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nov. 8 LASIK

November 05, 1999

By MEG H. PARTINGTON / Staff Writer

Photo by RIC DUGAN / Staff Photographer


A short procedure using a laser may mean freedom from pushing glasses up the bridge of your nose and sticking contact lenses in your eyes.

During Laser In-Situ Keratomileusis, or LASIK, a knife called a microkeratome is used to cut a thin flap in the upper layer of the cornea. The inner layer is reshaped with the use of a laser to correct visual weaknesses, then the flap is replaced. Patients' eyes are numbed with drops before the procedure and they are asked to stare at a flashing red light throughout.

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It takes about 20 minutes to complete the surgery on both eyes, says Dr. Harvey Fracht, an ophthalmologist who does the procedure at Allegany Medical Eyecare at Allegany Optical in Hagerstown's Valley Mall.

The results will be most apparent to the patient the morning after the procedure, Fracht says. Most people are able to drive the day after the surgery, he says.

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The cost to have both eyes done at Allegany Medical Eyecare is $3,500, Fracht says, but he's heard of some surgeons charging up to $5,500.

Both eyes can be worked on the same day. It is a matter of personal choice.

"I let the patient tell me that," Fracht says.

Good candidates

Laser vision correction can be done on those 18 and older who are nearsighted and on those 21 and older who are farsighted or have astigmatism, according to VISX, the company that manufacturers the VISX STAR S2 Excimer Laser System, which is what Fracht uses. The equipment is approved by Food and Drug Administration for use on those who are nearsighted, farsighted and have astigmatism, Fracht says.

Those with mild to moderate corrections are the best candidates for the procedure, according to Mayo Clinic.

Healthy eyes also are a prerequisite, says Dr. Gerri L. Goodman, medical director at Laser Vision Center of Baltimore, LLC.

Patients need to have realistic expectations. They can't expect perfect near and distant vision, Goodman says.

In fact, those 40 and older who have the procedure done likely will need reading glasses, Fracht says.

Who should steer clear

People with pupils measuring larger than 6 1/2 millimeters in dim lighting are not good candidates for LASIK, Fracht says.

Some parts of the cornea in those patients would be left untreated, making their vision less than optimal.

Those who are extremely nearsighted or have a pronounced astigmatism also should avoid the laser procedure, says Ron Link, executive director of Surgical Eyes, a not-for-profit organization in New York City established in May to help people who have undergone unsuccessful refractive eye surgeries.

Prospective patients who are predisposed to having tissue on the back of their retina detach also would be risky candidates for LASIK. Link says the pressure applied during LASIK could lead to such detachment, which leads to objects floating into a person's visual path.

Thin corneas are not conducive to LASIK, Goodman says, and some have a shape that is not conducive to the procedure.

"Ultimately, a careful exam can highlight those who are at higher risk," says Fracht, who never has needed glasses.

Downfalls

Among the risks of LASIK are infection and irregular astigmatism, which is hard to correct, Fracht says.

Goodman says lack of crisp vision in dimly lit conditions can be a long-term effect of LASIK, as can halos, which are noticed in dim light when a second faded image is produced by the untreated peripheral cornea. She has experienced both in the seven years since she had the procedure done on her eyes.

Regardless, she says not having to worry about breaking or losing glasses makes it worthwhile.

"For me, it was the best thing I ever did. It's not perfection (but) it's a wonderful feeling," Goodman says.

"Most people have an initial star burst - the Christmas tree effect," Goodman says. That visual effect creates a star-shaped glare around lights, which she says goes away in the majority of cases.

Eyes also may be dry for up to three months after the procedure, Goodman says.

If a procedure doesn't meet the patient's expectations, doctors will do what they call "enhancements," but those don't get rid of some of the side effects. So people are left wondering what to do next, often traveling from expert to expert to find out what can be done to fix the problem, Link says.

"There is no plan B for those who have poor outcomes," Link says.

It is not known how long the effects of LASIK last since no follow-up studies have been done, Fracht says.

See related story: LASIK Disaster

See related story: LASIK Success

See related item: LASIK Resources

See related item: LASIK program set for Nov. 18

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