WRITER: Amy Lillard
CONTACT: DAVE PEDERSEN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-8032; fax (319) 335-8034
Release: Dec. 15, 1999
UI department of ophthalmology and visual sciences expands its laser surgery
IOWA CITY, Iowa As laser surgery to correct vision problems increases
in popularity, the University of Iowa department of ophthalmology and visual
sciences has expanded its technical capabilities, enabling more patients to
The laser refractive surgery LASIK, or laser assisted in-situ keratomileusis,
is now approved by the Food and Drug Administration for a greater number of
eye procedures. The new capacities mean that around half of those patients
with hyperopia (or far-sightedness) and nearly all of those with myopia (or
near-sightedness) are eligible for the surgery.
John Sutphin, M.D., UI professor (clinical) of ophthalmology and visual
sciences, said these changes will help the UI Refractive Surgery Services
expand patient care opportunities.
"We can now offer LASIK to more people," he said. "The number of procedures
is growing because patients recognize the benefits of freedom from glasses.
For those with contact lenses, having 24 hour vision is more desirable than
12-14 hours a day."
Refractive surgery involving LASIK uses an implement called a microkeratome
that creates a flap in the corneal tissue. The flap is lifted up while the
laser reshapes the eye underneath to correct the distorted shape that causes
hyperopia or myopia. The surgery usually takes 15 to 60 seconds, with the
entire procedure for each eye lasting about 10 minutes, and results can be
seen within a day.
The procedure is growing in popularity, with more than 1 million surgeries
performed in the nation. In some areas of the United States, nearly one percent
of eligible patients undergo the surgery, Sutphin said. In Eastern Iowa, the
rate is probably nearer .1 percent, but it is growing rapidly, with the procedures
available at the UI and three practices in Cedar Rapids alone.
But with the growing popularity are signs of growing dissatisfaction.
Patients nationwide are reporting ineffective surgeries, as well as added
discomfort or, in rare instances, permanent decrease in vision. Dissatisfaction
is due in some cases to patient expectations, according to Sutphin.
"Some dissatisfaction is predictable because patients' expectations may
exceed the capacity of the surgery," he said. "Although we get around 93 percent
of participants to have 20/25 vision or better in at least one eye, there
will be a few who for various reasons still cannot attain that acuity. We
also know that low contrast acuity is one of the last functions to return,
so night driving and seeing well on foggy days can be difficult, especially
in the first year. Also, patients who have glare and haloes with contact lenses
or glasses will probably still have them after surgery."
Other factors can lead to unhappiness with laser surgery, Sutphin said.
"For example, not every patient is examined as closely by the operating
surgeon as we do here at Iowa," he said. "Sometimes patients are seen literally
for the first time while on the laser table. This is especially true of the
large laser vision correction clinic chains where networks of optometrists
feed patients into the centers, with all pre- and post-operative care done
elsewhere by non-surgeons. This may lead to inappropriate patient selection
and dissatisfaction when results are not perfect."
Another option in laser correction that has less permanence than laser
surgery but many of the same benefits is INTACS, which has recently been approved
for use at the UI. INTACS are paired ring segments placed through a small
incision in the peripheral cornea. The 20-minute outpatient procedure is advantageous
since the rings are removable and the procedure spares the central cornea,
Patients with a small amount of myopia are eligible for this procedure,
but there are also disadvantages. While the laser surgery is relatively painless,
the INTACS cause more discomfort, and it takes a little longer for patients
to see effects. Also, the procedure's long term effects are unknown.
Despite its growing popularity, laser corrective surgery may not be for