DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. Did you know about 60 million Americans don't see well? But today, more and more of them are turning to laser eye surgery. How does it work and is it for everyone? Joining us today to help shed some light on this topic are two experts, one doctor and one patient. First we have Dr. Julius Shulman. He's an Associate Clinical Professor at Mount Sinai Hospital in New York and he also has a private practice in New York City. Welcome.
Next to him we have a patient. It's Israel Bordainick, and he's had at least a couple of these procedures. So you're going to shed some light on how it feels to be on the other side of the laser. Welcome.
Dr. Shulman, tell us what kind of vision problems can be treated with some of the new techniques.
JULIUS SHULMAN, MD: Most vision problems can be treated. Myopia, which is nearsightedness, hyperopia, farsightedness, and astigmatism. The laser companies first went after myopia because that's the most prevalent, then astigmatism, and now we can treat hyperopia, so the whole gamut is covered.
DAVID R. MARKS, MD: Tell us what astigmatism is.
JULIUS SHULMAN, MD: Astigmatism is when light does not fall to a point. A is without, stigma is point in Greek. It's a refractive error where everything is blurred, near and far, as opposed to farsighted or nearsighted. So astigmatism is kind of a combination.
DAVID R. MARKS, MD: There are a lot of ways now with the laser to treat, and you're a specialist at that, but there are some ways to treat these problems without resorting to laser treatment. What are they?
JULIUS SHULMAN, MD: Well, the obvious one is glasses. Glasses have been around for many, many years. There are contact lenses and contact lenses now can correct almost all refractive errors: myopia, even astigmatism. There are bifocal soft contact lenses. There are gas permeable. So contact lenses are generally an option. And most people probably will have tried contact lenses and certainly glasses before they come to laser eye surgery.
DAVID R. MARKS, MD: What are some of the negatives of using either glasses or contacts to treat a vision problem?
JULIUS SHULMAN, MD: Glasses are fine up to a point. After you become extremely nearsighted or farsighted, many people feel handicapped. They go to sleep, they wake up, they may not be able to find their glasses.
DAVID R. MARKS, MD: You see people putting them on and taking them off all the time.
JULIUS SHULMAN, MD: Exactly. They may have sports or hobbies or occupations where glasses are not feasible. It's difficult to scuba dive with glasses. Contact lenses are another option. They have disadvantages. Some people are not that tolerant of contact lenses. So these options are certainly something to be tried and if the patient is happy with these then they don't have to proceed with laser eye surgery.
DAVID R. MARKS, MD: Again, the downside of contact lenses as opposed to glasses?
JULIUS SHULMAN, MD: Contact lenses. The downside is some people cannot wear them a full day. People lose them. They break them. They have to reorder them. If you think of someone wearing a contact lens for their whole life versus having one laser eye surgery, the preference might be for laser eye surgery, although a good argument could be made for just staying with your contact lenses. Contact lenses can cause their own health problems in the eye. Infection is rare but it can occur. Irritation, dryness. So each modality has good and bad to it.
DAVID R. MARKS, MD: Izzy, what kind of vision problems did you have?
ISRAEL BORDAINICK: I was very nearsighted. I couldn't see two feet in front of me without my glasses.
DAVID R. MARKS, MD: How did that affect your life?
ISRAEL BORDAINICK: Little things, like if you go to bed at night and you reach in the morning for your glasses on the night table, you knock them off, you literally can't find them. I'd go into a restaurant that would be hot and my glasses would fog up. Go for a haircut and I couldn't see myself in the mirror, you know, when they ask you "Well, is this good?" Things like that.
DAVID R. MARKS, MD: Did you try contact lenses at all?
ISRAEL BORDAINICK: I tried contacts when I was in college. I felt always like there was something in my eye, like a little hair or something. A couple of times I kept them in too long and scratched my eyes. So I decided they weren't for me.
DAVID R. MARKS, MD: Tell me about the surgical options.
JULIUS SHULMAN, MD: Surgical options nowadays are basically laser vision correction. Years ago there was an option called radial keratotomy where very fine slits were made in the cornea to change the shape. That in effect improved your vision but it also weakened the cornea. Laser eye surgery is safe, it's effective. It's a procedure, and a procedure can always have problems, but it's one of the most successful procedures we now perform.
