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ENVISION LIFE WITHOUT GLASSES
BY SARAH BROBERG
Eyeglasses may make us look sophisticated, but
who among us lens-wearers hasn’t yearned for the chance to
read the newspaper, watch TV or play sports without the need for
prescription eyewear? Fortunately, medical advances in ophthalmology
have made this dream more attainable than ever, bringing the price
of safe corrective eye surgery to within reach of many Egyptians.
A number of corrective procedures exist [see sidebar, page 86],
but none has gained quite so much attention in recent years as LASIK
(laser-assisted in situ keratomileusis). The procedure, which uses
an ultraviolet excimer laser to reshape the cornea of the eye, can
be used to correct a number of common eye problems, including myopia
(nearsightedness), hyperopia (farsightedness) and astigmatism. Its
popularity is due to its advantages over other procedures, including
the relative lack of pain after the procedure and the fact that
improved vision is usually achieved immediately, or at least by
the following day.
If you are considering LASIK eye surgery, it is important that you
choose a good surgeon. A fancy office with snazzy equipment means
nothing if the doctor performing the operation is a hack. You should
base your decision on the surgeon’s level of experience, reputation,
and involvement in the surgery and post-operative procedures. A
surgeon that has logged at least 1,000 LASIK procedures could be
considered an expert; anything less and you could end up as the
proverbial guinea pig. Similarly, insist that the master surgeon
do the procedure himself – handing you over to his overeager
apprentice could be a serious mistake in hindsight.
Red lights should flash if a doctor agrees to do the operation without
first administering a battery of eye tests to determine your compatibility.
These tests are essential to determine the health of your eyes,
what kind of vision correction is needed and how much laser ablation
is required. Often they are not included in the quoted cost.
A typical LASIK evaluation includes a dilation exam to determine
pupil and corneal thickness, check for ocular irregularities and
refractive error measurement, which determines the severity of visual
impairment. Digital photography of your eye is used to create computerized
topographic maps of the cornea, which helps the surgeon to spot
any corneal irregularities and determine the precise shape that
the cornea must be cut to correct your vision. Most surgeons, including
those in Egypt, also perform wavefront-guided LASIK, which sends
digital waves through the eye to provide a customized map of the
irregularities that affect your vision. The procedure creates a
more precise vision correction guide than the traditional LASIK
evaluation.
Finally, the surgeon should ask questions about any health problems
you may have or medications you take. Some health conditions such
as autoimmune disorders, corneal scarring or pupils that dilate
too much will disqualify you altogether for LASIK, while others
such as recent eye infections or pregnancy may simply postpone the
procedure until a later date.
LASIK is an outpatient procedure, meaning you walk into the clinic
for a scheduled appointment, have the procedure and walk out again.
In fact, the actual surgery usually takes less than a minute, and
you’re awake the whole time. If, like most people, the thought
of blades and lasers poking into your open eyes is a tad terrifying,
be assured that the majority of patients report no pain during LASIK
surgery. Your surgeon will anesthetize your eyes with special drops
before the operation and may also give you a mild oral sedative
to help you relax.
That said, it’s understandable to feel anxiety. After cleaning
the area around your eyes, the surgeon affixes a lid speculum –
a metal device that holds your eyelids open to prevent you from
blinking during the operation. A ring is placed on your eye that
uses high pressure to create suction on the cornea and guide a microkeratome
blade that cuts a thin, circular flap in the cornea. Increasingly,
surgeons are using a computer-guided Intralase laser for this step
as the surgeon can program the laser’s precise movements according
to the flap diameter, depth, hinge location and side-cut architecture.
Once the flap has been created, the surgeon folds it back to expose
the underlying tissue. Then he uses an excimer laser – a precision
laser that emits a cool ultraviolet light beam that can vaporize
a thin layer of tissue without burning the adjacent tissue –
to reshape the cornea in a way that it is better able to focus light
into the eye and onto the retina for clearer vision. The laser is
connected to a computer that tracks the patient’s eye movement
thousands of times per second and, guided by the patient’s
topographic cornea map, repositions the beam accordingly. Nearsightedness
is corrected by flattening the cornea; farsightedness by flattening
the cornea, and astigmatism by smoothing out the irregularities
in the cornea’s shape.
After remodeling the cornea, the circular flap is returned to its
place. A removable protective membrane – similar to a soft
contact lens – is usually placed on the cornea to protect
it while it heals, which takes about 48 hours and leaves no scars.
An eye patch may also be worn. Patients can go home after the surgery,
though it is advised that they arrange to have someone else drive.
The most common post-operative complaint is dry or inflamed eyes.
