Vision Correction Surgery: Evaluating New Options

By Dominick Benedetto, MD, a New Jersey Lasik Surgeon

In October of 2004, the US FDA approved a new ocular device designed to correct vision for those who are near or farsighted, the Verisyse intraocular lens from Advanced Medical Optics. The approval signaled the beginning of new era in refractive surgery, the correction of optical errors using intraocular implants in contrast to laser reshaping procedures involving the surface of eye.

A long list of similar devices is scheduled for evaluation and approval in the near future, which correct astigmatism and presbyopia (reading difficulty) as well. These new devices broaden the application of vision correction surgery to many individuals who are presently not candidates for laser vision correction. With so many available options for vision correction, it is likely that the public will be confused from mass marketing and articles in the lay press.

The choices are actually simplified and determined mostly by clinical criteria and risk tolerance. Most vision correction surgeons are intimately familiar with both issues and can guide you through the process. However, a basic understanding of how the eye works and how these new devices achieve their desired effect can be helpful in the decision making process. The eye, being similar to a camera, has a lens system, which focuses light onto the photosensitive inner lining of the eye called the retina. Light information is processed in a very basic way in the retina and then transmitted to the brain for image generation and analysis. The lens system, which focuses light, is composed of two elements. The first of these is the cornea, the front surface of the eye. The second is the crystalline lens located behind the iris, the colored structure that we see when looking at the eye from the front. Both the cornea and lens are curved, transparent structures, which serve to bend light to a focal point on the retina. Visual disability from nearsightedness and farsightedness is caused by the eye being out of focus at the plane of the retina. Nearsightedness (myopia) is the condition of the lens system being too strong and farsightedness (hyperopia) is the condition of the lens system being too weak. Either condition can be corrected by changing the power of the eye’s lens (optical) system.

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Devices can change the eye’s optics in many ways. The system can be changed external to the eye by adding spectacle lenses or contact lenses, by changing the surface curvature of the eye by either PRK (photorefractive keratectomy), LASIK (laser assisted intrastromal keratomileusis), or newer procedures such as Epi-LASIK. In addition, the eye’s optics can be changed internally or by adding an additional lens either in front of or on top of the natural lens or by exchanging the natural crystalline lens of the eye. The last procedure is accomplished by removing the natural lens, as is done in cataract surgery, and replacing the natural lens with an artificial lens of the correct power to compensate’; for the eye’s optical error, either far or nearsighted. This list of procedures is by no means complete, but includes the most popular procedures presently available for vision corrective surgery.

From the patient’s perspective, the key distinguishing feature of these procedures, which determines how they are applied, is that surgery involving the natural lens of the eye is an intraocular procedure, which is associated with higher risk. The major risk, as with all surgical procedures, is infection. However the risk of blindness is much higher with intraocular procedures than procedures performed on the surface of the eye like LASIK. The criterion for application of intraocular procedures is simple and guided by patient safety. Since all vision correctionprocedures have well defined limits to their effectiveness, intraocular procedures are reserved for individuals desiring vision correction, which cannot be achieved effectively by a less risky operation.

Choosing from options needs to be done in consultation with your chosen surgeon. Under these circumstances, it is more important than ever that individuals desiring vision correction surgery seek practitioners who have demonstrated dedication to this subspecialty of Ophthalmology.

Criteria for application of new procedures and devices are constantly changing, requiring dedicated effort to keep abreast. While on the surface finding a dedicated surgeon may seem as easy as checking credentials, and looking at the practitioner’s procedure volume, there is no substitute for your “gut” feeling about the professionalism of the doctor and his dedicated vision correctionsurgery staff.

The amount of face-to-face doctor time is probably the most important part of the entire process. It is important for the doctor to get to know your particular needs and motivation for vision corrective surgery to clearly dispel any myths or misunderstandings you may have about the entire process and to review your individualized options. Even dedicated paraprofessional counselors can easily overlook many of the small details necessary to ensure happy patients. There is no substitute for one or more visits for counseling with your surgeon. After all, the discussion is about surgery performed upon your most valuable sense, eyesight.

About the Author:

Dominick Benedetto, MD
Eye MD Associates, P.C. is a lasik new jersey surgeon performing new jersey lasik surgery in New Jersey.

phone: (877) EYE-MDMD
email: eyemdmd@aol.com
url: www.eyemdmd.com