The Laser’s Edge

Los Angeles, CA (PRWEB) September 14, 2006

The first morning Carol Rice, rolled over to see his bedside clock read 6:00, she let out a jubilant cheer that almost hit her husband in the bed.

“It was the first time in 20 years that I could see the time without having first put on my glasses and making the clock an inch from my face,” said 36 years San Diegan, who underwent refractive surgery laser eye yesterday. “Those first few days (after surgery) I was walking around smiling and looking at things -. The trees, birds, the faces of my children, cobwebs in the corners What a thrill. ”

Thanks to laser technology, a vision of 20/20 may be in sight for millions of people who depend on glasses or contact lenses.


various modern methods of corrective eye surgery have been around for over 25 years – all using the same concept to flatten the cornea to change the way light is bent when it enters the eye – the techniques have changed dramatically.


used to rely solely on their hands regularly and scalpels while patients had to endure long and painful recovery, often with inaccurate results.

Now with lasers and computers, the risks have been reduced (not eliminated), with recovery time and discomfort.

Today, many nearsighted (myopia) of patients who can barely make out the big E on the eye chart may undergo laser surgery and usually be back to work or play in a few days with a significantly improved vision.

“The procedure itself was nothing. Approximately 15 minutes (both eyes), tearing a little, and I was done, “said Rice, who underwent Lasik surgery, one of the two laser procedures offered by a growing number of eye surgeons . “The next day I took the kids to soccer practice, going to the laundry and the grocery store was life as usual -. Except that I could see. “

Among the 40 people interviewed for this story, the positive experience of Rice was by far the most common.

However, experts

want anyone considering the procedure to enter with eyes wide open.

Not only is there no guarantee of perfect vision, but there are also risks – some very serious. Add to that the fact that doctors do not always see eye to eye on which procedure is the best laser, and laser eye surgery can be a big blur to consumers.


current procedures

There are two types of corrective laser surgery in progress today – photorefractive keratectomy (PRK) and laser in situ keratomileusis (Lasik).

PRK is similar to radial keratotomy (RK), the old and now obsolete procedure that involves cutting surgical incisions on the perimeter of the cornea to reshape it. PRK is less invasive than the old technique because the surgeon uses an excimer laser, instead of a scalpel and the corneal tissue is vaporized, not cut. No stitches are needed.

Approved by the Food and Drug Administration in 1995, PRK is used to correct mild to moderate cases of myopia. The procedure does not work as well on patients with severe myopia.

Lasik is the latest kid on the block laser and is often described as the “Wow! surgery, “because patients recover very quickly.

Sometimes called “flap ‘n zap” surgery, the surgeon slices a flap in the cornea tiny (about the thickness of a contact lens) with a small surgical instrument called microkeratome. The flap is folded, and the surgeon uses a laser to vaporize small amounts of tissue from the central layer of the cornea. The flap is then folded up, requiring no stitches.

Lasik is generally recommended for moderate to severe cases of myopia.

With LASIK, the surface of the cornea is not treated so patients generally have two laser eye at a time with minimal discomfort and improved vision almost immediately. PRK, on ​​the other hand, affects the outermost layer of the cornea, so recovery is not as fast or as comfortable. The eyes may hurt for a few days to weeks while the surface of the

eye repair. PRK patients may experience blurred vision, glare and night (see halos around lights when driving, for example) and be unable to see objects closely for a few weeks to several months.

The final results of laser surgery – the best view of the patient will achieve – can take as long as three months with PRK. It takes several days to a week to Lasik.


PRK has a longer healing time, the FDA recommends the procedure will be done separately on each eye at least three months apart, although some doctors still perform the procedure on both eyes at once.

Despite the recovery time longer, some people believe that the PRK procedure safer because it uses a computer to perform all calculations laser surgery. Since LASIK involves making an incision, it is dependent on operational skills of a surgeon.

Glasses for reading

It is not unusual for both Lasik and PRK patients require an additional laser procedure – delicately called “touch-up” or “improvement” – for best results. Because too many corrections can not be cured, doctors would rather under-corrected eye, then come back later and make more corrections. The “process improvement” is usually performed several months after the initial surgery.

Although both PRK and Lasik

successfully restore distance vision, anyone who thinks or laser surgery corrective eye glasses will leave forever should think again.

Refractive surgery does not alter the aging process of the eye, and at a certain age, you’ll probably still get reading glasses. Presbyopia, the hardening of the lens inside the eye that usually occurs in the mid-40, causes people to have difficulty focusing on close objects. Myopic people over 40 who must remove their glasses for close work need to give

additional thought about the vision correction surgery.

