have you read the consent form?" she challenges before I can blurt out that I'd already had LASIK. To be sure, the ten-page document, listing every possible side effect from minor vision problems to blindness, is a bit daunting.
The medical culture of New York, in any case, has been resistant to refractive surgery. Neither patients nor practitioners embraced RK, and we've been only slightly more receptive to PRK and LASIK. Around 3,000 to 4,000 PRKs and 1,200 LASIKS have been done here to date-a scant 5 percent of the national total. "The philosophy in the Northeast is different from anywhere else in the U.S.," says Dr. Jeffrey Cooper, my Manhattan optometrist for the past twenty years, who recommended LASIK but never RK. "Unlike consumers in the Sun Belt, this is not a group that runs out and says, 'Cut me up and make me beautiful.' "
Of the 400 excimer lasers in operation in the U.S., New York has only fourteen machines so far, New Jersey four, and Connecticut two. Some are owned by hospitals, some by private practitioners, and some by corporate entities - wannabe WalMarts of the new technology. But most local lasers are "underutilized," says Dr. Speaker. Indeed, only 10 percent of those who come to seminars at Crystal Vision actually have the surgery, says a disappointed Dr. Steve Joffe, an Ohio ophthalmologist and president of LCA Vision, which owns one laser center in Manhattan, one in Westchester, and seventeen others nationwide.
"It's growing slowly," Dr. Speaker acknowledges, "but it's beginning to reach critical mass." The busiest machines, not surprisingly, are those used by the best surgeons. For example, the machine Dr. Speaker uses at the New York Eye and Ear Infirmary-owned by 20-20 Laser, a network of O.D.'s and M.D.'s sharing operating costs and profits-is responsible for a third to half of all LASIKS done locally.
Certainly, with 50 percent of the population in glasses or contacts, vision correction is big business. Some 24 million Americans wear contacts-another 10 million have tried and failed, or worn them and abandoned them. This is especially common among boomers, once heavy consumers of contacts. And although glasses are by far the safest alternative, a recent survey by LensCrafters indicates that a third of the patrons they surveyed strongly agree with the statement "I hate wearing glasses."
WHETHER LASER VISION CORRECTION WlLL SOMEDAY BECOME a "rite of passage" is open to debate. But it's already clear that these new procedures are reasonable options for at least some people. The question is, how do you know if you're one of them?
The first step is to educate yourself: Read about the procedure-at the library, online-and talk to patients. Many doctors offer demo videos. Mark Speaker goes so far as to invite prospective clients into the operating room, which can have a calming effect or not. I stood by in utter awe as the woman on the table. having her second eye done, cracked jokes and traded stories with him.
"People have to go into this with their eyes open," says Franette Armstrong-no pun intended. A writer excited about her own PRK, Armstrong compiled the incredibly informative and comprehensive Beyond Glasses! The Consumers Guide to Laser Vision Correction. "It can wreak havoc in your life if you don't do the research, go to the right place, get the right support." she says.
Ask yourself-as I did a hundred times-why am I doing this'? I had worn lenses for 39 years, but my eyes were getting drier with age. The possibility of having to wear glasses all the time pushed me over the edge-a function of both vanity and vision. I simply didn't see as well with glasses, and I felt extremely vulnerable whenever I wore them. Some patients, like Clare Ferraro, 47, publisher of Ballantine Books, chose surgery because they ran out of options. A minus eight who had worn hard contact lenses for almost 30 years, she developed dry eyes and, after trying twenty different types of soft lenses, took the plunge. (Her post-surgical enthusiasm led her to publish a primer on the subject, The Eye Laser Miracle, by California ophthalmologist Andrew Caster)
 A human hair: etched by the excimer laser.
Others elected to have the surgery out of concern about eye infections and other long-term implications of wearing contacts-or they simply no longer wanted the hassle. Sports Illustrated editor Paul Fichtenbaum, 36, a self-confessed "baby" when it comes to surgery, had been wearing lenses for fifteen years to correct his minus-four vision. "It's the little things that other people take for granted-like when I take a shower and put my 14-month-old son in the playpen, not being able to see him across the room," he told me days before his surgery.
The worse your vision, the greater your motivation. But if you're only slightly nearsighted and don't mind glasses or contacts, risk may outweigh gain. One of the few disgruntled PRK patients I talked with was only a minus three before surgery. She experienced severe discomfort for two weeks after the operation and was so disappointed with the results, she not only refused to have the second eye done but was considering suing the surgeon. Still, when I told her how nearsighted I was, she said, "Oh, your case is different. I'd have the surgery if I were you."
It's important to remember that many of the vocal supporters of the excimer laser are often the same surgeons who did clinical trials for the manufacturers; many M.D.'s and O.D.'s are heavily invested in equipment. It's not a bad idea to ask a practitioner about his or her personal stake in the technology. Get a second opinion-from someone up-to-date on all types of vision correction. I went to Barry Farkas, a Manhattan contact-lens specialist, who agreed I'd be a good candidate for LASIK.
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