The doctor may give you eye drops to help lubricate the eye, but
the problem should resolve itself within a month. Typically, antibiotics
are not prescribed unless the eye gets infected.
Most patients notice an improvement in their vision immediately
upon completion of their surgery. By the next day, vision is often
dramatically improved. However, patients should understand that,
while fast visual recovery characterizes the operation, it can take
several months before patients achieve their optimum vision. During
this time, patients may experience slight fluctuations in vision
throughout the day. These symptoms generally diminish with time.
While no statistics are available for Egypt, over one million patients
underwent LASIK surgery in the US last year with relatively few
complications. Of those reported to the US Food & Drug Administration
(FDA), the most common were infection, night glare, sensitivity
to light, visual fluctuations and halos. Only 3 percent of patients
reported vision worse than before the surgery. These conditions
aside, patient dissatisfaction was usually the result of unrealistic
expectations rather than faulty surgery.
Don’t expect bionic vision. With LASIK, most people are able
to achieve 20/20 eyesight. However, patients with serious eye problems
may only be able to safely get 20/40 vision, which might not be
enough to go without glasses, but at least they’ll be able
to ditch their coke-bottle lenses.
As LASIK is a relatively new procedure it is too soon to say how
long it lasts or if it may lead to complications 20 or 30 years
down the road. In the short term at least, regression (a gradual
loss of visual clarity) is rare and most common among women on hormone
therapy. In such cases the surgeon may opt for an “enhancement”
or “touch-up” surgery to correct the problem.
One thing LASIK cannot prevent is the gradual degeneration of eyesight
that occurs we age. The surgery can give you 20/20 vision, but somewhere
down the road you may still need reading glasses or bifocal contact
lenses due to a condition called presbyopia, which begins to develop
in most people in their 40s. Your distance vision will probably
remain crisp, but seeing up close will be more difficult.
A number of reputable clinics in Egypt offer LASIK with base rates
starting from approximately LE 5,000 for surgery on both eyes excluding
the eye exam, which usually costs about LE 50-100. By contrast,
private clinics in the US charge anywhere from $1,000 to $5,000
for the procedure. To mitigate any risks should complications arise,
it is recommended that each eye be treated as a separate procedure.
This article is intended only as a guide. You should consult a
licensed ophthalmologist before undergoing any eye operation.
CLEARER VISION ALTERNATIVES
Photorefractive keratectomy (PRK): a procedure to treat myopia,
hyperopia and astigmatism without creating a corneal flap.
Unlike LASIK, which remodels the tissue beneath the cornea,
PRK reshapes the surface of the cornea itself. As the protective
superficial layers of the cornea are operated on, a longer
recuperation time is required.
Astigmatic keratotomy (AK): a procedure used to reduce astigmatism
by making one or two incisions at the steepest part of the
cornea. These incisions cause the cornea to relax and take
a more rounded shape. It is often used in combination with
other vision correction surgeries.
Intrastromal corneal rings: clear, thin, polymer rings implanted
in the cornea to correct low-level myopia only. The aim of
the corneal ring implant is to flatten the cornea and thus
reduce the degree of myopia.
Implantable contact lenses: also known as phakic intraocular
lenses (IOLs), are thin, synthetic lenses implanted in the
eye without removing the natural lens of the eye, as is required
in cataract surgery. Monofocal and multifocal lens implants
and implantable contact lenses are stable, reliable options
for those who cannot undergo laser surgery due to extreme
myopia, thin corneas or other conditions.
Automated lamellar keratoplasty (ALK): a procedure that uses
a microkeratome to reshape the cornea and produce clearer
vision in people with severe nearsightedness and mild degrees
of farsightedness. ALK has become less common because other
vision correction procedures give more predictable results.
Conductive keratoplasty (CK): is a treatment used for mild
and moderate farsightedness (hyperopia) and presbyopia, a
form of farsightedness known as “aging eye”, in
which the eye gradually loses its ability to focus on close-up
objects or print. CK is a non-laser technique that uses mild
heat energy from radio waves to shrink the glue-like connective
tissue (collagen) in the periphery of the cornea, which steepens
it, resulting in better vision. |
LASIK Centers
El Magrabi Eye Center
211 Mohieddin Aboul Ezz Street
Mohandiseen
Tel: 761-0916/0878
www.maghrabihospitals.com
International Eye Center
Vinni Square
Dokki
Tel: 338-1818
Dr. Ahmad Khalil Eye Clinic
Saridar Clinic Tower
Apt 67, Floor 5
92 Tahrir Street, Dokki
Tel: 760-6985
www.eyecairo.net
Egyptian Ophthalmic Clinic
15 Ramo Buildings, Floor 5
Nasr Road
Nasr City
Tel: 690-3361 or 012 394-0223
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