Jewish World Review Jan. 21, 2003 / 18 Shevat, 5763

"Super'' lasik is on the horizon



A new laser-surgery approach holds promise for "super'' vision


By Kathleen Doheny

http://www.NewsAndOpinion.com | Like millions of others with less than perfect vision, Ken Pimental decided to undergo laser vision correction surgery and be done with the nuisance of contact lenses and glasses.

But the technique his doctor used was a bit different, and his results better than those obtained with traditional LASIK (laser-assisted in situ keratomileusis).

In late 2001, the 36-year-old Los Angeles businessman underwent the so-called Super LASIK, an approach that is still being tested in clinical trials but expected to be generally available later this year. He went from being moderately nearsighted to having vision that is even better than 20/20. At his last checkup, his vision was 20/12 or so.

The new technique uses what doctors call wavefront analysis -- a way of analyzing slight deviations in the way your eyes focus light, explains Dr. Robert K. Maloney, a Los Angeles ophthalmologist and pioneer in LASIK surgery, who performed Pimental's surgery.

For a hundred years, Maloney explains, both nearsightedness and farsightedness have been measured by a single average number. Your eye doctor, for instance, might tell you that your eyesight is minus 2 diopters, which translates to mild nearsightedness.

But a University of Rochester scientist, David Williams, found that different points on the pupil have different refractive or vision errors, even in normal eyes. With his research team, Williams developed a way to measure the degree of nearsightedness or farsightedness at each point on the pupil instead of coming up with an overall average number. The matrix of numbers can be fed into an excimer laser and used to produce a much more precise correction with LASIK, Maloney explains -- and that translates to better postoperative vision.

The approach made sense to Pimental, who says Maloney explained it so well to him that he had no qualms about being part of the clinical trial. "I was comfortable with the idea,'' he says.

LASIK involves the use of a knife, called a microkeratome, used to cut a flap in the cornea. The flap is folded back to reveal the middle section of the cornea. Next, laser pulses vaporize a tiny portion to reshape the cornea. The flap is then replaced. The altered curvature permits light rays to focus on the retina rather than in front of it or behind it, which occurs with nearsightedness or farsightedness and makes images blurry.

With the new approach, which fine-tunes the amount of correction needed at various points, Maloney says, "We are getting 95 percent of our patients seeing 20/20 (and some even better) the first time around,'' he says. "Historically, we could get about 95 percent of the eyes to 20/40 with traditional LASIK.''

At a Research to Prevent Blindness seminar in Washington, D.C., this past fall, Maloney reported on 314 eyes in his clinical trials with Super LASIK, using a laser called the Visx S3 and the Visx Waveprint wavefront analysis system. At the six-month visit, 95 percent of the patients had 20/20 vision, and 74 percent of those had even better than 20/20.

He says Super LASIK may also reduce night vision problems. "A higher percentage of people rate night vision as good after surgery,'' he says. After surgery, 80 percent were satisfied with their night vision, compared with 66 percent before. Night vision typically declines with age, Maloney says.

The new approach might also work well for those who did not get excellent results with traditional LASIK, says Maloney. "We are treating people who have had previous LASIK and are not happy with the results,'' he says.

The new technique is currently pending approval by the U.S. Food and Drug Administration, which approves the lasers for specific indications, such as nearsightedness up to a certain degree. About 20 physicians are involved in clinical trials of Super LASIK.

But Maloney is not suggesting most people need to wait for Super LASIK. "I had ordinary LASIK myself, six years ago,'' he says. "I still see 20/20.''

Those who need super-crisp vision might do well to wait for Super LASIK, he says. "If you are a fighter pilot or a professional baseball player, wait,'' he advises. Otherwise, he says, it's up to individuals whether 20/20 is good enough or they want to have "super vision.''

Kathleen Doheny is a free-lance writer with a special interest in health. She is based in Burbank, Calif. Comment by clicking here.

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© 2003, Kathleen Doheny, TMS