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WRITER: Amy Lillard
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-8032; fax (319) 335-8034

Release: Dec. 15, 1999

UI department of ophthalmology and visual sciences expands its laser surgery capabilities

IOWA CITY, Iowa – As laser surgery to correct vision problems increases in popularity, the University of Iowa department of ophthalmology and visual sciences has expanded its technical capabilities, enabling more patients to be served.

The laser refractive surgery LASIK, or laser assisted in-situ keratomileusis, is now approved by the Food and Drug Administration for a greater number of eye procedures. The new capacities mean that around half of those patients with hyperopia (or far-sightedness) and nearly all of those with myopia (or near-sightedness) are eligible for the surgery.

John Sutphin, M.D., UI professor (clinical) of ophthalmology and visual sciences, said these changes will help the UI Refractive Surgery Services expand patient care opportunities.

"We can now offer LASIK to more people," he said. "The number of procedures is growing because patients recognize the benefits of freedom from glasses. For those with contact lenses, having 24 hour vision is more desirable than 12-14 hours a day."

Refractive surgery involving LASIK uses an implement called a microkeratome that creates a flap in the corneal tissue. The flap is lifted up while the laser reshapes the eye underneath to correct the distorted shape that causes hyperopia or myopia. The surgery usually takes 15 to 60 seconds, with the entire procedure for each eye lasting about 10 minutes, and results can be seen within a day.

The procedure is growing in popularity, with more than 1 million surgeries performed in the nation. In some areas of the United States, nearly one percent of eligible patients undergo the surgery, Sutphin said. In Eastern Iowa, the rate is probably nearer .1 percent, but it is growing rapidly, with the procedures available at the UI and three practices in Cedar Rapids alone.

But with the growing popularity are signs of growing dissatisfaction. Patients nationwide are reporting ineffective surgeries, as well as added discomfort or, in rare instances, permanent decrease in vision. Dissatisfaction is due in some cases to patient expectations, according to Sutphin.

"Some dissatisfaction is predictable because patients' expectations may exceed the capacity of the surgery," he said. "Although we get around 93 percent of participants to have 20/25 vision or better in at least one eye, there will be a few who for various reasons still cannot attain that acuity. We also know that low contrast acuity is one of the last functions to return, so night driving and seeing well on foggy days can be difficult, especially in the first year. Also, patients who have glare and haloes with contact lenses or glasses will probably still have them after surgery."

Other factors can lead to unhappiness with laser surgery, Sutphin said.

"For example, not every patient is examined as closely by the operating surgeon as we do here at Iowa," he said. "Sometimes patients are seen literally for the first time while on the laser table. This is especially true of the large laser vision correction clinic chains where networks of optometrists feed patients into the centers, with all pre- and post-operative care done elsewhere by non-surgeons. This may lead to inappropriate patient selection and dissatisfaction when results are not perfect."

Another option in laser correction that has less permanence than laser surgery but many of the same benefits is INTACS, which has recently been approved for use at the UI. INTACS are paired ring segments placed through a small incision in the peripheral cornea. The 20-minute outpatient procedure is advantageous since the rings are removable and the procedure spares the central cornea, Sutphin said.

Patients with a small amount of myopia are eligible for this procedure, but there are also disadvantages. While the laser surgery is relatively painless, the INTACS cause more discomfort, and it takes a little longer for patients to see effects. Also, the procedure's long term effects are unknown.

Despite its growing popularity, laser corrective surgery may not be for everyone.