Is
Lasik the End All?
by Nathan
Johnson
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Not
long ago, those of us who squint without vision aids began the
day reaching blindly for a squealing alarm clock. This followed
by a day spent with a cumbersome pair of spectacles attached
to our heads. But with the growth and development of refractive
eye surgeries, the most chic of which is currently LASIK, many
of us now have reason enough to toss our glasses or contacts
to the wind.
The
recent LASIK boom sweeping the country has lead most people
to assume that LASIK is the laser eye repair par excellence.
In most cases they're right. The majority of eye doctors
seem to agree that all the hype surrounding LASIK is well
deserved. Kash Kansupada, MD, a Charlotte, North Carolina
ophthalmologist is one of them. "The quality of vision is
better with LASIK, the rapidity with which you obtain the
vision is better, and finally, the ability to obtain your
desired (eyesight) is better with LASIK," he says.
PRK essentially dissolves the top layer of the epithelium in order
to change the shape of the cornea, thereby improving vision. This endangered
procedure does not involve any incision or cutting of the cornea, but does
require a postoperative "band-aid" in the form of a contact lens. In
contrast, LASIK involves the creation of a small corneal flap. After
slowly peeling the flap out of the way, the surgeon uses the laser to change
the shape of your cornea.
PRK's last stand
With
LASIK all the rage these days, the other refractive procedures
used to correct nearsightedness, farsightedness, and astigmatism--such
as PRK--are slowly but surely being left by the wayside.
But is LASIK necessarily the end all be all in refractive
vision correction?
Without
a doubt, LASIK is a godsend for the average, nearsighted Joe
yearning to read the chalkboard. And most ophthalmologists
put their money on LASIK to be the corrective surgery of the
future. However, for a rare few LASIK is a bad idea, and sometimes
it's flat out impossible. According to Dr. Kansupada, this
includes a handful of scenarios. One is a mechanical reason,
where the ophthalmologist performing LASIK is unable to fit
the required equipment onto the eye. "In that case we can
only do PRK," says Dr. Kansupada. "Also, some people have
very tight eyelids and they just cannot open very well; for
those folks PRK would be beneficial." Another group of patients
that need to avoid LASIK are people with Anterior Basement
Membrane Dystrophy (AMBD), a condition that causes the skin
of the cornea to actually fall off.
In
many of these instances, PRK offers
a nice alternative.
According
to Dr. Kansupada, however, these cases are few and far between.
"The number of people who would not be candidates for LASIK,
but would be candidates for PRK, is rapidly dwindling," he
explains. "One of the reasons we've shifted from PRK to LASIK
is the marked reduction of corneal haze, where the cornea
develops scar tissue and thus affects the quality of vision.
And that happens more often in PRK, especially with higher
amounts of nearsightedness."
On
the other hand, says Providence, Rhode Island based ophthalmologist
Ezra Galler, MD, a clinical instructor of surgery at Brown
University, "the lasers we're using today are not the lasers
we were using for PRK 5 years ago-they're much better.so the
chances of corneal haze occurring with the current laser technology
is dramatically less than it was 4 or 5 years ago."
Is
PRK less complicated?
While
most doctors have happily converted almost entirely to LASIK,
others take issue with PRK's demise. In a recent article
published in the trade journal Ophthalmology Management, Dr.
Sylvia W. Norton, MD claimed that PRK may still be the least
complicated of all refractive procedures. While the need for
further treatment among her LASIK patients ranges between
10 % to 30 %, the average among PRK patients is just 2% to
3%.
Drs.
Kansupada and Galler dismiss this idea. "As experience with
LASIK increases (on the part of the doctor), the complication
rate dramatically decreases," explains Dr. Galler. "So I wouldn't
recommend PRK and say 'I think you should have it because
it's less risky than LASIK.'"
Dr.
Kansupada concurs, stressing that the risk of complications
with LASIK is quite small. For instance, he says, "a certain
thickness of corneal tissue needs to be maintained," he comments.
"If you apply the laser beyond a certain depth (250 microns),
that could cause problems. But nowadays we know not to do
that."
One
thing seems certain--the LASIK craze currently in swing will
likely continue into the foreseeable future. But it's good
to know that you've got options even without it. Most of
the refractive procedures available--including PRK, LASIK,
Intacs, and Intraocular lenses, among others--are appropriate
for at least some people.
And
that's a good thing, because we all like hitting the snooze
button on the first punch.
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