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This article by Vivian Fransen was published in U.S. 1 Newspaper on June 14, 2000. All rights reserved.
The Low Down on LASIK
Looking good and feeling good are universal interests,
motivating people to seek out the latest advances in improving their
health and well-being. But until recently the quality of one’s eyesight
was the exception.
Through the magic of plastic surgery you could add inches here —
or even there — and you could take them away, as well. Through
drugs and various electronic devices you could remove hair where you
didn’t want it, and add it where you did. But if God gave you a faulty
set of eyes, you were pretty much stuck in a daily routine of lost
and found games with misplaced eyeglasses or poking fingers in their
eyes to insert and remove contact lenses. If you were lucky your spouse
or significant other would say not to worry, that you looked better
in glasses. But was that a compliment?
But now comes the breakthrough: A medical procedure that promises
visual freedom, a lifestyle without the need for eyeglasses or contact
lenses, with the vast majority of patients concluding that the results
are well worth a 20-minute operation in a doctor’s office plus a few
The media is filled with articles, advertisements, and testimonials
about refractive surgery, which is designed to improve the eye’s natural
focus by altering the shape of the cornea. Of special interest is
the advent in 1991 of LASIK (the acronym for laser in situ keratomileusis),
the latest of the refractive surgery techniques, which offers a more
rapid recovery time with very little discomfort after the procedure.
Hundreds of websites — some that recommend this surgery and some
that warn against it — have been posted, and thousands of people
are making visits to eye doctors to request this procedure.
"This is a very exciting time in eye care," says Stephen Felton
MD of the Princeton Eye Group at 419 North Harrison Street. "And
I believe it can only get better."
Athletic-minded people who enjoy the outdoors are especially interested
in LASIK. Snorkeling and scuba diving can be much more enjoyable without
the hassle of eyeglasses or contact lenses. And in some climates,
such as Colorado, where the air is dry, you rarely find people these
days on the ski slopes with eyeglasses or contact lenses, observes
Felton, who will speak on laser eye surgery at the U.S. 1 Health and
Fitness Fair Tuesday, June 27, at the Holiday Inn on Route 1 South
at Ridge Road.
"In some places, entire police departments have received refractive
surgery," says Felton. "The rationale is that any activity
that can be dangerous, such as chasing a criminal, becomes even more
risky if eyeglasses or contact lenses fog up, fall off, or are dislodged."
"One of the most unique situations I’ve encountered was the request
for LASIK by a man in his 20s with muscular dystrophy who relies on
his wheelchair for mobility," says Felton. "He was very nearsighted
with eyeglasses that have thick lenses. While watching television,
his glasses would often slip down and fall off. Without the use of
his hands, he was forced to call upon someone to constantly put his
eyeglasses back in their proper place. Eliminating the need for these
heavy eyeglasses was one less detail for him to contend with."
How does it all work? First, a crash course in how we see, as explained
by the American Academy of Ophthalmology. To see clearly, the cornea
and lens must bend, or refract, light rays and focus them on the retina,
a layer of light-sensing cells that lines the back of the eye. The
light rays are converted by the retina into impulses that are sent
through the optic nerve to the brain, which recognizes them as images.
If the light rays are not focused onto the retina properly, the image
one sees will be unclear. This is called a refractive error. The purpose
of eyeglasses, contact lenses, and refractive surgery is to correct
or reduce refractive errors by focusing light rays closer to or directly
onto the retina.
If the eye is longer than usual or the cornea and lens have too much
focusing power, light rays focus in front of the retina instead of
on it. Called "myopia" or nearsightedness, this condition
means a person has poor distance vision. More than 25 percent of adults
in the United States have myopia, which is often inherited and found
in children when they are ages 8 to 12.
If the eye is shorter than usual or the cornea and lens lack the necessary
focusing power, light rays focus beyond the retina. Called "hyperopia"
or farsightedness, this condition means a person doesn’t see things
clearly that are close to them.
Astigmatism occurs when the corneal curve is steeper in one direction
than in the other, similar in shape to a football. As a result of
the unevenness, light scatters and focuses on the retina at multiple
points, distorting both near and far vision. Many people have astigmatism
in combination with myopia or hyperopia.
Here’s how refractive surgery works: If a person has myopia, the surgeon
flattens the optical zone or center of the cornea to reduce its refractive
power. If a person has hyperopia, the surgeon makes the cornea steeper
to give it more refractive power. If a person has astigmatism, the
surgeon will selectively reshape the uneven curves of the cornea.
LASIK uses the laser technology of the "excimer" ultraviolet
laser and a highly specialized automated instrument called a microkeratome
to make these adjustments. It’s a two-step procedure in which the
surgeon uses the microkeratome to make a thin flap in the cornea.
This flap is folded back, and the excimer laser is used to remove
a thin layer of tissue from the exposed surface. The surgeon uses
a high power microscope to align the eye and to monitor the amount
of tissue being removed. Once the correction has been made, the flap
is returned to bond back into place.
Not everyone is a good candidate for LASIK. In addition to being in
good health, individuals need to be 21 years old or older and have
a stable vision correction prescription, according to Felton. Other
conditions that prohibit people from receiving LASIK include pregnancy,
uncontrolled diabetes, uncontrolled high blood pressure, autoimmune
disorders, lupus, and rheumatoid arthritis.
"A thorough screening by an experienced surgeon is critical,"
says Felton, who conducts cornea mapping, also known as corneal topography,
as part of a free consultation to anyone considering LASIK. In some
cases, a person’s pupils are too large. Or, prolonged use of contact
lenses may suggest LASIK is not an appropriate procedure.
