If only Mr. Magoo had been around a few decades later, he might have been able to benefit from some of the leading-edge corrective eye procedures available today. Granted, his television show would have been significantly less entertaining with the absence of humorous situations caused by his extremely poor vision. Nevertheless, the world of corrective eye surgery has been changing at breakneck speed, and it is clear that the experience of today’s patient is vastly improved over those of patients past.
Pe Than Tin, MD, FACS, founder and Medical Director of Tin Laser Vision Center, remembers when he performed RK (Radial Keratotomy) in 1984 to correct nearsightedness and astigmatism. In 1997, “We introduced LASIK (Laser Assisted In-Situ Keratomileusis). Initially, it was used to treat nearsightedness. At that time, Erlanger Medical Center’s Miller Eye Center had the only FDA-approved Excimer Laser for eye surgeries in the city.”
One of two eye surgeons to introduce LASIK to this area, Dr Tin was chosen as an adjunct investigator in a select group of US surgeons providing data for LASIK before FDA approval, and in his role as microsurgical instructor, trained many area ophthalmologists in the LASIK procedure.
"Now," Dr. Tin explains, "Lasers and microsurgeries have become safer, much more sophisticated and advanced to treat refractive errors including nearsightedness, farsightedness and astigmatism, and with monovision correction, patients are very happy with their near and distance vision.”
In addition to LASIK, other cutting edge procedures are now available. Dr. Tin continued, “We now offer Implantable Collamer Lens (ICL), a cutting edge procedure that corrects a higher range of nearsightedness, and Multifocal and Toric Lens Implants that provide excellent vision for Cataract patients. Another amazing advance is the ability to implant TORIC ICL lens for astigmatic correction."
Today, LASIK surgery is commonly used to eliminate a patient’s need for glasses or contacts. During a LASIK procedure, a laser is used to cut a flap in the middle layer of the cornea, the stroma, to expose it for the corneal ablation, or the removal and reshaping of the corneal tissue which corrects the patient’s vision.
Dr. Deborah DiStefano of the DiStefano Regional Eye Center notes that LASIK is one of the most common corrective eye procedures performed today. When asked about advances in LASIK that have occurred over the last few years, Dr. DiStefano immediately mentions that the lasers have improved. She names two in particular, the IntraLase and the Allegretto. The IntraLase performs the same function as the blade did during the LASIK procedure—it makes the flap in the stroma. It is, however, safer and more accurate than the traditional blade. This, combined with the more precise Allegretto laser, has allowed surgeons to produce even better results. “The combination of the IntraLase with the new laser called the Allegretto will give you the best vision. It is the safest and easiest to do. It has the fewest complications, and most people are seeing close to 20/20 the next day,” Dr. DiStefano commented. “Now that it’s all lasers and no blades, it really has made it safer, and your vision’s better.”
The LASIK procedure has improved in other ways as well. Dr. DiStefano added that surgeons are able to better eliminate poor surgical candidates. She explained that prior to a LASIK procedure, a map is made of the patient’s cornea. If the corneal tissue is too thin, the patient is eliminated from candidacy. LASIK performed on a patient with thin corneal tissue may cause an ectasia, a very rare but serious condition similar to a hernia that can necessitate a corneal transplant. Dr. DiStefano says that the safety of the procedure has been improved by the ability to better determine good candidates for the surgery.
In addition, two fairly common risks —haloing and glare—have been greatly reduced. “I think a lot of the haloing and glare that we used to see with some of the older procedures are eliminated with the custom ablations we do now,” said Dr. DiStefano. The ablations are tailored to each patient and their size is larger, preventing the haloing and glare that previously occurred at night because the patient did not look through the center of the ablation.
The timeframe of the surgery has quickened as well. Early in LASIK’s history, the government made surgeons wait six months between each eye. Now, both eyes are done at the same time. Today, it takes 23 seconds to make the flap, compared to the 60 seconds of earlier procedures. Dr. DiStefano noted, “When you have suction on your eye and people are trying to hold it open, the difference between 60 seconds and 23 seconds is a world of difference.”
