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NEWS
LASER SURGERY AIDS FARSIGHTED PATIENTS
Steve Camey Daily News Staff Writer

01/30/99
Los Angeles Daily News
VALLEY
Ni
(Copyright 1999)

As revolutionary as a laser procedure that vastly improves nearsightedness, a newly approved technique now is available to just about reverse farsightedness. And the breakthrough surgery was perfected by a doctor during clinical trials at his Encino eye clinic and at Cedars - Sinai Medical Center.

After years of waking up to a blurry world, Kathy Redline wept when she saw her face clearly in the mirror for the first time in decades.

"I was putting makeup on and the whole time I was crying because I could see what I was doing," said Redline, a Newbury Park resident. "And I can shave my legs. This sounds stupid, but I can see what I’m doing in the shower."

The work by Dr. James Salz at Cedars - Sinai and the Freedom Vision Laser Center, and by others around the country, led to Federal Drug Administration approval in November for laser surgery to correct farsightedness. And Salz and others are now conducting trials to correct farsightedness complicated by astigmatism.

Salz is working with 35 Southern California volunteers out of 200 cases nationwide for the astigmatism study, which he expects will be done by August. The previous study, with about the same number of patients, ran from February 1997 until FDA approval in November.

In 94 percent of those cases, patients were restored to at least 20/40 vision, he said. Nearsightedness, or myopia, results when the eyeball is too long, forcing light rays to focus in front of the retina, instead of on it. Farsightedness, or hyperopia, occurs when the eyeball is too flat, so light rays reach the retina before they come into focus.

Astigmatism is an unequal curvature of the cornea, which can cause further distortion beyond near- or farsightedness.

The FDA had long ago approved use of the laser to correct nearsightedness, which affects about 60 million Americans. And with the federal approval, the 30 million farsighted people in the country now have a chance to see without glasses that fog up in the heat or get splattered in the rain, or contact lenses that dry up in air conditioning or float away during a swim. "And what if there’s an earthquake and you can’t get to your glasses, or a fire?" Redline asked.

80 Percent Improvement
Calliopi Ash of Encino constantly felt uncomfortable wearing glasses or contacts. After her surgery in September, she said her vision improved about 80 percent. "I can’t see like I used to see when I was a young girl, but I can see without the glasses," Ash said.

And West Hills ophthalmologist Samuel Masket, who has begun using the laser to treat farsightedness, said those people "are among the happiest patients I’ve ever seen." His wife, Barbara, will have the surgery soon herself Nearsighted people can at least see at close range, Masket said. But a farsighted person "past a certain age doesn’t have good vision at any range."

Masket said about 5 percent of laser-surgery cases have complications, which can include improper cuts or infections that can result in a corneal ulcer. Permanent damage is extremely rare, and the result of most complications is vision correction that isn’t quite as good as it should have been.

Paving the Way
Salz’s laser research opened the door for two types of surgery - PRK and LASIK, both of which were already being used for nearsightedness. Once the FDA approved the use of the laser to correct farsightedness, ophthalmologists were free to perform either type of work.

With PRK, or photorefractive keratectomy, the surgeon cuts away at the surface of the cornea. With LASIK, or laser in-situ keratomileusis, the doctor shaves a flap from the surface of the cornea, then uses the laser to sculpt the less-sensitive inner cells of the cornea. So LASIK involves a slightly greater risk, but results in a shorter recovery period and less chance of pain, Salz said.

"The results are actually pretty similar. People obviously want the easy way out if they can get it," he said.

Myopia is easier to fix, because it involves shaving some tissue off the center of the cornea, making it flatter. Fixing farsightedness is a little trickier - the surgeon must use the laser to trim around the center of the cornea, to make it steeper.

Neither Medicare, Kaiser Permanente nor Blue Cross covers the laser procedures, which can cost between $2,000 and $3,000 per eye, the doctors said. But Redline and the other patients compared the cost to continual replacement of eyeglasses or contact lenses. "It’s expensive, but then so too are a lot of things," Redline said. "It wasn’t too much or I wouldn’t have done it."

With the right tools and the proper training, the surgery isn’t very difficult, Salz said. But visions of someone cutting into the eyeball like a butcher slicing luncheon meat, or incinerating part of the cornea with a laser, can be a little intimidating.

"You have to be a little brave," Ash said. The patient is awake during the entire procedure, which takes only a few minutes. The only anesthesia is eye-numbing drops.

"I was scared, which I think is natural, because it’s your eyesight," said Redline, 54. "If you lose it, you don’t get it back." But after the operation, "they sit you up and you see. It’s instant. It’s just amazing."

REPAIRING FARSIGHTED EYES WITH LASERS: The FDA has approved the use of lasers to correct farsightedness. Laser treatment of nearsightedness has been used since 1995. Knight Ridder Tribune