Some, such as police officers and pilots, need clear vision for on-the-job survival. Others want to pursue sports unfettered by corrective lenses.
“Many would simply like to get up in the morning and look out at the world without having to put on their glasses,” says Dr. Erik Williams, an ophthalmology researcher at Eisenhower Medical Center, in Rancho Mirage, Calif.
The dream is becoming a reality through surgical techniques known as refractive surgery. Rarely covered by health insurance, they are performed on an outpatient basis and require local anesthesia.
– Radial keratotomy, the most common corrective-vision surgery, pioneered in Russia 20 years ago, corrects myopia and astigmatism. About 1 million procedures have been performed in the U.S. since the late 1970s. The surgery takes 5 to 10 minutes. The largest clinical trial found that 60 percent of patients had 20/20 vision without glasses or contacts up to five years after surgery. Radial keratotomy corrects only distance vision. Those over 45 may require reading glasses.
Cost: About $1,000 to $1,200 per eye.
– Lamellar keratoplasty, not considered experimental, is used most often to correct nearsightedness and sometimes farsightedness. More than 30,000 surgeries have been performed in the United States since its development in the 1970s. The surgery takes five to 15 minutes and is restricted mainly to those with severe myopia. At least half achieve 20/40 or better vision without glasses. Unlike radial keratotomy, the operation does not weaken the cornea but is not recommended for those with glaucoma.
Cost: $1,500-$2,200 an eye.
– Photorefractive keratectomy corrects nearsighted, farsighted or astigmatic vision. Refined over eight years, the gas excimer laser used is made by several companies; the FDA is expected to give at least one company full approval to market its model within a year. The laser is being tested at more than 50 centers nationwide. The procedure takes about 30 to 60 seconds. According to FDA data, about 90 percent of more than 5,000 operations performed in the U.S. achieved at least 20/40 vision after a single procedure. There have been no reports of vision-threatening complications. One in 1,000 eyes become infected; five in 100 patients see halos at night around lights.
Cost: $1,500 to $2,000 an eye.
– Holmium laser thermo-keratoplasty corrects farsightedness and astigmatism. FDA-approved clinical trials are under way. The procedure takes one to three minutes. Most recently, 60 percent of patients achieved 20/40 vision and 20 percent 20/20 or better. Many patients regress over six months. The surgery cannot correct large amounts of farsightedness.
Cost: $2,000 an eye.
– Intrastromal corneal ring mainly corrects nearsightedness. The device is in early FDA-approved clinical trials. About 164 procedures have been performed worldwide. The procedure takes 15 to 20 minutes. At one research clinic, 10 of the first 15 patients had 20/40 vision or better six months after surgery. The operation is reversible. The ring also is adjustable, allowing fine-tuning after the initial implant. The ring is limited to correcting low amounts of myopia, from 20/100 to 20/400. Less than 2 percent of patients reported glare or halos at night.
Projected cost: $1,000 to $1,350 an eye.
– Corneal inlay to correct presbyopia (farsightedness that is a natural part of aging) is in very early FDA-approved trials. Like bifocal glasses, corneal inlays allow simultaneous viewing of distant and near targets. They can be removed if a patient no longer wants them or to install inlays with different powers. Ghosting or multiple images may occur if the inlay is not centered exactly.
Cost: About $1,200 an eye.
– Intraocular lens implant, used to correct severe near- or farsighted vision, is a new application of a well-established procedure in which the eye’s natural lens is replaced by a synthetic intraocular lens. No FDA approval is needed as the technique is approved for treating cataracts. The surgery takes 15 to 40 minutes. The power of the implanted lens can be selected with exquisite precision. By one preliminary estimate, 60 to 80 percent of patients no longer need glasses for most of their daily tasks. The intraocular lens can be replaced if a refractive adjustment is needed.
Cost: $1,500 to $3,000 an eye.
Other sources: Dr. Tom Tooma, Loma Linda University Medical Center; Dr. Perry S. Binder, Vision Surgery and Laser Center, San Diego; Dr. Robert J.S. Mack, Hunkeler Eye Clinic, Kansas City, Mo.; Dr. Peter McDonnell, Doheny Eye Institute, Los Angeles; Dr. John Allavie, Riverside; Dr. James J. Salz, USC School of Medicine, Los Angeles; American Academy of Ophthalmology.
