Vision Update

Ocular surgeons, those who operate on eyes, have been a very busy bunch. In 2006, it was estimated that 1.3 million people had elective vision correction via LASIK (Laser-Assisted In Situ Keratomileusis). That statistic is expected to increase annually as the surgery continues to gain popularity.

    “LASIK surgery is the most common surgery we offer at Eye Care Associates and also the most commonly performed elective procedure in the United States,” says Dr. Stephen Wexler, an ophthalmologist at Eye Care Associates of St. Louis. Wexler is anticipating new advances in LASIK equipment and techniques, but he warns patients to be cautious about embracing the newest thing.

    “As a consumer, remember that not all innovations in elective surgery pass the test of time,” he says. “Several procedures for vision correction have come and gone. As a conservative surgeon, I like to see objective scientific results reported in the medical literature before I undertake a new procedure.”

    Dr. Jay Pepose, medical director of Pepose Vision Institute, agrees. “Patients need to recognize that their eyesight is priceless,” he says. “Be sure you find a well-trained, experienced surgeon who knows exactly what outcomes can and can’t be achieved.”

That said, both Wexler and Pepose are enthusiastic about recent advancements in cataract surgery. Cataracts, which cloud the lens of the eye, are the leading cause of blindness, according to Pepose. “There’s been a lot of innovation in cataract surgery,” he says. “In the past, people who had cataracts removed were hospitalized and had sutures in their eyes. Now it’s an outpatient procedure that requires only local anesthesia and no stitches.”

    The incisions made during modern cataract surgery are so small they seal themselves without the need for stitches. During the procedure, the cataract is removed and an artificial lens is implanted. Patients walk out of the office with clear vision and can return to normal routines within a couple of days. Perhaps the most exciting innovation is the development of lenses that function like bifocals, allowing the patient to see both near and far without the aid of glasses.

    “People always were happy to have their vision restored, but now we can take the cataract out and also make you less dependent on glasses,” Pepose says. “It’s like combining cataract surgery with vision correction.”

    Another innovative procedure is being performed by Dr. Andrew Huang, an ophthalmologist with Washington University Physicians. Known as Descemets Stripping Endothelial Keratoplasty (DSEK), the procedure allows for suture-less corneal transplantation. The cornea is the eye’s transparent, dome-shaped surface that helps us focus. Surgeons used to perform complete transplants on damaged corneas using donor corneas. However, DSEK allows surgeons to transplant only a thin layer of corneal tissue instead.

    Huang notes that while corneal transplants require 16 to 24 stitches and a recovery period of 12 to 18 months, DSEK patients can recover within three months because the single layer of innermost corneal cells transplanted can bond to the eye without sutures. “The cellular layer is so thin that we are able to use a small air bubble to hold the cells in place until they adhere to the host,” he says.

    The only stitches placed are three or four tiny sutures that close the surface wound through which the implant is performed. “This has revolutionized corneal transplantation,” Huang notes, adding that a Washington University research team contributed to the procedure’s development and refinement.