European Stars and Stripes (Newspaper) - November 05, 1991, Darmstadt, Hesse                                Mem doctors Experiment with laser surgery for nearsightedness by Sandra Blakeslee the new York times hoping to throw away their glasses and Contact lenses More than a thousand nearsighted americans have had their eyeballs reshaped in an unusual procedure in which a laser beam trims away part of the Cornea the Clear layer that covers the Lens. It is still too soon to recommend the procedure Tor wide use ophthalmologists say but results Are promising. Researchers testing the new technique said at a conference last month that 85 percent of the myopic volunteers who have undergone the procedure see Well enough six months after the laser surgery to drive a vehicle without using their Normal corrective lenses the researchers said. The rest still need glasses or contacts but not such Strong ones. Results so far Are encouraging said or. Walter Stark professor of ophthalmology at Johns Hopkins University in Baltimore and a principal investigator of the technique photo refractive karate Tomy. Quot but we should be rightfully cautious Quot he said. Quot nearsightedness is not a disease. The safety and effectiveness of the surgery have to be absolute before we recommend it to the  in the current trial which began in 1990, 1,000 Young adults with average cases of myopia have undergone the experimental surgery. Another 1,000 people will have the procedure in the next two years at 30 research centers around the country Stark said. All the volunteers will be followed for at least two years. The food and drug administration which is sponsoring the trial is expected to announce final results in late 1994. Surgical treatment for nearsightedness or myopia is generating Lively debate among ophthalmologists who Are cautious about performing invasive medical procedures on healthy eyes. At the annual meeting of the american Academy of ophthalmology held in Anaheim calif., in october sessions on laser surgery for myopia attracted standing room Only crowds. Doctors said that if the surgery proves Safe and effective demand from patients will be heavy. Sixty million americans Are nearsighted said or Carmen a. Puliafito chairman of ophthalmology at Tufts University school of Medicine in Boston. Quot this is a surgical procedure that could treat myopia in a single treatment with 20 seconds of laser exposure time Quot he said. Quot ultimately it could be the most common procedure performed in Medicine Quot nearsightedness occurs when the Cornea improperly bends incoming Light. Instead of falling on the Retina the focal Point Falls Short causing Distant objects to appear fuzzy and blurred. Glasses and contacts work by altering the Way Light is Bent so Light rays focus on the Retina. Another Way to Correct vision is to change the shape of the Cornea. About 5 percent of ophthalmologists perform a surgical technique called radial Kera Toomy Stark estimated. Eight deep slits in the Cornea Are Cut to flatten the Eye and change the Way Light is Bent. He said most ophthalmologists do not recommend it As Quot this severely weakens the  the new laser technique is a potential replacement for radial Kera Toomy said Puliafito. Quot the structural integrity of the Eye is not affected Quot he said so the technique is More elegant and perhaps safer. Many practising Eye doctors level identical criticism at laser surgery and radial Kera Toomy Why Cut or Zap your eyeballs to treat nearsightedness that can be easily corrected with glasses or Contact lenses a having this done on your eyes to get rid of your glasses is nonsense Quot said Tom l. Johnson an Oklahoma City ophthalmologist. Quot Why take a healthy myopic Eye and expose it to surgery Quot while the laser used in the new technique is not considered suitable for treating farsightedness other laser techniques Are being explored for the condition said or. George o. Waring a professor of ophthalmology and director of refractive surgery at Emory University in Atlanta. Most lasers which Are beams of highly concentrated Light create High temperatures and significant Thermal damage when they Cut he said. The exciter laser which cuts without producing Thermal damage can remove Small amounts of tissue without damaging surrounding tissues. The laser was first used in Medicine to remove scars from Corneas Waring said and is now being used to treat several kinds of Eye damage. Then experts got the idea of using the laser to scan the Cornea map its Topography and then flatten the entire surface with a 20-second blast said Waring. The myopic Eye which is abnormally elongated is literally re sculptured. In the procedure Waring said a patient is lightly sedated and Given drops to numb the Eye. The Eye is kept open with clamps As a machine measures the re tailoring curve off the Eye in nearsightedness Light rays Are focused too far Forward in the Eye. Original curvature of Cornea Light rays in myopic Eye ski my ejected fragments of Cornea epithelium. A v-4 a a a in Quot <1%. Its 4 is 1 1 ass exciter laser beam exciter laser Cornea source America Academy Al ophthalmology epithelium removed in Center new flatter curvature of Cornea in experimental surgery a Cool laser produces Shock Waves that fragment ize part of the Cornea. The outer covering is shaved off and the Center is flattened. The new shape focuses Light on the Retina. Not Eye and calculates