The Sci-Fi World of Corrective Eye Surgery


by by Jeanne Faulkner /

Posted on March 20, 2009 at 10:15 AM

Updated Thursday, Nov 12 at 1:52 PM

About the Author

Jeanne Faulkner is a freelance writer and registered nurse in Portland, Ore. Her work appears regularly in Pregnancy and Fit Pregnancy, and she has contributed articles to the Oregonian, Better Homes & Gardens, Shape and other publications.

For 700 years, spectacles were the only option for correcting blurry vision. Then, in the 1950s, contact lenses were developed. And we now live in the futuristic era of laser corrective eye surgery, allowing some patients to lose their contacts or glasses forever.

What's the Problem? Forming picture-perfect images involves many parts of the eye, but a misshaped cornea (clear, dome-shaped surface of the eye) is responsible for the majority of blurry pictures. The cornea helps focus light to create images on the retina the way a camera lens focuses light on film. Refraction means bending and focusing light. If the cornea is too flat, round or long (a refractive error), the image on the retina is out-of-focus.

 (NEI) says that 120 million Americans wear corrective lenses. Three common refractive errors are responsible for this statistic:

  1. Myopia (nearsightedness),
  2. Hyperopia  (farsightedness), and/or
  3. Astigmatism (oval-shaped cornea).

Corrective lenses, eye surgeries like Lasik, PRK, and implanted artificial lenses change the way light enters the eye by reshaping the cornea.

Laser VisionAmericans were introduced to the first surgical procedures intended to permanently ditch glasses or contact lenses in the 1980s. Radial Keratotomy (RK) used spokelike incisions to flatten the corneal surface, but only for nearsightedness. Then came the laser, and the world of eye surgery underwent a complete transformation.

William Mathers, MD, an ophthalmologist at Oregon Health and Sciences University's Casey Eye Institute says that advances in laser and computer technology have led to a creative revolution. " The laser has caused a tremendous boom. It has essentially cured diabetic retinopathy, which used to cause blindness. It enables us to customize vision correction with Lasik and PRK and do better corneal transplants."

Lasik and PRK Lasik (laser-assisted in situ karatomileusis) uses lasers to resurface the cornea.  It's a painless day-surgery that combines new computer technologies with lasers to customize treatment.  Dr. Mathers says: "It's very precise, and tailored specifically to each patient.  We can correct many degrees of hyperopia, myopia and astigmatism. We shine light beams in a grid through the eye to the retina, reflect them back and see how each point deviates. The computer measures these deviations, creates a pattern to correct them and feeds that into the laser."

The term Lasik refers to the creation of a cellophane-thin flap in the cornea.  The surgeon lifts the flap and lasers the inside of the cornea. "When we lay the flap back down," Dr. Mathers adds, "it assumes the shape of the new surface. Most patients see well the next day."

Suddenly Everything's Clear Nancy Rommelmann, one of Dr. Mather's patients, wore contact lenses for 25 years. "My vision was so bad, I couldn't find my contacts without glasses. Lasik was a breeze. The next morning, I could see perfectly with my own eyes for the first time ever. I'll never worry about dropping another lens."

Patients whose corneas are too thin for Lasik may be candidates for photorefractive keratectomy (PRK). "PRK removes epithelium [surface cells], and lasers change the corneal shape directly," says Dr. Mathers. "Epithelial cells grow back in 5-7 days." Patients might experience a few days of discomfort, and clear vision usually occurs within two to three weeks. Two new variations, Lasek (laser epithelial keratomileusis) and epi-Lasik involve similar corneal resurfacing techniques. 

So, What's the Bad News?Lasik and PRK successfully correct vision for 80 percent of patients who undergo the procedures. Some people require follow-up, fine-tuning treatments. But not everyone's a candidate for laser surgery. Older patients (between 40-70) may take longer to heal and require treatment adjustments. Diabetics may have more complications and less successful results. Consultation with an ophthalmologist with experience treating diabetics is important.

Other downsides are that corneal changes made by Lasik are permanent, and corrections can only be made with additional surgeries. It's relatively expensive (the average price is around $2,300 per eye), and insurance may not cover it. But compared to a lifetime of glasses, for many, the procedure eventually pays for itself.

Laser eye surgeries are tricky procedures, and success depends on the surgeon's skill. Choose an ophthalmologist with lots of experience and a good reputation. It's rare, but some patients complain of glare, dry eyes or seeing "halos." That said, the Food and Drug Administration hasn't reported any long-term negative effects.

A Look Into the Future "Lasers have changed the way we treat serious eye diseases," says Dr. Mathers. "We can do far more refined, complicated work. We can now do corneal transplants on premature newborns and treat diseases like retinopathies and wet macular degeneration. Future laser technology will allow us to manipulate healing in ways we only dream about now." Dr. Mathers thinks the future of corrective laser eye surgery lies in genetic and molecular biology, essentially correcting problems before they start. We've come a long way from the monocle, and the future looks very clear indeed.