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Thursday, June 21, 2018

When I sat down to write this column, I realized it’s been 20 years since I took my first laser vision course in 1998. Back then, the field was in its infancy. We have gone from surface laser treatments to creating a LASIK flap with a (precision) metal blade to all-laser LASIK. Now, looking back with almost 20 years of experience performing LASIK and PRK (laser vision correction, LVC), I’m gratified by all the patients whom I have helped liberate from their glasses and contact lenses. Today I thought I would dispel some of the more common myths associated with this surgery.

The laser doesn’t correct astigmatism—false. To understand this, I first need to explain how the eye works. Generally, if you are nearsighted, you have difficulty seeing at a distance because the cornea, the clear front part of your eye, is too steep and the light rays focus in front of the retina. Remember your physics from high school or college? This is where it comes in handy. If you are farsighted, you have more trouble with close vision but also some at a distance, because the cornea is too flat and the light rays focus behind the retina. Astigmatism can be associated with either near- or farsightedness and occurs when the cornea is more oblong or football shaped, rather than round. Glasses and contact lenses correct all of the above by refocusing the light rays on the retina, resulting in a clear image. Laser vision correction works by using a “cold” laser to reshape the cornea so that the light rays focus on the retina without glasses or contacts. So, even if you have astigmatism, the laser works to eliminate the need for corrective eyewear. It is true, however, that if you have extreme amounts of nearsightedness, farsightedness or astigmatism, or if your astigmatism is irregular, you may not be a candidate for the surgery. The best way to find out is to have a scan of your cornea performed, which is a non-invasive test performed in the office.

“I’m too old for laser vision surgery”—once again, this is false. There is no upper age limit to have LVC surgery. It is FDA approved for 18 and older, but we typically wait until the glasses prescription stops changing, sometime in the early 20s. It is certainly possible to correct your distance vision at any age. However, if you have the surgery after age 45 it only corrects your distance vision and you most likely will still need glasses to read. So the misconception arises when people believe that they are too old to completely eliminate glasses for both far and near, which is true. The desire to have surgery in this age group really depends upon your lifestyle. If you spend most of your day performing distance tasks and are active, putting on reading glasses may be only a small inconvenience. However, if you spend much time reading or in front of a computer screen, then think twice before you have surgery, as more likely than not you will be wearing reading glasses for these tasks. Personally, I had the surgery performed on my eyes at age 37. For the first five to six years I was completely free of glasses. In the past few years I’ve increasingly needed them for my near tasks, but I remain glasses free to drive, go to the gym and for social occasions.

When patients come to see me for a LVC consultation I spend considerable time discussing their visual needs with them. This is almost as important as determining their suitability for surgery from a medical standpoint. My goal is to make my patients happy, and it is vital that they understand for what tasks they will need glasses after surgery.

Even though there is no upper age limit to LVC, older patients may have early cataract formation and may be better served by having their cataracts removed and using a lens implant to correct their vision rather than LVC. That’s why a full eye exam is an important part of any surgical consultation.

The effects of the surgery wear off with time—also false. Usually I tell patients that their visual result at four to six months will remain indefinitely. A minority (5 percent) of people will need a “touch-up” in the first few months after surgery simply to refine the result if a small residual eyeglass prescription remains. But a vast majority of LVC patients have stable vision that does not change over time. I have seen a few patients over the years whose nearsightedness has returned to a small degree, but never to the initial prescription. These patients are the rare exception.

The surgery is painful—not true. The sensations are strange, but not painful. I use anesthetic eye drops and a mild sedative like xanax to alleviate anxiety. The entire procedure usually takes no more than 15 minutes. There may be some mild pain or irritation for a few hours after surgery and the vision remains blurry for the first 12-24 hours. Most patients return to work the next day.

“I’ve been told my eyes are dry, so I’m not a candidate”—true. LVC, specifically LASIK, can worsen a pre-existing dry eye condition. Fortunately, there are advances in the diagnosis and treatment of dry eye that allow us to treat patients who were previously not considered ideal candidates for surgery. The first step is identifying the type of dry eye, tailoring treatment to the individual patient and monitoring for improvement. I still hesitate to perform LVC on patients with symptomatic dry eye, but it is no longer a definite “no.”

In the 20 years that I’ve been performing laser vision-correction surgery I’ve seen major advances and minor adjustments, but the results have been the same: legions of satisfied patients who can reduce or eliminate their need for glasses and contacts. My wife and I have both had surgery, I’ve performed the surgery on friends and family, and I would not hesitate to recommend it for my children when they are of the appropriate age.

Most cosmetic surgeries simply change the way a body part looks on the outside. Laser vision correction is unique because it actually changes the way a body part works. There is no better feeling than the smile of a postoperative patient who tells me that the procedure changed their life!

By Michael Farbowitz

Michael Farbowitz, MD, is a board-certified ophthalmic physician and surgeon with offices located in Short Hills and Clifton, New Jersey. He specializes in family/comprehensive ophthalmology and cataract and refractive surgery. Dr. Farbowitz also performs a great deal of charitable surgery, including medical missions abroad as well as Vision Harvest, which takes place right here in New Jersey. He lives in Teaneck with his wife of 22 years and two teenage children.