“If you are nearsighted, surgery will get rid of your myopia,” said Dr. Richard Burns, a refractive surgeon Rees-Stealy Sharp Vision Surgery Center. “But if you wear reading glasses or bifocals, you’ll still need reading glasses and perhaps a stronger prescription for reading. “

For those who want to improve their distance vision, but do not want to wear reading glasses, monovision may be a solution. Monovision corrects one eye for distance and leaves the other sightly nearsighted for reading. About two-thirds of patients who try monovision are able to adapt. Those who can not adapt may have their eyes reading corrected, so that both eyes are used for remote viewing.

FDA panel recently recommended approval of a laser procedure to correct farsightedness, or hyperopia. As with laser surgery to correct myopia, both PRK and LASIK procedures will be available to help patients who have difficulty seeing objects at close range. Instead of flattening the cornea as is done to correct myopia, a donut is cut in the middle of the cornea, making the center steeper.


predict they will be able to perform laser surgery for vision within six months.

Lasik and the FDA

issue that has caused some confusion and concern somewhat is that, unlike PRK, LASIK is not approved by the FDA. Although the same laser is used for both procedures, the agency has not OK’d the laser to perform Lasik surgery.

Most doctors do not seem

hindered by this, and it is not a deterrent to the LASIK procedure.

FDA only regulates the laser machine – without surgery or the surgeon – FDA Approves Lasik to do if doctors believe it is the best procedure for this patient. The FDA does not allow doctors to advertise or call their Lasik surgery Lasik clinical practice, but they can advertise as experts Lasik. Lengthy consent forms must be signed by the patient.

The reason the FDA has not approved LASIK is performed, because the data proving the safety and efficacy of the procedure has not been submitted to the agency.

However, the doctors we spoke to say the lack of FDA approval is of little consequence. Just because the procedure does not have the federal nod does not mean it’s dangerous, ineffective or illegal. Doctors say it simply means they have not spent time and money on unnecessary clinical trials and data. Many doubt that the ophthalmologists Lasik will never have the stamp of approval by the FDA, and they do not seem to care.

“The FDA approves only the machine. And, the laser has already been approved. has the microkeratome (surgical tool that slices of the flap). So why provide data for this? There no need, “said Dr.. Kawesch Glenn, a surgeon in San Diego of refraction.

Some doctors point out that many recommended treatments for patients are not FDA approved. Aspirin, for instance, is not FDA approved to prevent stroke by thinning the blood, but doctors still prescribe because it works.

that Lasik is not approved by the FDA does not seem to bother the patient, either.

“They gave me a lot of information on research and explained all the risks,” said Jill Pfeiffer, 40, a mortgage broker in Sorrento Valley. “My biggest concern was the long term. But the way they explained, and with all (procedures) that they had no problems, it seemed safe and worth the risk. “

two surgical procedures are relatively new, with limited studies done in this country. Research data and studies over the last 11 years have been collected on the PRK. Although Lasik is much more recent in the United States, surgery has been around for about nine years in other countries, said Dr. Burns, Sharp Rees-Stealy.


preferences “

While there are advantages and disadvantages for both PRK and Lasik, patients who undergo laser procedure often depends on who does the surgery, because different doctors have very different opinions on both.

Proponents of PRK

say dealing with the thin flap in Lasik surgery can be risky. The flap can tear, crease or tear completely. Many of these problems can be treated, but some can cause permanent damage or blindness. “Lasik is more complex than PRK. And the more complex the process, the greater the risk of potential complications,” said Dr. Barry Kassar, a refractive surgeon at Scripps Memorial Mericos Eye, which is both procedures, but prefers PRK.

While acknowledging

PRK can be painful and requires more recovery time than Lasik, in two or three weeks the results for the two is generally the same, he said.

“So if the two procedures are identical in the long run, who would you rather have?” Kassar asked. “I would rather have a little discomfort and fewer complications.”

however, argues that Kawesch Lasik procedure is superior. He believes PRK will eventually eliminated, as RK was.

“Lasik is very pleasant for the patient,” said Kawesch, whose practice is 99 percent of Lasik. “Of course, patients are happy about three months after PRK (surgery). But before that, they are unlikely to tell their friends it was a great experience. “

comparing PRK and Lasik, he offered the analogy to remove a cyst under the skin using two different methods:

“You can cut a large hole in the skin and remove it. Then the skin to heal, usually with a lot of discomfort and the risk of infection and possible scarring,” he said comparing a PRK procedure. “Or, you can lift a flap of skin and remove the cyst. The skin is perfectly intact, with minimal discomfort and little risk of infection or scarring. “

About half a percent to 1 percent of patients have problems after Lasik surgery. 2 to 3 percent of patients develop problems PRK – most trouble with healing, says Dr. David Schanzlin, a professor of ophthalmology and refractive surgeon at the center of the UCSD Shiley Eye.