DAVID R. MARKS, MD: In what percentage of people does it work?
JULIUS SHULMAN, MD: Given the whole spectrum of people with all different prescriptions, about 95% of people would be able to pass a driver's vision test without glasses after having the procedure.
DAVID R. MARKS, MD: Are there some people in whom it shouldn't be used?
JULIUS SHULMAN, MD: Yes. You have to be very careful in evaluating patients to make sure that they are a good candidate. It may not be advisable for all people.
DAVID R. MARKS, MD: Who are some of these people?
JULIUS SHULMAN, MD: One of the things that we look for is the pupil size in the dark. If your pupils get too big in the dark, light coming in, especially when you're driving at night, can hit the edge of the laser zone and cause a lot of glare as it goes into the pupil. Some people have a thin cornea, and so some types of laser surgery are not good because the laser does remove a small portion of the cornea, the front of the eye. That's how it works. You have to have enough left over for the health of the eye. Some people have weaknesses or scar tissue in the cornea and it may not be advisable.
DAVID R. MARKS, MD: So not everybody can just walk in and get this surgery.
JULIUS SHULMAN, MD: No. It has to be carefully evaluated. Young people whose eyes are still changing should not have this done because you don't want to have this done twice if you can help it, so you have to wait until your eyes have stopped changing.
DAVID R. MARKS, MD: Does a person have to reach a certain degradation in their vision? Does their vision have to be bad enough to a certain extent to get this procedure done?
JULIUS SHULMAN, MD: It's generally for people who would have to wear their glasses or contact lenses all the time in order to see. For someone who is very, very slightly nearsighted it doesn't really pay to do the procedure. It doesn't mean that you have to be severely nearsighted to have this done. People have this done at all different spectrums. But at least the risk/benefit ratio that we talk about should be in effect.
DAVID R. MARKS, MD: Izzy, you had a couple of different procedures done. What made you finally decide to throw away those glasses and get something done for your vision?
ISRAEL BORDAINICK: I wanted to wait a little while and make sure that I felt confident that the surgery was safe. As I kept reading about it, I felt that it was perfected and that it was time. I just felt like a slave with glasses on and I just thought, now's the time to do it, and I just went ahead. I actually had both done at the same time; I had Lasik in one eye and I had the other procedure in the other eye. I think the anticipation is worse than the reality. The reality is that it's actually a very quick procedure, relatively quick healing process. With the Lasik, you instantaneously can see. So I think the biggest thing is just anticipating what's going to happen. But for me it was just terrific.
DAVID R. MARKS, MD: You're not wearing glasses right now so I take it your vision is pretty good?
ISRAEL BORDAINICK: My vision is great. I love it.
DAVID R. MARKS, MD: What is it, 20/20, 20/30? Can you put a number to it?
ISRAEL BORDAINICK: In actuality I'm of the age where I needed progressive lenses so that I could also read with my glasses. So what Dr. Shulman did was with one eye he made it 20/40 so that eye could be the dominant eye for reading and then the other eye was scheduled to be 20/20, so that would be the dominant eye for being able to see far. It worked well with both eyes.
DAVID R. MARKS, MD: You were shooting for the 20/40 and the 20/20. Can you get everybody to see 20/20 if you want to?
JULIUS SHULMAN, MD: The numbers are misleading. What I did with Izzy was try and make him independent of glasses, so one eye had Lasik and that eye I wanted to get as good for distance as possible. He did get 20/20. Some people will get 20/25, 20/30. That's on an eye chart. But in real life, if your vision is clear, it doesn't matter that much what the eye chart tells you. It's more important what you do in real life. His other eye had PRK and that eye I made a little better for reading. That's something we call monovision. So, with both eyes open in the real world, the brain uses whatever eye is in focus and it's kind of automatic. So he's 20/20 for distance and for reading. Not everyone gets that.
DAVID R. MARKS, MD: But you're treating the patient as opposed to a number on the chart.
JULIUS SHULMAN, MD: Correct. To help the patient rather than the numbers on the chart.
DAVID R. MARKS, MD: Which is the job of a doctor.
JULIUS SHULMAN, MD: That's right.
DAVID R. MARKS, MD: Well thank you both for being here. I appreciate it. And I hope we brought this into sharp focus for you. I'm Dr. David Marks and I'll see you next time.