EYE SURGERY
"In 20 years of wearing contact lenses, I've never been able to see this clearly," she said.
It's a problem she'd been living with a long time.
"They knew something was wrong," she said, "when my mother came to get me at kindergarten class and I couldn't see her standing in front of me."
At 12, Todd went from glasses to contacts, and through the years has tried soft contact lenses, hard contact lenses and oxygen permeable lenses, all of which left her eyes red, irritated and painful.
"I never saw 20/20, even with contact lenses," she said. "People joke about being blind as a bat, but I was literally blind as a bat. When I woke up, every morning of my life, I had to reach for my glasses before I could see the clock."
Then, in the mid-'90s, the LASIK vision correction procedure was approved by the Food and Drug Administration. It seemed like a miracle cure for people who were nearsighted, farsighted or had an astigmatism. LASIK quickly became the country's most widely performed elective refractive surgery, surgery that refocuses light on the retina. Millions of LASIK procedures are performed every year now, and the satisfaction rate remains high.
But it wasn't an option for Todd.
"I have dry eyes and large pupils and my corneas weren't thick enough, so I wasn't a candidate for LASIK," she said. "I felt alone, like there was no option for me, and I almost gave up."
But then Todd's doctor offered a ray of hope. He told her about the new surgically implantable lens that was being used as an alternative to LASIK for nearsighted people.
The Visian ICL (implantable collamer lens) was created by STAAR Surgical in Monrovia, Calif., and approved by the FDA in December 2005. It is designed to help people with moderate to sever myopia - the medical term for nearsightedness - who might not be candidates for LASIK or might be hesitant about the permanence of the laser procedure.
"This is the biggest advance since LASIK," said Dr. Brian Boxer Wachler, a Beverly Hills ophthalmologist who performs both procedures. "I've seen a big shift in my practice, about a 20 percent decline in LASIK in favor of the lens."
Both LASIK and the lens implantation are elective procedures that take about 20 minutes per eye. Both are done on an outpatient basis with the patient fully awake.
During LASIK, a flap is created in the outer layer of the cornea and folded back while a laser reshapes the underlying tissue. The flap is then replaced and the reshaped cornea does a better job of focusing light for better vision. The procedure permanently alters the shape of the cornea.
In the implantable lens surgery, the small, foldable Visian ICL is inserted behind the iris over the eye's natural lens through a tiny incision. Once inside the eye and properly positioned, the lens works much the same way a traditional contact lens does, by refocusing light for better vision, but it works from inside the eye.
Boxer Wachler said the lens implant is preferable to LASIK in many instances because it doesn't permanently alter the shape of the cornea, offers a faster recovery time, provides sharper vision and avoids the risk of side effects such as dry eye, glare and light halos.
Another advantage of the lens implantation over the LASIK procedure is that once a cornea has been reshaped by the LASIK surgery it cannot be donated later in life for use as a transplant. And the LASIK procedure makes it harder for doctors to determine correct lens specifications during cataract surgery, something doctors say everyone eventually will need as they age.
One disadvantage of the ICL procedure is that it is slightly more expensive. Boxer Wachler charges $3,150 per eye for LASIK and $4,250 per eye for the ICL. Being both procedures are elective, neither is covered by insurance. And although the ICL looks like an attractive alternative to LASIK in many ways, it corrects for only one distance.
Like LASIK, the ICL procedure is not without risks, which is why some ophthalmologists remain skeptical of the new technology.
"It's a good idea, but my personal preference is to continue to do LASIK for two reasons," said Dr. Aarchan Joshi, an ophthalmologist who runs the South Bay Eye Institute in Redondo Beach, Calif. "LASIK is an exterior procedure. The (lens implant) is an interior procedure. Every time you enter the eye for an interior procedure, you risk devastating eye infection. And the first generation of these lenses caused cataracts. I would not want to risk subjecting someone to medically caused cataracts.²
According to Boxer Wachler, the ICL is now in its fifth generation and the cataract problem has been worked out. As for infection, he said that of the more than 50,000 ICL implants that have been done so far, he is not aware of any infection having occurred.
So will the implantable lenses replace LASIK for people who suffer from nearsightedness?
"Not likely," said Dr. Jeffrey Weaver, clinical care director for the American Optometric Association. "LASIK is well-entrenched, and it keeps getting perfected. The bottom line on this issue is that the more options that are available to correct refractive error, the more likely it is that there will be something to help every patient. We have to see how all this new technology advances."
Weaver and Joshi agree that the exciting new technology to watch is the multifocusing IOL (intraocular lens). The multifocus IOLs, also called accommodating lenses, are implantable lenses that can correct vision at near, midrange and far distances. They eliminate the need for bifocal and trifocal glasses, have been approved by the FDA, and frequently are used in cataract surgery.
But use of these lenses requires surgical removal of the eye's natural lens. How all the new technologies pan out remains to be seen. But for Todd, who had the ICLs implanted in June, the new lenses are a godsend.
"I can go swimming now and not worry about opening my eyes underwater," she said. "I can wake up every morning, open my eyes and see the clock. It has changed my life."
Greater Paramus News and Lifestyle Magazine
http://www.paramuspost.com/article.php/20060903150658796