• Laser surgery and other fixes for vision woes

    LASIK procedure can offer an alternative to glasses, contacts
  • PORTSMOUTH — Glasses are fashion accessories today. For those who do not agree, there are contact lenses.
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    For a longer fix for people who are facing challenges to their vision, there is LASIK surgery. And now, lasers are being routinely used in cataract surgery as well. One down side to this option is that none of the procedures are covered by health insurance since they are considered elective surgeries and not medically necessary.
    Problems in the human eye are caused by a variety of what are called refractive errors, meaning a problem exists with the front surface (cornea) and/or lens inside the eye, which form the eye's focusing system and are primarily responsible for focusing incoming light rays onto the surface of the retina, much like the way lenses of a camera focus light onto the film.
    In a perfect optical system, the power of the cornea and lens are perfectly matched with the length of the eye and images are in focus. Any mismatch in this system is a refractive error, and the result is one of several types of blurred images.
    There are three main types of refractive errors.
    Myopia (nearsightedness) is the mismatch in focusing power and eye length that causes distant objects to be blurry and near objects to be clearer.
    Hyperopia (farsightedness) is also a mismatch in focusing power and eye length, but it causes near objects to be blurry and distant objects to be relatively clearer.
    In astigmatism, either the corneal or the lens shape is distorted, causing multiple images on the retina. This causes objects at all distances to appear blurry.
    Dr. Robert Kwon, an ophthalmologist at Tallman Eye Associates, affiliated with Anna Jaques Hospital in Newburyport, Mass., said he thinks the relatively new cataract surgery is a very good alternative to what is usually done for cataracts.
    "Cataract surgery is traditionally done using manual methods and ultrasound to remove them," Kwon said. "It involved small incisions under anesthesia. Now we are entering the next generation of cataract surgery."
    Kwon said lasers are used to make a better incision and to soften the cataract, making it easier to remove.
    "It helps with the accuracy, the precision," Kwon said. "As an analogy, look at prostate surgery, now done using robotics. LASIK is the robotics of cataract surgery."
    When it comes to general vision problems, laser surgery is a good option, for the right candidate.
    But it is not for everyone. Dr. Peter Mocklis, an optometrist at Lens Doctors in Portsmouth, said anyone considering the procedure should completely discuss the pros and cons with their doctor before making a decision.
    "The laser is used to flatten the cornea to a shape that does what your glasses or contacts will do," Mocklis said. "However, it only corrects one vision, say nearsighted, but not more than one. Also, it is not a permanent fix. As people age, their eyes will still change and their prescription for vision will change. Laser surgery corrects the condition that exists today, but will not prevent changes that affect vision down the road."
    Mocklis said a laser screening is needed to determine if a person is the right candidate for the procedure.
    "Certain corneas cannot be touched," Mocklis said. "If they are too thin, it will not be good because the laser takes tissue. That leaves the person at risk if they get an injury. And once they age and their eyes change, chances are that they will not be able to change to contact lenses."
    Kwon said younger people, ages 20 to 40, are generally better candidates. But there are criteria to evaluate when a person is considering the procedure.
    "If the cornea is thin, it is harder to reshape," Kwon said. "Keratoconus is another condition, where the shape is cone-like, and that will also not make a good candidate for LASIK surgery."
    Another problem, said Mocklis, is that as people age they become presbyopic, meaning the muscles in the eyes used to focus are no longer as efficient. He said reading glasses or glasses for driving at night will probably be required.
    "I'd say 99 percent of the surgeries are a success," Kwon said. "There is that 1 percent risk, as with any surgery. Some people do experience issues with glare or light, but that usually resolves itself fairly quickly."
    Mocklis said laser surgery has value to people who are in occupations in which wearing glasses would be a safety hazard.
    "So, if you do it at age 25, you may get another 20 years before your eyes change enough to make it an issue," Mocklis said. "That being said, there are so many good contact lens options today, that I would recommend my patients explore that first. I think there are no cases, or few, where a person could not find contacts that work for them."
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