Caster Eye Center
Excellence in Laser Vision Correction of
Nearsightedness · Farsightedness · Astigmatism
My Own
Experience as a Lasik Patient
Dr. Andrew Caster
I began
wearing glasses when I was twelve years old. Although I
could see very well with them, I never liked the way I
looked in glasses. Growing up in Florida, I loved to swim,
but I couldn’t see very well when I took my glasses off.
Playing sports with glasses was often a problem, because
my glasses would become foggy, sweaty, or would get
knocked around.
Laser vision correction could soon free millions from their glasses. The new procedures are safe, but only if you have a competent surgeon. By Brad Stone
Holly Williams got her first pair of eyeglasses in kindergarten. She graduated to hard contact lenses at 16, then moved to soft lenses two years later. But the 35-year-old senior VP for a New York market-research firm never felt contacts fit into her active lifestyle. On airplanes, her eyes would dry out. On scuba-diving outings, she worried about losing a lens in the ocean. One month ago Williams decided to abandon her visual crutches, and during a 45-minute procedure in an ophthalmologist's office, she bared her corneas to the ultraviolet light of an excimer laser. The result after three days: 20/20 vision in both eyes. "I am seeing better than ever before," she says. "There is nothing between me and the world."
For Williams and roughly 1 million of the world's other dysfunctional spectators, laser vision correction has been a windfall: quick, safe and the end of cumbersome eyewear. The FDA approved the excimer laser for myopia (nearsightedness) in October 1995, and recently gave the OK for treatment of astigmatism, an irregular curvature of the cornea that causes blurriness. Only 64,000 of an estimated 60 million eligible Americans had corrective laser surgery in 1998, but industry watchers expect the number to double this year--and some believe laser vision correction will be the world's most
common surgical procedure by the end of the decade. "I think we are finally reaching the point where people feel comfortable enough with the idea to think about having it done," says Dr. Andrew Caster, a Los Angeles ophthalmologist and author of a new book titled "The Eye Laser Miracle."
Depending on the ophthalmologist they visit, patients will be offered one of three procedures, known as
RK, PRK and LASIK (chart). In radial keratotomy (RK), the oldest and most primitive technique, the doctor flattens out the cornea by making manual incisions with a scalpel. Both PRK and LASIK rely on an excimer laser to reshape the cornea. In
PRK, the only procedure so far approved by the FDA, the surgeon uses a speculum to prop open the patient's eyelids. After scraping away the eye's outer membrane, the doctor activates the computer-guided laser, which flattens the top of the cornea so that light will focus properly on the retina. To treat astigmatisms, the laser simply smooths out the cornea's abnormal curve. The patient stays awake, but the eye is anesthetized with special drops to prevent pain. With PRK it takes three days for the eye's membranes to heal, and several months for vision to fully improve.
Many doctors are now giving up PRK for LASIK, the newer procedure also known as nap and zap. Though LASIK is still under review by the FDA, doctors can perform it with approved PRK lasers at their own discretion. Instead of scraping away the outer layer of the cornea, a surgeon performing LASIK uses a motor powered blade called a microkeratome to partially detach a hair-width nap. The nap is pulled back and the laser then remodels the corneal tissue underneath. Afterward the nap is folded back into place, no stitches needed. Since cutting causes less trauma than scraping, the eye's outer membrane heals almost immediately and vision is restored in a day instead of months. LASIK is the preferred treatment for folks with extreme myopia because the healing response with PRK can interfere with results.
While there's no consensus on which is the better method for average nearsightedness, both PRK and LASIK are relatively safe, with more than 95 percent of patients enjoying 20/40 vision or better. Complications can include eye irritation, light sensitivity and a nighttime halo effect, but they're usually temporary. Under- or over- correction is reported about 5 percent of the time, but it can be remedied with a repeat operation. Every patient's nightmare--blindness or permanent eye damage--is technically possible but highly unlikely, and less probable than, say, putting out an eye while removing a contact. The most pressing complication may be the cost: $3,000 to $4,000 for PRK and $4,000 to $5,000 for LASIK (including pre- and postoperative checkups). Most insurance plans don't cover the surgery.
Prospective patients still need to be cautious about whom they trust with their eyes. Only two companies' excimer lasers have been approved by the FDA for vision correction: Visx and Summit. Each machine costs a half-million dollars, and the manufacturers charge physicians $250-per-eye royalty fees. To avoid the expense, some doctors have imported lasers from Europe or bought devices from other manufacturers. The FDA approves some of these lasers for experimental use, but others are illegal. LASIK patients need to be especially careful in their choice of a surgeon, since the flap-slicing microkeratome could cause real harm in inexperienced hands. The best doctors perform at least five procedures a week; you should avoid doctors who are new or who offer steep discounts. Flight attendant Linda Taylor recalls one ophthalmologist in Florida who was, he admitted, still "working out the cobwebs" in his laser. Wisely, she fled.
Both Visx and Summit offer toll-free numbers to refer callers to qualified ophthalmologists (800-246-8479; 800-880-4582), but it's up to the patient to quiz doctors on their education and experience. If you seek advice from an optometrist, be aware that many have agreements with laser centers to receive fees of up to $1,700 per referral. The optometrist, not licensed to perform surgery, shares in the pre- and postoperative care, but some experts wonder if patients are getting referred to the best surgeons.
"People should not trust their optometrists on this," says one
ophthalmologist who resents the practice.
These are merely precautions in a field that holds great promises. And soon more people will be eligible. A procedure for use on the 30 million Americans afflicted with hyperopia (farsightedness) is about a year away ham FDA approval. Specialists also have ways to treat
presbyopia, the natural deterioration of the eyes that forces us into bifocals after the age of 45. Skeptics need only talk to patients like Kathleen Webster, who had LASIK last April. "It's the first time in 31 years of marriage I've been able to see my husband without lenses," she marvels. Later this year Webster will demonstrate her enthusiasm by getting it for her 28-year-old son Doug--as a Christmas gift.
The Caster Eye Center in Beverly Hills, Los Angeles, California
specializes exclusively in Lasik-Laser-vision correction and other
procedures to correct nearsightedness, farsightedness, and astigmatism,
including the latest wavefront technology. Dr. Caster was selected by
Los Angeles Magazine as the Best Lasik Laser Eye Surgeon in Los Angeles.
