Below, ophthalmologist Dr. Julius Shulman sheds some light on the topic.
What kind of vision problems can be treated with these new techniques?
Most vision problems can be treated, such as myopia, which is nearsightedness, hyperopia, farsightedness, and astigmatism. The laser companies first went after myopia because that's the most prevalent, then astigmatism, and now we can treat hyperopia, so the whole gamut of vision problems is covered.
What is astigmatism?
Astigmatism is when light does not fall to a point; It's a refractive error which results in everything being blurred, near and far, as opposed to farsighted or nearsighted. So astigmatism is combination of the two.
What are some alternatives to laser treatment?
Well, the obvious alternative is glasses. Contact lenses now can correct almost all refractive errors: myopia, and even astigmatism. Bifocal soft contact lenses and gas permeable lenses are available. And most people probably will have tried contact lenses and certainly glasses before they come to laser eye surgery.
What are some of the negatives of using either glasses or contacts to treat a vision problem?
Glasses are fine up to a point. After you become extremely nearsighted or farsighted, many people feel handicapped. They go to sleep, they wake up, and they may not be able to find their glasses. They may have sports or hobbies or occupations where glasses are not feasible. It's difficult to scuba dive with glasses. Contact lenses have their own disadvantages. Some people are not very tolerant of contact lenses, and cannot wear them for a full day. People lose them or break them. Contact lenses can cause their own health problems in the eye, such as infection which is rare but it can occur. Irritation and dryness can also occur. So, each modality has good and bad aspects.
Could you describe the surgical options?
Surgical options nowadays are basically laser vision correction. Years ago there was an option called radial keratotomy where very fine slits were made in the cornea to change the shape. It, in effect, improved vision but it also weakened the cornea. Laser eye surgery is safe and it's effective. It's a procedure, and a procedure can always have problems, but it's one of the most successful procedures we now perform.
In what percentage of people does it work?
Given the whole spectrum of people with all different prescriptions, about 95 percent of people would be able to pass a driver's vision test without glasses after having the procedure.
Are there some people in whom it shouldn't be used?
Yes. You have to be very careful in evaluating patients to make sure that they qualify for laser surgery. One of the things to evaluate is the pupil size in the dark. If your pupils get too big in the dark, with light coming in-especially when you're driving at night-light can hit the edge of the laser zone and cause a lot of glare as it goes into the pupil. Some people have a thin cornea, and so some types of laser surgery are not good because the laser does remove a small portion of the cornea in the front of the eye. That's how it works. You have to have enough left over for the health of the eye. Some people have weaknesses or scar tissue in the cornea and surgery may not be advisable.
So not everybody can just walk in and get this surgery.
No. It has to be carefully evaluated. Young people whose eyes are still changing should not have surgery done because you don't want to have this done twice if you can help it. You have to wait until your eyes have stopped changing.
Does vision have to be "bad enough" to a certain extent to get this procedure done?
It's generally for people who would have to wear their glasses or contact lenses all the time in order to see. For someone who is very, very slightly nearsighted, it doesn't really pay to do the procedure. It doesn't mean that you have to be severely nearsighted to have this done. People have this done at all different spectrums. But at least the risk/benefit ratio that we talk about should be in effect.
