Better Lasik is in sight
Judd Hoffman hated putting in contact lenses. Laser eye surgery was just as unappealing. Not only did he shudder at the thought of an instrument touching his eyes, he was afraid something would go wrong.
So, nearsighted though he was, the 30-year-old Hermosa Beach businessman stuck to eyeglasses even as many of his friends underwent the surgery -- the most common is called Lasik -- and urged him to try it.
Last month, however, Hoffman changed his mind. He was persuaded, he says, by recent improvements in the procedure. Doctors said this new technology essentially takes out all the complications, Hoffman said. “So I felt, now I have to do it.”
The technology, called “wavefront,” maps the cornea before a laser reshapes it, more accurately measuring imperfections in the eye and yielding a more precise correction than has been possible. The advance is so significant, doctors say, that it could reinvigorate a Lasik market that has flattened out in recent years.
Lasik became available in the early 1990s and was increasingly popular for about a decade. Most Lasik patients report satisfaction with their results, but as many as 10% require a second, “touch-up” surgery to refine the correction. About 1% suffer permanent complications, such as dry eyes and poor night vision.
Wavefront-guided Lasik, experts say, dramatically reduces night-vision problems, such as glare and halos, and the need for second surgeries. The first wavefront technology, from Alcon Laboratories Inc., was approved by the Food and Drug Administration late last year. And, last month, a second system, from Visx, was approved. Other companies, such as Bausch & Lomb, are working furiously to bring their own wavefront systems -- often referred to as “custom Lasik” -- to the marketplace.
“Even though Lasik is a wonderful procedure, wavefront-guided Lasik represents a significant advancement,” says Dr. Andrew Caster, director of the Caster Eye Center in Beverly Hills. “We are looking at really big improvements in night vision.”
The wavefront technology is expected to add $500 per eye to the cost of Lasik, which ranges from discount fees of $500 per eye to the more standard $1,500 per eye. The technology has long been used by astronomers adjusting their telescopes to account for distortions caused by the Earth’s atmosphere.
The wavefront machine beams a ray of light into the eye, and the light is reflected off the retina and back into the device. The waves of light are computed into a pattern that displays the irregularities. While conventional Lasik applies a single correction to the eye, wavefront technology measures about 200 places on the cornea and applies a correction to each spot.
The actual surgery remains the same. A flap is made on the outer layer of the cornea and a laser is used to reshape the cornea before the flap is replaced. The difference now is that the computer-guided laser delivers a more detailed reshaping of the cornea.
“There are fewer side effects with wavefront,” says Dr. Brian Boxer Wachler, of Boxer Wachler Vision Institute in Beverly Hills. “It’s a more precise Lasik procedure.”
*
Candidates for surgery
Doctors insist, however, that the improved technology doesn’t mean that the millions of people who have already had conventional Lasik received a second-rate service.
“I get a lot of patients coming in saying, ‘Did I do something wrong getting Lasik?’ ” says Caster. “If your vision is fine, then, no, you didn’t do the wrong thing.”
But experts expect wavefront-guided Lasik to appeal to people who are dissatisfied with the results from conventional Lasik.
“There is a whole subset of patients who have had Lasik and are not as happy with the quality of their night vision who are good candidates for being fine-tuned with wavefront-guided Lasik,” says Dr. Stephen Brint, an associate professor of ophthalmology at Tulane School of Medicine in New Orleans who was a leading investigator of the traditional Lasik system.
The new technology may also appeal to people who, like Hoffman, are nervous about conventional Lasik.
“People have been waiting for something that makes them feel very comfortable” about the low risk of complications, says Boxer Wachler.
Lasik procedures peaked around 2000 and have dropped each year since, according to Market Scope, a company that tracks the Lasik business. Because only about 10% of people who are candidates for Lasik have had it, many experts believe there is still a large market to be tapped. Manufacturers are even touting wavefront-guided Lasik as technology that can improve vision beyond 20/20 -- providing so-called “super vision.”
But some doctors caution against such heightened expectations.
“Until we can achieve that in every person, I think we should stay away from that kind of hype,” says Caster.
Vision of 20/15 or 20/10 may be valued by certain people, says Dr. Robert Maloney, director of the Maloney Vision Institute in Los Angeles.
The 20/20 designation is considered normal vision, meaning a person can see an object clearly from a distance of 20 feet, while 20/10 means vision is so good one can probably see something at 20 feet that most people see from 10 feet.)
“It’s important for certain professions, such as race-car drivers, artists, surgeons. For the average person in the average life, it’s not important,” Maloney says.
Wavefront-guided Lasik isn’t perfect, however. Doctors still expect that a small number of patients will require a touch-up surgery and that some complications may occur, such as infection or, later, dry eyes or problems with halos and glare. The surgeon’s abilities remain a significant factor in getting a good result in any Lasik surgery; on rare occasions, people have lost their vision due to surgeon error.
Most eye surgeons have strong preferences for one type of system -- either Alcon and Visx, for now, though others will soon be available -- but the systems share many more similarities than differences.
Consumers should “pick a surgeon he or she trusts and then trust the system they use,” Maloney advises. “Good surgeons can get good results with any system.”
