Laser surgery corrects near-sightedness

June 13, 1997


Staff Writer

Ed Beck had worn eyeglasses since he was about 20 years old. They always were dirty or breaking and got in the way of the basketball he played in his 20s and the active lifestyle he has maintained since. He once lost his glasses while kayaking on Salmon River in Idaho. He had to wait three hours in Missoula, Mont., to have them replaced. Beck and his family, who live in Waynesboro, Pa., like to take "adventure vacations" - horseback riding and whitewater rafting.

Beck recently had LASIK, Laser Assisted in-Situ Keratomileusis, to correct his nearsightedness and astigmatism, refractive errors of the eye. It is the newest technique, following radial keratotomy - RK - which has been available in the United States since the late 1970s, and photorefractive keratectomy, PRK, a procedure in which the laser precisely shapes the surface of the cornea.

In RK, a surgeon reshapes the cornea by using a handheld blade to make a spoke-like pattern of incisions in the cornea. This permits the cornea to flatten, shortening the length of the eye and correcting the refractive error.


LASIK is considered to be an "off-label" use of the excimer laser. The excimer laser device was approved by U.S. Food and Drug Administration for use in PRK. Once a device is approved for any use, doctors can use their discretion for what they deem in the best interest of their patients, according to Sharon Snider of FDA.

Patients are awake for the entire LASIK procedure, which takes less than 30 minutes. Beck says he was concerned about staying still, but he found it easy to look at the light as directed.

Anesthetic eyedrops numb the eye. A thin layer of the cornea is lifted up when an instrument called a microkeratome glides across it. The laser reshapes the cornea in less than 60 seconds. The flap of the cornea is placed back in its original position. Stitches are not required, and no contact lens "bandage" is required as in PRK, according to optometrist Philip Berry. Berry provides free consultations for the Hagerstown office of Gladsden Refractive Center. The surgery is performed at Gladsden's Rockville center.

Although Beck says he couldn't stand looking at light for about four hours after his LASIK procedure, he had no pain or discomfort. And his vision improved immediately. He now needs glasses only for reading, and he attributes that to "creeping age." Beck, 48, says he is pleased with the results; the change has been very good for his tennis game. Being able to see perfectly in an active mode is important to him.

Berry says he makes no guarantees for the zero discomfort Beck experienced, but he says 97 percent of LASIK patients have improvement of their vision to 20-40 or better. That's about what's required to pass a driving test.

Not everyone is a candidate for refractive surgery. People younger than 21 are not considered unless they have had a stable prescription for three years. Pregnant women and people with certain medical conditions may not be good candidates for LASIK.

"We are extremely picky in whom we choose," Berry says.

The cost is about $2,000 to $2,500 per eye. Some insurance companies may cover the cost.

As in any surgery, there are risks. Antibiotic eyedrops reduce the chance of infection, Berry says.

Walter Stark, M.D., a professor of ophthalmology at Wilmer Eye Institute at Johns Hopkins in Baltimore, recommends a cautious approach to surgery. He says people have refractive surgery because they feel disabled or want to reduce their dependency on glasses. He warns that refractive surgery is irreversible.

"Make sure you have a doctor who does not promote too much and tells you the risks," Stark says.

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