HEALTH & MEDICINE :: APRIL/MAY 2007
VISION CORRECTION… The Most Commonly Asked Questions
As a cataract and refractive specialist, I would like to share with you some of the questions I am frequently asked by my patients regarding cataract and refractive surgery.
WHAT ARE THE SYMPTOMS OF CATARACTS?
A cataract is the clouding of the internal lens of the eye. Aging and various environmental factors contribute to the development of cataracts, which form in most people over the age of 60. While early cataracts may not cause symptoms, over time people experience blurry vision (distant or near), glare or halos, difficulty distinguishing colors, difficulty with night vision or shifting eyeglass prescriptions. Cataract surgery to remove and replace the cloudy natural lens can restore clear vision.
ARE THERE ANY NEW TECHNOLOGIES IMPROVING CATARACT SURGERY?
Over fifty percent of people over the age of 60, and quite a few younger than that, suffer from cataracts. Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only way to see clearly again is to have them removed from the eye. Cataract surgery has undergone a steady evolutionary process, improving safety, patient convenience, and, most importantly, outcomes. Twenty years ago, cataract surgery was considered risky, required a lengthy hospital stay and had outcomes which improved vision but did not restore normal function. Today, cataract surgery is performed on an outpatient basis and takes only minutes. The advent of small incision surgery, without the need for needles or sutures, has greatly improved comfort and results. Following cataract surgery, many patients experience vision that is actually better than what they had before they developed cataracts.
One of the most exciting new advances in cataract surgery over the last two years is the development of intraocular lens implants (Crystalens®) which actually focus, allowing patients to see both near and far, with little or no dependence upon glasses, even reading glasses. While not every patient is a candidate for this new lens technology, other lens implants offer improved clarity and contrast sensitivity, beyond what conventional lenses offered even several years ago.
WHAT IS LASIK SURGERY?
Before you can understand what LASIK (Laser In-situ Keratomileusis) surgery is, you must first understand refractive errors. A nearsighted (myopic) person has an eye which is too long or a cornea which is too steep, causing images entering the eye to focus in front of the retina, resulting in blurry vision when looking in the distance. A farsighted (hyperopic) person has an eye which is too short causing images entering the eye to focus beyond the retina causing close and distant objects to appear blurry. Astigmatism occurs when the curve of the cornea is uneven, steeper in one direction than in the other, causing images to focus on many points of the retina, distorting both near and far vision. LASIK surgery corrects nearsightedness, farsightedness, and astigmatism by reshaping the cornea (the transparent part of the eye that covers the iris and pupil). The surgeon uses a computer controlled excimer laser (a cold, ultraviolet laser) and a surgical instrument called a microkeratome. A flap is created in the front of the cornea with the microkeratome and the laser precisely removes a very thin layer of tissue (usually less than one tenth of one millimeter). By removing the tissue, the cornea is either flattened, reducing nearsightedness, or steepened, reducing farsightedness. Astigmatism can also be corrected. The flap, which is replaced without sutures, adheres back to the cornea within minutes.
HOW SUCCESSFUL IS LASER VISION CORRECTION?
LASIK and related laser vision correction procedures have become the procedures of choice for reducing dependency on glasses and contact lenses. The most common of these is LASIK (Laser In-situ Keraomileusis), but Epi-LASIK (epithelial or epikeratome LASIK) is gaining in popularity due to even greater safety advantages. Various laser manufacturers exist, each with their own subtle differences and ad-vantages. VISX is the industry leader, as one of the first approved systems (having undergone numerous up-grades since development) and with the most procedures performed. A promising new technology, called wavefront-guided LASIK, provides an advanced method for measuring optical distortions in the eye. This creates an optical map of the eye, highlighting individual imperfections allowing the surgeon to tailor the laser beam settings for a more precise procedure. This provides a patient sharper, better quality vision as well as a reduction in nighttime vision difficulties. The U.S. Food and Drug Administration (FDA) approved the VISX CustomVue™ procedure for correcting nearsightedness, farsightedness and astigmatism.
The following are some of the FDA clinical study results, as reported by VISX. One year after the VISX CustomVue™ procedure for low to moderate nearsightedness:
- 100% could pass a driving test without glasses or contact lenses
- 98% could see 20/20 or better without glasses or contact lenses
- 70% could see better than 20/20 without glasses or contact lenses
- Four times as many participants were very satisfied with their night vision after CustomVue™, compared to their night vision with their glasses or contact lenses
Overall, many participants were more satisfied with their quality of vision after the VISX CustomVue™ procedure than before the procedure with use of glasses or contacts.
IS THERE A SAFE SURGICAL PROCEDURE TO ELIMINATE READING GLASSES IN PEOPLE AS THEY AGE?
In March, 2004, the U.S. Food and Drug Administration approved the use of a procedure called conductive keratoplasty (NearVision CK®) to correct presbyopia, the age related process in which the eye loses the ability to focus on near objects. The CK procedure takes less than five minutes, is done in the Ophthalmologist’s office (using only eye drops to provide anesthesia), and creates immediate results. The procedure involves the use of a tiny probe, thinner than a human hair, through which radio frequency energy is applied to the front surface of the eye (the cornea) in a circular pattern, reshaping it to bring near objects into focus (the procedure is performed on only one eye in most cases). After 3 years of treatments, I am impressed with the excellent results produced by this technology. Published reports show 97% of patients reading print smaller than typical magazine print, and I have found similar results in my own patients.
It is rewarding to practice in an era with so many amazing technological advances. Eye care remains at the forefront of medical progress and I am pleased to have the opportunity to be a part of this evolution.
Jeffrey B. Minkovitz, M.D., is with Eye Physicians and Surgeons, P.A., 1207 North Scott Street, Wilmington, DE 19806. Dr. Minkovitz is affiliated with Christiana Care, Wilmington, DE; St. Francis Hospital, Wilmington, DE; and Wills Surgery Center, Wills Eye Surgical Network, Wilmington, DE. Dr. Minkovitz served as an Assistant Professor with Johns Hopkins University from 1998-2004. He received his M.D. in 1990, University of Massachusetts Medical School; and his B.A., Magna Cum Laude, Harvard University in 1986. Dr. Minkovitz received his certification in 1996 with the American Board of Ophthalmology and in 1991 received certification with the Nation-al Board of Medical Examiners. For six consecutive years, Dr. Minkovitz was awarded the distinction of “Top Doc” for excellence in the field of Ophthalmology in a survey of his peers. Dr. Minkovitz is a highly accomplished surgeon with over 13 years experience. Dr. Minkovitz is fellowship trained in cornea, cataract and refractive surgery. As one of Delaware's leading cataract surgeons, Dr. Minkovitz offers both ReZoom™ and Crystalens® to his patients. For further information or to schedule an appointment please call 302-656-2020 extension 38.
