jvz@loral.UUCP (04/26/84)
Does anyone have any information and/or direct knowledge of the
relatively new procedures for using surgery to correct vision?
Recently I have been hearing a number of ads about making micro-incisions
on the eye to reshape the eye. I am particularly curious about the
long-term effects of such work, such as:
a) is this permanent (only need be performed once and lasts forever)
b) what is the failure rate
c) what complications can arise and what is the seriousness of a failure..
specifically, can one lose their sight
Also, what sort of costs are involved and do insurance companies pick up
the tab?
As someone who has worn glasses (or contacts) his whole life, a more natural(?)
and comfortable solution would be welcome... but I also would not want to
risk my eyesight.
John Van Zandt
uucp: ...sdcsvax!jvz or sdcsvax!sdccsu3!loral!jvznorm@ariel.UUCP (04/27/84)
Two years ago I went to a doctor in Austin, Texas who had already performed over 500 such operations (keratotomies, if my spelling/memory is correct). He claimed that only one person had a problem, an infection that he was able to cure without damage. I called two people that he had operated on, and they were ecstatic about the results. A third person, operated on by another doctor was also happy. None of these endorsements came, however, from people who made the endorsement years after the operation. More years are needed before anyone can say with any confidence what the long term prospects are for continued good eyesight. I very badly wanted the operation for myself, but I finally decided against it. Here's why: An optometrist explained to me that when people have lense (terminology?) transplants, that many, if not most, of the transplanted lenses eventually deteriorate and fog up. The person then has to go back for another transplant, and the line of surgery has to be moved back further on the eye. After enough such transplants, the line of surgery cannot be moved back any further, and more transplants become impossible. Now, the mechanism behind the deterioration of the lense is not known, but it is supposed that the lense gets inadequate nutrition through the line of surgery, and then deteriorates. There is laboratory evidence (see Roger Williams) about cataracts being related to improper nutrition. The line of surgery for a lense transplant entirely surrounds the new lense, whereas the surgery to correct near-sighted- ness is done by radial cuts only, and then not all the way through. However, I still worry enough about the effects of those cuts on my eyes' nutrition that I would like to postpone the surgery a few more years untill the results are in. Two years ago the cost of the first operation was $600.00 per eye. Some insurance companies paid for it, but I heard that they were about to change the policy since enough people were getting the operation that the insurance companies were getting worried. The Austin doctor is Leslie Doyle, and is probably one of the most experienced in the country for this operation. His Austin phone number is (512) 454-0333. But I wouldn't do it just yet. Most people don't research these things very well. They think doctors are gods I guess... -Norm Andrews, (201) 251-9326 after 6.
gek@ihuxj.UUCP (glenn kapetansky) (05/01/84)
OK, I posted an answer to this question months ago, and I feel
obligated to do so again. Keratotomies (sp?) are DANGEROUS!
The Russians first promulgated the technique, using 15 or more
slashes in their typically crude way. They didn't do any long
term studies, no followup, CERTAINLY no report of failures.
American doctors picked up the technique, and now use far
fewer slashes (down to 8, last I heard). This is important,
because the cornea is pulled into its new shape by the scar
tissue in these (radial) cuts. But scar tissue isn't transparent,
so incident light can be refracted by the scars internally across
the entire cornea. This means that drivers at night will
suffer flashes across their entire field of vision due to
oncoming headlights. Ycch, I say. I LIKE to drive at night!
Hmmm. So you say maybe it's still worth it, if it works, to
finally be rid of your glasses. Sorry. You see, the correction
is unpredictable. I (with my 20/800 vision) may get to 20/200,
you (with your 20/200) may only get to 20/100. Or I may end
up better than you. For a while, that is. Because, my son
(says my father, who's a specialist in matters ocular), after
about 10 years the cornea tends to revert to its original
shape. This leaves you with poor vision AND scars. Double ycch!
--
glenn kapetansky
"If I only had a brain"
...ihnp4!ihu1j!gek harrison@ucsfcgl.UUCP (Peter Harrison%MIS) (05/01/84)
There are several surgical techniques for correcting refractive errors in eyesight (ie you need glasses to see properly). One of these is a radial keratotomy which involves making multiple partial thickness radial incisions in the cornea, thus changing its curvature. This is a highly skilled (ie it is by guess and by God, and the surgeon had better have done a LOT of them already) and my reading of the literature is that you may not have to wear coke bottle bottoms any more but you will be lucky to have 20/20 without some correcting lenses, either spectacles or contacts. The other technique I am not really familiar with involves taking a plug of cornea (?cadaver cornea as in corneal transplants) and machining it to be a new lens and implanting it into your original cornea a la corneal grafts. Both techniques are too new to be sure of long (5-10) year problems. We have no idea what the 20 year followup might be. They involve surgery of the cornea, and you WILL get scarring. One distressing note: in San Francisco, the magazine City Sports carries a 3 by 4 ad for radial keratotomies, touting them as the wonder cure. I wonder if they really get "informed" consent for the procedure. Peter Harrison ucsfmis!harrison@ucbvax.ARPA
fish@ihu1g.UUCP (Bob Fishell) (05/02/84)
(oo)
The procedure I've heard about involves removing a layer of the
cornea, freezing it in liquid nitrogen, and turning it on a lathe
so as to make it act like a lens. Then they stitch it back on.
Cornea surgery has been procticed for a long time, so they know
how to do it, but there are risks. For this reason, the surgery
is recommended only for persons like airline pilots who need to
be able to pass vision tests without glasses, or for people with
severe vision problems that are correctable now only with coke-bottle
lenses. As for me, I'd rather just grope for my specs in the morning
than have my eyeballs machined. To my knowledge, the procedure only
works for focal length problems like myopia and hyperopia, and won't
work for astigmatism, which is the bulk of my vision problem, anyway.
I'm not sure about this, though, and these things improve all the time
As an aside, has anybody out there had experience with the new contact
lenses for astigmatism? My eye doctor has recommended against them,
but that was a couple of years ago.
--
Bob Fishell
ihnp4!ihu1g!fish