“Almost all the complications with Lasik I can go back and fix it. But the problems with PRK have to do with the healing of tissues. It’s hard to go back and correct the cornea where it has thickened in the healing process, “he said.


Kawesch, what laser procedure a doctor recommends a patient is likely to depend on how much experience he or she had with refractive surgery.

“Those (ophthalmologists) who are exclusively made refractive surgery Lasik done almost exclusively,” he said. “Physicians who are occasional refractive surgeons (as well as treat other eye conditions such as cataracts, etc. ) are not so much because Lasik Lasik is technically more difficult and they are not comfortable with him again. “

However, Kassar warned patients to be wary of the sensationalism surrounding the laser eye surgery the most recent.

“Doctors who promote exclusive Lasik patients do not tell the whole story. You need to separate hype from reality, “Kassar said.

Neither the American Academy of Ophthalmology or the California Association of Ophthalmology, both based in San Francisco, take a position on either laser surgery.

“Every doctor has their own individual preferences. Thus, it is important that you were going to trust someone, “said Michelle Stephens, spokeswoman for the American Academy of Ophthalmology. “Laser Eye Surgery is certainly one of the types` buyer beware ‘of things. We urge people to really check it out and do their homework before doing so. “

happy campers

Despite the cost, discomfort and lack of guarantees, most patients – both Lasik and PRK – are very satisfied. Among the patients in the laser eye surgery we talked about this story (none of them referred by physicians), almost all of them have given rave reviews of their laser procedure and their new vision improved.

“I only wish they would have had PRK 10 years ago,” said Mark Hagger, a computer salesman, 38, of Carlsbad, who had the laser procedure last fall . “It’s like a new world opened up when I could see without my glasses.”

Hagger said

pain after surgery was “very important” and worth the end result – 20/25 vision.

“If I just lost my new vision of the future, I would do without hesitation,” he said.

Courmousis Sharon, a financial advisor in University Heights, shared the enthusiasm of Hagger. Severe myopia, its dependence on glasses for the past 30 years made her feel vulnerable, she said.

She and her ophthalmologist decided LASIK monovision was for her.

“I knew I wanted (surgery), even after all the statistics and risks were explained to me. I thought at worst I might need another procedure or wear a lens or glasses with a level (lower) of the correction, “she said. “But things turned out better than I expected. I recommend it without hesitation.”

Even people who have had PRK or Lasik “alterations” were impressed with the end result of their laser eye surgery.


Richard Phillips had PRK last January, his left eye was corrected to 20/60 only. The Business Analyst 41 years for the City of Encinitas wanted better, so he had the procedure repeated on that eye four months later. Today, he sees out 20/20 in one eye and 20/30 in the other.

“For me, it’s something of the quality of life. I always had to worry about making contacts on travel or losing one or a tear,” Phillips said.

Jill Pfeiffer was the first LASIK surgery on both eyes in July of last year. His right eye had to be redone last January and his left eye needed a touch up in March because her vision has declined by about 20/70 in one eye and 20/80 in the other. His vision seems to have stabilized and now is about 20/25 in both eyes.

“Although I was very upset when my eyes first fell, I knew there were no guarantees,” said Pfeiffer, who had to sign “a bunch of exceptions” before surgery. “I’m always glad I did, and we recommend it. It’s so nice not having to wear contacts all the time. “

Among all patients with eye laser we talked, one person had a bad experience.


Baleme, 49, of Kearny Mesa had PRK in one eye in May 1997 after his ophthalmologist told him she would be a good candidate for surgery.

To his dismay and surprise of the doctor, nothing happened.

“(The doctors) said they had never taken place before this. They blame on the (laser) and it was not calibrated properly,” she said.

Not only she was disappointed by the failure, but she still had to go through the discomfort of surgery – “for nothing,” she said.

Last September, had PRK in the same light again. While myopia Baleme has improved, she was left with an injury or epithelial surface to the center of the eye, creating a blur when she looks straight ahead.

“It was not funny. Supposedly (the default) will disappear, but it has not and it’s been months,” she said, exasperated.


has not had the procedure on her other eye and do not know if it will ever be.

“I think I’ll just stick with a contact lens, at least until that spot (on the eye laser) cleared,” she said, knowing that there is a chance the stain can never disappear.

However, despite the risks, the controversy and the high cost, short-sighted people are lining up for laser surgery.

“I know this is not a panacea – there are risks and a moderate amount of pain, and I may need to wear glasses at times that my eyes change,” said Richard Phillips PRK patients . “But I’d still do it again and recommend it to anyone.”

Glenn Kawesch

Kawesch Laser


San Diego Office

Hard Executive


San Diego, CA 92121

Office in Los Angeles

11600 Wilshire Blvd, Suite 120, Los Angeles, CA 90025

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