"The post-op exam (24 hours after the procedure) is also very
important, with around-the-clock care readily available," says
Felton. "Our experience is that 5 out of every 100 patients will
have a problem. Such problems are correctable as long as the proper
follow-up care is provided."
Not everyone who receives the LASIK procedure can toss away eyeglasses
or contact lenses right away. Additional enhancement surgeries may
be required. And some individuals may still need to use eyeglasses
or contact lenses to achieve their best vision even after refractive
surgery. Refractive surgery does not alter the aging process of the
eye, so reading glasses may still be necessary for middle-aged and
Realistic expectations are important, says Felton. Individuals request
LASIK for a variety of reasons but the most satisfied patients are
those with realistic expectations and a thorough understanding of
the risks and possible complications of refractive surgery. That probably
explains why Felton and his colleagues require the signature of each
LASIK patient on each page of their six-page informed consent form
before the procedure is done.
No health insurance policies cover the cost of LASIK at this time.
And the price for this surgery can vary considerably. Many eyecare
providers charge as much as $5,500 for this procedure, including screening
and follow-up care.
"Our charge is $3,900," says Denise Pichey, LASIK coordinator
for the Princeton Eye Group, which now has six physicians: Michael
Y. Wong, Richard H. Wong, R. David Reynolds, Sam Liu, and Anita I.
Miedziak, as well as Felton. "Our physicians want to keep this
procedure affordable for those who are properly screened. And we even
offer payment plans to help people with this expense." These physicians
are also part of the Wills Eye Surgical Network, which regards the
Princeton Eye Group as "a center of excellence for LASIK vision
Born in Poland, Stephen Felton left for America with
his mother, a nurse, in 1942, when his father and grandfather died
in the concentration camps at Auschwitz. He and his sister (now a
pediatrician working in Boston who is married to an ophthalmologist)
grew up in New York, raised by their mother and stepfather (who was
"I never seriously considered a career in medicine while I was
growing up because I knew my family couldn’t afford the educational
expense," says Felton. Instead, he studied at Brooklyn College,
majoring in chemistry and physics. He went on for a doctoral degree
in organic synthesis at Rutgers and received a post-doctoral fellowship
in Santa Barbara, California, in 1967. After working three years in
the perfume and flavor industry, he decided to apply to medical school
at age 29, enrolling at Rutgers Medical School (now known as UMDNJ-Robert
Wood Johnson Medical School). Narrowing his choices to internal medicine
or ophthalmology, he chose ophthalmology when he was accepted to do
his internship at the Wills Eye Hospital in Philadelphia. He set up
his practice in Princeton in 1980.
Describing himself as a conservative doctor, the qualities he admires
most in other physicians are caution, compassion, and sensitivity
to each patient’s needs.
"I’m a family man and I really enjoy my work," says Felton.
He is married to a lawyer and has two daughters (one is a lawyer in
California and the other is a college student at Tufts) and a son.
"Our 9-year-old son, Jake, knows the anatomy of the eye and wants
to become an eye doctor one day."
"Doing what it takes to restore eyesight is truly rewarding and
exciting," he says. "I schedule most of my surgeries for Thursdays,
which means I see my patients for post-operative care on Fridays.
I can hardly wait to see how my patients are doing the next day after
their procedures. Whether it’s a cataract or LASIK procedure, it’s
so satisfying when a person tells me, `I can see so clearly now.’"
Susan Vogel, a LASIK procedure recipient who lives and works in Pennsylvania,
came to Felton earlier this year out of desperation.
"My sister (Sheila Albert of Princeton) listened to me talk about
all the aggravation I was having with my eyes," says Vogel. "She
scheduled that first appointment for me. And now (after having the
LASIK procedure) I can see everything. I wake up in the morning and
can see the clock and the TV from across the room. I don’t have to
put lenses in or out of my eyes anymore. I even read the fine print
of a fortune cookie last night without the use of reading glasses.
And I’m still as amazed with the results today (six months after LASIK)
as I was the day after my procedure. I have experienced a miracle."
With so much good news about LASIK, it is somewhat surprising to discover
eye doctors at the Princeton Eye Group wearing eyeglasses. Why haven’t
they gotten on the LASIK bandwagon and undergone this procedure?
"That’s a question many of my patients ask," says Felton.
"My answer is: Just because a highway is there doesn’t mean I
have to use it. The truth is that I only wear eyeglasses for distance.
I like to operate on my patients without the need to wear eyeglasses.
Correcting my vision in such a way that it eliminates my need for
eyeglasses for distance may impact the clarity of my near vision.
And besides," he says, eyes twinkling, "my wife tells me my face
looks better with my glasses on."
Eye Group at 609-921-9437. Details about upcoming free seminars on
LASIK can be found on their website: www.princetoneyegroup.com.
See page 47 for details on the U.S. 1 Health and Fitness Fair
on Tuesday, June 27.
One website at www.surgicaleyes.org chronicles a number
of nightmare stories and is devoted to "focusing attention on
the problems recipients of unsuccessful refractive surgery undergo."
Another (www.allaboutvision.com) suggests "Tough Questions To
Ask A Refractive Vision Surgeon Before Choosing Who Will Do Your Surgery."
The desired responses come from the Council for Refractive Surgery
(At least 3 years.)
(Not less than 100.)
visual acuity of 20/40 or better, meaning, 20/40 without glasses or
contacts? (Be suspicious of a number greater than 90 percent.)
(Yes, here it is.)
Corrections or additions?
This page is published by PrincetonInfo.com
— the web site for U.S. 1 Newspaper in Princeton, New Jersey.