As for the future of LASIK, Dr. Charles Kirby of the Chattanooga Eye Institute adds that the next step in the procedure’s evolution might be multifocal ablations, providing both distance and near vision. LASIK technology will continue to improve.
Another common corrective procedure that has seen many advances in the last few years is cataract surgery. A cataract occurs when the eye’s natural lens becomes cloudy. Because the lens is clouded, light cannot reach the retina and vision is severely compromised. In order to restore vision, the cataract must be removed, and the natural lens must be replaced with an artificial lens, or intraocular lens (IOL).
Dr. Kirby notes that the procedure itself has become more efficient. He remarked,
“Really what we see with cataract surgery, what’s happened in the last five years, is that we’re able to do more efficient surgery from the standpoint that we’re able to make a small incision and actually break up the cataract with, typically, ultrasounds or other technologies, such as using water jets. You’re able to make a very small incision into the eye, go in, remove the cataract, and replace the natural lens with an artificial lens.” The smaller incisions (what used to be a ¾ inch incision is now less than ¼ inch) have led to quicker vision recovery times following surgery, the amount of sedation given has decreased, and patients feel less pain.
This is radically different from the type of cataract surgery performed when Dr. Ira Long, also of the Chattanooga Eye Institute, began practicing in the late 1940s. He adds, “From when I started in ’48 or ’49, it’s just a different operation. It’s so much easier on the patient and you get a better result. What used to be a two week hospital stay is now just outpatient. When I first started, you put patients in bed, put bandages on both eyes, and kept them perfectly still for two weeks. Now, the patient is up and about right after the surgery, as soon as the medicine we’ve given them wears off. They can go about their normal business.”
In addition, the intraocular lenses themselves have improved. ReZoom and ReStor are second-generation multifocal IOLs that, according to Dr. Kirby, allow the patient “to see distance, near, and in-between, most of the time without glasses.” This prevents the patient from having to choose between distance and near vision as in earlier cataract surgeries. Dr. Kirby anticipates that these IOLs will continue to improve, providing even better vision for cataract sufferers.
What does the future of cataract surgery hold? Dr. Kirby feels that the technology will continue to improve, just like computers or cars. Dr. Long believes the cataract may potentially be dissolved with an injection. He adds, “Anything is possible.”
Advances are being made in other forms of eye surgery as well. Dr. Jody Abrams, a newcomer to the Chattanooga area and the Chattanooga Eye Institute, is the only fellowship-trained subspecialist in neuro-opthalmology and oculoplastic surgery in the Tri-State area. Concerning advances in oculoplastics, a field dealing primarily with reconstruction, Dr. Abrams stated, “There are some new implants that are getting very popular and doing well in rebuilding fractures for people who have been in severe traumas or have had major tumors removed.
“The implants can be custom made, so we have gotten to the point where we are able to offer people who have had disfigurements a better outcome, to reconstruct that a little bit better, a more anatomically correct outcome.” Some of the neurological surgeries Dr. Abrams performs have advanced enough that general anesthesia is no longer needed.
Dr. Abrams also mentioned another remarkable advance—the use of Botox to relieve headaches. A great deal of research is going into the use of this substance, typically associated with plastic surgery, and its applications in resolving health issues. According to Dr. Abrams, Botox allows doctors to “get [patients] off megadoses of oxycontin and oxycodone and give them back a life.” The futures of neuro-opthalmology and oculoplastics also seem boundless.
Clearly, eye surgeons today are able to provide their patients with safer, more comfortable procedures that render better results in a shorter period of time. Those considering corrective eye surgery may rest assured that they can receive the latest procedures, using the most advanced technology from experienced professionals right here in the Chattanooga Region. Dr. Tin noted, “Ophthalmological advances are infinite. It is exciting to be a member of this profession that restores vision to millions of patients and brings new light to their world.” Mr. Magoo should have been so lucky.