Is LASIK Right for You?

Donita Rossi, a Los Angeles advertising professional, used to have vision so poor that she could hardly take a step without glasses or contacts. She was nearsighted and also had astigmatism, a refractive error often associated with an irregular shaped cornea. Her eyes were getting drier, making contacts painful to wear. So she underwent LASIK (or laser in-situ keratomileusis) surgery at the Jules Stein Eye Institute at the University of California, Los Angeles. Her surgeon made a shallow slice through the front of her cornea, used a laser to remove deeper corneal tissue to change its focusing power, then dropped the flap back without stitches. Her eyes never “knew” that a cut was made. The healing—and vision correction—took just hours. It changed her life.

“It was so exciting,” Rossi recalls. When she woke up, she could already read the clock across the room. “The next day I could read signs on the street from within my living room.” A glasses wearer since fourth grade, she phoned her parents with a new report: “Guess what I can read now?”

Rossi’s surgeon was Dr. Robert K. Maloney, clinical professor of ophthalmology at UCLA. Today, at his Maloney Vision Institute and as the LASIK surgeon for the ABC television show “Extreme Makeover,” he frequently sees patients experience such relief and rejoicing.
“You live your life with the constant sense that you are in big trouble if you lose your glasses; you can’t go swimming, can’t play basketball,” says Maloney. Corrective surgery can be “profoundly transforming.”

Maloney, for example, now uses a newer, highly accurate type of LASIK: a wavefront-guided laser. Traditional LASIK takes just one measurement to make a correction compared to wavefront, which measures and corrects at 200 different points, according to Maloney. “It turns out that the imperfections in your vision are as unique as your fingerprint,” he says. This type of surgery reduces the potential of night glare, compared with traditional LASIK.

Maloney predicts that even these lasers will be eclipsed, eventually, by contact lenses implanted behind the cornea. (He is chief medical officer and a shareholder in a firm that is working to produce such implants.) In 10 years, implantable “flexible lenses” will simultaneously restore distance and reading vision for people over 45, he says. Now, the difficulty in changing focus from distance to near that comes with advancing age (presbyopia) may be addressed surgically by correcting one eye for distance and the other for close work.

For those not ready for LASIK or to shell out over $2,000 per eye for the procedure, you should know that contacts are getting better and better, says Elizabeth Hakim Sworst, an optometrist and instructor at Wayne State University School of Medicine’s Kresge Eye Institute in Detroit. Colored contacts are especially popular, she says.

There are two types of contacts: soft lenses cover the entire cornea; gas permeable (hard) lenses are smaller. The type your eye care professional will recommend depends on your vision problem. Sworst’s advice: If you can, get soft disposable (daily, weekly, biweekly, monthly or quarterly) contacts. They’re easier to keep clean. Why disposable? She answers with a kitchen analogy: “If you have a sponge, over time that sponge is going to get dingy. It’s going to get yuk on it. When you wear the lens for a year, proteins, lipids and other things are deposited,” causing infection and irritations.

Colored soft lenses, with vision correction or without, cost about $300 a year (without color, about $100 less), including the eye care professionals services.

Toric (saddle shaped) lenses correct astigmatism and cost roughly $450 a year. Severe astigmatism requires custom-made gas permeable lenses ($250-$500). Bifocal contacts ($300 to $600) come in gas permeable or soft disposable versions. Colored bifocals aren’t available, but they’re coming.

Forget “extended wear” contacts ($400), Sworst says. Sleeping in contacts is generally a bad idea; it deprives the cornea of crucial oxygen and increases the risk of bacterial ulcers.

Orthokeratology (Ortho-K) is another possibility. Special contacts are worn overnight so that contacts aren’t needed during the day. Ortho-K temporarily reshapes and flattens the cornea, allowing for clear vision for a period of time. Pros: These temporary changes are reversible. Cons: It can be costly, provides a limited amount of refractive correction, and requires lens cleaning and maintenance, which some wearers hate. Steve Ernst, of Contex Inc., in Sherman Oaks, CA, which designs, sells and fits Ortho-K, suggests purchasing the lenses with a six-month service contract including unlimited check-ups. Cost: $1,000 to $2,200.

Play the eye-care game by the rules:

• Mind the hygiene. Gross offenders, Sworst says, are teenagers who share and swap colored lenses. Also dangerous: “cleaning” contacts in your mouth. “Your mouth is the dirtiest part of your body,” Sworst says. “Never put contacts in your mouth.”
• Find a pro. Get an exam from an eye care professional. Most people don’t need the expertise of an ophthalmologist (an M.D. who performs surgery and treats more-serious eye problems); an exam by an optometrist is often sufficient and is usually less expensive. Any eye care professional dispensing contacts should dilate your eyes as part of a complete exam. If dilation isn’t included, flee.
• Stick with the pro. Ignore internet offers for contacts and cleaners that let you skip the exam by an eye care professional (even beauty shops sell colored contacts). Get expert help choosing lenses and learning about care and cleaning. Ineffective cleaners foster infections. An exam should include follow-up in a week, a month and as often thereafter as needed.

Remember, the lenses are disposable, your eyes are not. Take care of them.