the amount of the Cornea that should be removed. The ophthalmologist then shaves off the Center of the epithelium of the Eye a layer about five cells thick Waring said and Aims the laser at the Cornea. The actual surgery takes 20 seconds. From 20 to 40 microns of material is removed from the Cornea which is about a Quarter of an Inch or 550 microns thick Waring said. When people have astigmatism created by irregular corneal surfaces the laser can Correct the condition by removing tissue from key spots. Because the epithelium and some corneal tissue grows Back after laser treatment Waring said the surgeon removes a Little extra material to compensate for that. For that reason the patient May be farsighted for a few weeks or months before vision becomes 2020. Patients experience considerable pain in the treated Eye for about a Day after the surgery Waring said but any discomfort tapers off in three or four Days. People report a sensitivity to Bright Light for several weeks. About half of Tho Volu Toora who have undergone the trial surgery have 20-20 vision several months later and 85 percent have 20-40, which is Good enough to drive a car without using corrective lenses Waring said. But until two years have passed he said it is too soon to say whether the effect is Long lasting. And it is not known what effects the procedure will have As the Eye Ages. The Best results have been achieved in people with mild to average myopia about 90 percent of the group Waring said. About 15 percent of the patients Are experiencing a regrowth of some corneal tissue Waring said and still need to Wear glasses. Many patients report seeing a significant Haze after surgery Stark said. In some cases people experience a permanent reduction in visual acuity he said. Other people report seeing a Halo around Bright lights for several months Waring said. Laser surgery for nearsightedness will Cost about $800 to $1,500 per Eye about the same As radial Kera Toomy Waring said. That could prove cheaper than glasses or Contact lenses in the Long run. Contacts offer advantages in sports and exercise by Sally Squires the Washington Post for the Quot four eyes Quot who like sports and exercise the question is. Quot do you work out with glasses or switch to Contact lenses Quot a recent  found that 81 percent of americans who Wear both glasses and Contact lenses prefer contacts when competing or working out. Quot Contact lenses can help an athlete see better and play better a said optometrist Donald Tieg of the Institute for sports vision in Ridgefield Conn. The advantage of contacts is that they Don t fog up during play. They also extend peripheral vision giving a competitive Edge Over Standard glasses whether an individual is playing football jogging or doing aerobics. Quot i really can t think of any sports except swimming or downhill skiing where the condition might be somewhat Adverse to wearing Contact lenses Quot said Frederick Brightbill clinical professor of ophthalmology at the Quot University of Wisconsin medical school in Madison. Contacts can of course occasionally get knocked out of the Eye during play. But that is rare because of the increasing use of soft Contact lenses which stay in place better because they Are larger and More pliable than the hard lenses a called rigid Gas permeable lenses. Today roughly 85 percent to 90 percent of Contact lenses Are soft. Quot the Gas permeable Lana a Are about two thirds the size of the Cornea Quot Brightbill said. A so they Are More Likely to be knocked off if the person wearing them is jarred or looks the wrong Way during a  hard or soft contacts can provide some Protection. The lenses distribute the Impact of being hit in the Eye across the surface and absorb some of the Force according to ophthalmologists. But they can to do much to protect the Eye from severe blows. A fast flying football or an Elbow Jab can cause the Contact Lens to skim across the Cornea producing a painful scratch. So Contact Lens wearers need to take the same precautions As other athletes in donning protective Eye Wear appropriate to their particular sport. In some cases prescription goggles or other sports glasses May be the better Choice. The Speed of downhill skiing often dries out contacts and makes them uncomfortable to Wear Brightbill said. That s Why Many skiers who need glasses switch to prescription goggles. Swimming also can be Tough on Contact lenses hard lenses can easily be washed out in the Pool both types of Contact lenses can pick up bacteria even in chlorinated pools a that May cause infection Quot if you Wear Contact lenses in the poo remove and sterilize them after you get out Quot said James v Aquavella clinical professor of ophthalmology Al the University of Rochester school of Medicine and dentistry. But what about those who use sex landed Wear lenses a the kind that Are not cleaned and sterilized but Are worn for Days and then discarded Quot Don t open your eyes while swimming under water Quot Aquavella said. Also keep eyes shut in the Shower where soap shampoo and bacteria from hair eyelids and skin can was Hanto Tho eyes and Lodge in the Contact lenses he said the Best bet is for athletes who Wear Contact lenses to be prepared Quot have a spare Lens Case and spare contacts with you Quot Aquavella said Quot when in doubt take them out Quot Page 14 b the stars and stripes tuesday november 5, 1991 the stars and stripes b Page 15