(Republished with permission from the St. Louis Post-Dispatch. This article originally ran in the Health & Fitness section on Monday, August 22, 2005)
By Harry Jackson Jr.
Of the Post-Dispatch
If you’ve spent your life wrestling with glasses, contacts and all the accompanying annoyances, local ophthalmologists say life for your eyeballs can be easier.
“The approach is now age-dependent; we can help someone’s vision from childhood to most mature,” said Dr. Michael Conners, assistant professor of ophthalmology at Washington University. “Different things can be done wherever you are in your life cycle.”
If you are under 18 your eyes are still developing, so you can expect to get glasses to correct poor vision, Conners said.
At about age 18, contact lenses are an option. They run from soft to rigid-soft, and can now correct astigmatism.
Adults can also choose laser eye surgery, which has grown substantially since it first became popular more than a decade ago. New technology makes it more accurate and safer.
Following are the most common modern options to help correct vision.
“Glasses are still the mainstay of vision correction,” said Dr. Kevin W. Greuloch, assistant professor of ophthalmology at St. Louis University. Better materials have reduced the weight and thickness of lenses and made them more durable so they don’t break as easily.
The good – Eyeglasses don’t touch your eyes; the lenses are protective.
The bad – Glasses can cause injury in rough sports. Running can make them jiggle. However, manufacturers make versions of glasses for rough sports and even for wear underwater.
The ugly – Glasses can get lost, broken or scratched. Some people think they look bad in glasses. When you’re a kid, other kids may make fun of you.
Modern lenses come in so many materials with so many purposes that nearly everyone can find a compatible version, even for serious astigmatism (vision distortion), something that limited contacts’ use in the past.
The good – Lenses are more convenient than glasses. Their vision correction rivals eyeglasses, and they can be customized for unique vision problems. Modern lenses are less prone to scratching the eye surface, and they’re less likely to cause infection. Contacts also can block ultraviolet rays.
The bad – Infections are rare, but if you wear contacts for years and years, you’re probably going to get an eye infection at some point. People with allergies and itchy eyes might have problems. Generally, doctors don’t like 24-hour lenses.
The ugly – Doctors don’t like cosmetic contacts. “Young individuals are wearing lenses to change the (eye) color, change to cat eyes or wear the logo of their favorite football team,” said Conners. “These can be purchased on the Internet or at beauty parlors. … We’ve treated some serious bacterial infections from these, and they can be sight-threatening that can need surgery to repair the vision.” If you must wear cosmetic lenses, says the Food and Drug Administration, get them through an eye doctor.
LASIK stands for laser-assisted in-situ keratomileusis – a surgical procedure where doctors surgically reshape the cornea.
There are two types of LASIK. The older procedure uses a blade and laser. A newer type, called Interlace, uses one laser to prepare the eye and one to do the surgery.
LASIK can correct nearsightedness, farsightedness and astigmatism; it’s not used to treat diseases or injuries. Many people opt for LASIK for lifestyle reasons, such as military personnel who may face combat and don’t want to bother with glasses. The age range to be suited for LASIK is about 18 to the mid-60s.
The good – “Now it’s mainstream,” says Dr. Stephen Wexler, associate professor of ophthalmology at Washington University and medical director of TLC Laser Eye Center in Creve Coeur. Wexler says that in the 15 years since the FDA approved the procedure, results show that the surgery doesn’t generally wear out. Even when there is a change, vision is never as bad as before the surgery, he said. Healing takes hours, and many people return to work the next day.
The bad – While your vision can be improved, it can also be worsened. Doctors say such incidents occur in well below 1 percent of surgeries. Wexler says that complications from LASIK, “compared to years of wearing contact lenses, are about the same.”
LASIK is also expensive. Expect to pay about $4,000 for the standard LASIK for both eyes and up to $5,000 for Interlace. Most insurance plans won’t pay for LASIK unless it’s the only option to improve safety on your job.
Finally, about 10 percent of people aren’t suited for LASIK, because their corneas are too thin. “It’s like shoe size,” said Wexler. “Everyone is different.”
The ugly – Side effects can include dry eye, slow healing, seeing halos and infection. The way to avoid problems is to be vigilant and ask a lot of questions. Don’t trust anyone charging only a few hundred dollars for LASIK surgery, says Greuloch of St. Louis University. Safety becomes a casualty of a volume medicine. “Luckily, I think we’ve weeded most of them out by now,” he said.
PRK and LASEK
PRK (photorefractive keratectomy) and LASEK (laser-assisted sub-epithelial keratectomy) are surgical options for people with thin corneas. Part of LASIK surgery involves removing some of the front of the cornea in order to shape the middle layer of cornea with a laser. With PRK and LASEK, doctors shape the front of the cornea with the laser. After the eye is reshaped, the doctor places a contact lens over the cornea while the eye heals, which can take up to a week. With LASIK the healing time is a matter of hours.
The good – You end up with greatly improved vision. Side effects such as scarring can be repaired the same as LASIK.
The bad – There’s always a risk with surgery. In most cases, the screening process will tell you if you are a candidate for PRK, LASEK, LASIK or none of the above. Reputable doctors will turn you down if you’re not suited for one of the three procedures.
The ugly – Rare complications can include problems with glare, poor night vision and worsened vision in general. Prices usually start about $1,900 per eye. Beware anyone who offers the procedure at a price that’s suspiciously low.
Phakic intra-ocular lens
This is a surgically implanted contact lens. The technology grew from cataract surgery, which replaces a cloudy cornea with an artificial lens. This is a last-resort procedure; doctors use it mainly on older patients whose vision is so poor that it affects their quality of life.
The good – It can improve the vision immensely, even better than LASIK in some cases. It can allow someone who’s nearly blind to see again.
The bad – It’s very new, just recently approved by the FDA, and it can cost twice as much as LASIK. As it becomes more routine, the price may fall.
The ugly – The same problems as with contacts can occur with this treatment. But for people who haven’t seen their grandchildren in years, that may seem like a small risk, says Conners. Insurance may or may not pay for this procedure. If you need new lenses because of an injury or they’re the only option to blindness, that’s a consideration.
SOURCES: Dr. Kevin W. Greuloch, assistant professor of ophthalmology at St. Louis University; Dr. Michael Conners, assistant professor of ophthalmology at Washington University; Dr. Stephen Wexler, associate professor of ophthalmology at Washington University and medical director of TLC Laser Eye Center; FDA Web sites; NIH Web sites.
Reporter Harry Jackson Jr.
Copyright 2005 St. Louis Post-Dispatch, Inc.