SELF MAGAZINE
JANUARY 1999

I CAN SEE CLEARLY NOW

A patient's report on the promise (and perils) of laser vision surgery.

By Amy O'Connor

This time last year, I was lying on an operating table, a speculum stretching my right eye open Clockwork Orange-style. A machine inches from my face zoomed in, squeezing my eyeball and holding it taut. The room went dark-breifly-as a razor sharp device sliced partially through a layer of tissue at the tip of my cornea, creating a flap. I stared into a pulsing red light and smelled a sizzling vapor as a laser gently zapped the exposed cells. When the corneal flap was closed, the shape of my eye had been made imperceptibly flatter.

Laser surgery to correct nearsightedness sounds harrowing-after all, who isn't squeamish about her eyes? But my procedure, called Laser In Situ Keratomileusis (LASIK), lasted only about 10 minutes. The anesthesia came in eye drop form, I felt no pain and there was no blood. The real drama came later, when my vastly improved sight made a lifetime of legal blindness a memory.

The curve of the cornea determines clarity of vision-too flat and your farsighted, or hyperopic; too bulbous-and your nearsighted, or myopic. Laser vision correction, or refractive surgery, works by changing the shape of the cornea, cell by cell. It's one of medicines fastest growing specialties; 300,000 people had their eyes corrected in 1998, a figure expected to double by the turn of the century. A farsightedness treatment approved last November could swell the potential patient pool to 30 million. Over the next decade, more promising innovative procedures currently in development are expected to expand consumers options even further.

Despite such dizzying growth, potential candidates need to consider that it is experimental, and although the specific type of laser used-the eximer-is approved by the FDA for photorefractive keratectomy eye surgery (PRK) and treatment of farsightedness , it is not specifically approved for other applications, including LASIK. (That doesn't mean my surgeon violated any law; doctors are free to use the laser"off label" at their own discretion.)

Perhaps the scariest-sounding risk of refractive surgery is loss of"best-corrected vision", meaning sight can never be restored to perfect clarity - even with glasses or contact lenses. (this happens in one out of 100 cases, and often the patient doesn't even notice the diminution.) These procedures are irreversible and expensive-approximately $2000 per eye-and rarely covered by insurance. Although post-op blindness has never been reported, experts say booming demand, a loose regulatory climate and the lure of extra income are prompting inexperienced doctors to jump into the vision-correction business, possibly putting their patients at risk for complications.

On the upside, a recent study found that the majority of patients who underwent PRK enjoyed vastly improved vision six years later, without any ill effects such as infection. LASIK, a more advanced method accounts for 70% of refractive surgeries. The key to maximizing your chances of achieving near-perfect vision with refractive surgery is an experienced surgeon. Another important choice is between PRK and LASIK. Less invasive, PRK corrects nearsightedness by flattening the corneal surface using a laser. With LASIK, the surgeon creates a corneal flap, zaps the tissue underneath-killing some corneal cells while keeping surface cells intact-then closes it. The"flap and zap" method allows for more tissue to be removed, which is necessary to correct severe nearsightedness, and lessens the chance of vision regression. That's because active cells on the corneal surface , zapped in PRK are more likely to grow back than is the tissue removed from beneath the surface in LASIK. Both are improvements over the methods developed in the 80's, such as radial keratotomy, which required making fine incisions in the surface of the eye with a scalpel.

For me, the choice was easy. PRK can't correct severe nearsightedness, but I might have opted for LASIK anyway. PRK involves a lengthier healing process, more risk of infection and, according to some experts, less predictable results. However, LASIK is more complicated and requires longer training."Purely from a patient safety issue, PRK has a longer track record and a lower complication rate for patients with low degrees of nearsightedness," says Ken Moadel, MD, a New York City-based ophthalmologist and refractive surgery editor for Ophthalmology Times.

My doctor, Mark Speaker M.D., Ph.D., director of refractive surgery services at the New York Eye and Ear Infirmary, has probably performed more LASIK procedures then any one in the New York City area (laser vision correction is much more popular on the West Coast). He encouraged me to call patients, pepper him with my questions and observe surgeries. My squeamishness subsided after watching people emerge for his operating room beaming with joy.

My own procedure went as smooth as the ones I observed, though my post-op vision was blurry, and I needed a friend's help getting home. Three weeks later, when I focused on a tree 100 yards away, every leaf was crisply delineated. Over the next few months, Dr. Speaker recommended I undergo a second LASIK procedure-even quicker than the first-to bring both eyes back into focus again. I did.

The quality of new, improved sight exceeded my expectations. Following my last checkup, where I read from the 20/20 line on eye chart, I tempted fate by donating my old eyeglasses to charity.

Amy O'Connor is SELF's nutrition editor.