Cutting Edge Technology for Correcting Vision

How Lasik Surgery Works

Not For Everyone

Stephen Felton

Need a Closer Look?

Corrections or additions?

This article by Vivian Fransen was published in U.S. 1 Newspaper on June 14, 2000. All rights reserved.

The Low Down on LASIK

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Cutting Edge Technology for Correcting Vision

E-mail: Vivian.Fransen@princetoninfo.com

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

thousand dollars.

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."

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How Lasik Surgery Works

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.

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Not For Everyone

"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

older adults.

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

correction."

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Stephen Felton

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

an engineer).

"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."

For more information, call Denise Pichey of the Princeton

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.

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Need a Closer Look?

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

Quality Assurance.

1. How long have you been performing refractive surgery?

(At least 3 years.)

2. How many procedures have you done? (Not less than 500.)

3. How many of my particular procedures have you done?

(Not less than 100.)

4. What percentage of your patients have achieved uncorrected

visual acuity of 20/40 or better, meaning, 20/40 without glasses or

contacts? (Be suspicious of a number greater than 90 percent.)

5. May I have a list of 10 previous patients I can contact?

(Yes, here it is.)


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