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December 12, 2003

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Publication Date: Friday, December 12, 2003

Laser vision Laser vision (December 12, 2003)

Lasik eye surgery is one solution to seeing better

By Diana Reynolds Roome

Last month, Scott Vermeer, Mountain View's chief of police, decided it was time to turn himself in -- to eye surgeon Dr. Daniel Beers at the office he shares with Dr. Mark Volpicelli at Castro Commons. Though his nearsightedness was mild, it was increasing, and Vermeer felt it needed correction with Lasik surgery.

The procedure is essentially the same for the 30 to 40 people who have eye correction surgery at the Peninsula Laser Eye Medical Group every week: after the eyes are numbed with drops, the patient is reclined in a chair and the eye positioned beneath a small laser.

Using an instrument called a microkeratome, the surgeon makes a protective flap -- less than a hair's breadth -- on the surface of the cornea. In a matter of 30 seconds, a high-precision laser gently reshapes the cornea according to a pre-programmed "map" of the individual's eye.

To anyone watching the procedure on a video screen -- there is one in the waiting area -- it looks like a rapid blue flashing light. A pupil tracker follows the eye, keeping it automatically centered if the pupil moves. Afterwards, the corneal flap is replaced and the patient gets up and walks out, without the need for stitches or eye patches.

Vermeer (like most patients) returned to work the next day -- this time leaving behind his glasses. "It was a very positive experience," he said afterwards, "trouble-free, without complications, pain, or even any real recuperation time."

When people get up, they can usually see the poster on the wall, and read the clock. Afterwards, the eyes can be itchy with some redness, but usually no real discomfort.

"The next day, many patients come in grinning from ear to ear and ready to do cartwheels through the office," says Barbara Campbell, refractive surgery coordinator and optician at the Peninsula Laser Eye Medical Group. As someone who has also had the surgery, along with her husband and almost all her office colleagues, she knows it from the inside. Frequently, people are seeing better than 20/20, with excellent peripheral vision, and they are ecstatic, she says.

Close to 70 percent of adults wear glasses or contact lenses, yet many are inconvenienced by needing more than one pair of glasses for different functions (reading, driving, using the computer or watching television) or dislike the discomfort of wearing contact lenses for long hours.

Early adopters of Lasik technology (Laser in-Situ Keratomileusis) since its approval by the FDA in 1998, doctors Volpicelli and Beers each have treated about 5,000 patients to correct myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

Both doctors teach surgical techniques to ophthalmology residents at Stanford Medical Center, and both are on staff at El Camino Hospital. Beers is currently chief of ophthalmology there, and Volpicelli is past head of the department.

They regularly perform eye surgeries such as cataract, corneal transplants and diabetic retinopathy, and have done Lasik surgery on one another with great success. Their office also offers a full range of ophthalmology services, with the latest in glasses and contact lenses.

But even for Volpicelli and Beers, the reality of improved vision has recently taken a huge leap forward. This is due to an optical instrument that measures all the parameters of the eye with unprecedented precision.

Originally developed for use in high-powered astronomical telescopes such as the Hubble, WaveFront technology is 25 times more accurate than conventional optical measuring instruments.

While the patient looks at a light (much the same as in a normal glasses or contact lens check-up), a WavePrint machine, which is made in Santa Clara, captures and plots data from 255 points in each eye -- including high-order aberrations, which can cause blurring and haziness that have never been correctable until now. This information is later fed into the laser to precisely customize surgery for each individual's unique optical distortions.

"No two people are the same," says Volpicelli. "The WavePrint beam penetrates through the eye and captures data that is customized for every point."

Using standard optical measurements, regular prescriptions (for glasses and lenses) can only provide a certain level of correction. The new technology means that, for the first time in history, people can achieve their personal best vision.

During surgery, the programmed laser follows the "map" of the individual's eye to remove microscopic layers of corneal tissue -- flattening it in the case of myopia, making it steeper for hyperopia and more spherical for astigmatism. Most patients feel nothing but mild pressure in the eye.

"The corneal tissue is like a book with 500 pages," says Volpicelli. "We go about 130 pages inside."

"We're not weakening the cornea," says Beers. "The old radio-keratotomy used to weaken the cornea, but it's not done now."

There are risks, and they are low when the procedure is done by qualified surgeons who also offer thorough pre- and post-operative care. However, the procedure is so new that nobody really knows the long-term effect on the cornea.

Generally, short-term problems are rare. One in 4000 gets an infection, which can be treated promptly and effectively. More often than causing problems, laser treatment is used to treat corneal scars from improper use of contact lenses or other injuries of the eye. (In such cases the appropriate laser treatment would be PTK, in which a thin layer is removed from the front of the cornea).

Vermeer wasn't particularly worried about the risk; he said his confidence in Beers allayed any anxiety he might have had about the procedure.

But not everyone is a suitable candidate for Lasik surgery, which costs $499-$2,750 per eye for the traditional surgery and $4,500 for Lasik using WavePrint (insurance coverage varies and private payment plans are available). Beers and Volpicelli charge $1,750 to $2,250 per eye.

Also, certain eye conditions preclude the surgery and candidates must be over 18, but there is no upper age limit.

One patient was 82, and several in their seventies have found their improved eyesight greatly enhances their enjoyment and success at activities ranging from fishing to bowling. Volpicelli even did Lasik for his father-in-law, a keen hunter who can now see clearly in all weathers.

He and Beers meet with patients beforehand and go over all the details of their individual cases after a free evaluation is done in the office. Of those who are interested, about 90 percent can benefit from Lasik.

The reasons for having the surgery are as individual as the profile of their eyes -- they have problems with contact lenses, are fed up with fumbling for their glasses in the morning, want to see the fish when they scuba dive, or need to be more observant in their jobs.

As someone whose job is to keep an eye on the city (even if it's mostly from an office), Vermeer is acutely conscious of the importance of keen vision for the police, especially street officers.

"Eyesight is key to picking up little details," he said. "It's critical to see street signs, license plates from a distance, and to recognize someone before they recognize you."

Though most people don't depend on eyesight for such fast work, the eyes are still vitally important for clearly seeing the way to safety, success, and sheer enjoyment of life.

Information

For moreon laser eye surgery, visit www.fda.gov/cdrh/lasik or www.surgicaleyes.org.
Mark Volpicelli, MD and Daniel J. Beers, MD can be reached at:
Peninsula Laser Eye Medical Group
1174 Castro St., Suite 100
Mountain View, CA 94040 961-2585,
www.lasik2020.com


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