Soviets Pioneer New Eye Treatment : Surgeons Use Heat to Correct Farsightedness, Astigmatism

A Soviet ophthalmologist may have brought good news to Americans who suffer from farsightedness and astigmatism. Post-operative results delivered by Prof. Svyatoslav Fyodorov to American eye surgeons this month indicate a procedure has been found to permanently correct these conditions. The procedure is called radial thermocoagulation.

“We’ve done 2,000 cases in the Soviet Union over a five-year period and have perfected the technique,” said Fyodorov, who has received many Soviet honors for developing RTK and other eye procedures. Most notably, he was recently awarded the Soviet Union’s highest non-military honor, the Hero of Labor, for his eye research.

At the annual meeting of the Kerato-Refractive Society in Dallas, Fyodorov presented a study he conducted at the Moscow Research Institute for Eye Microsurgery, which involved 959 RTK cases: “The six-month to four-year follow-up indicates that RTK can correct mild, moderate and severe hyperopia (farsightedness) and that the results are very predictable. The method is simple . . . it requires putting energy (heat) into the right place.”

Focusing the Rays

Fyodorov explained that a small metal probe is inserted into the cornea for 0.3 seconds and heated to 600 degrees Centigrade. The microscopic burns increase the curvature of the central cornea so that the light rays will be focused exactly on the retina. In the farsighted eye, they are focused behind the retina. The operation is painless and the only anesthesia required are eye drops and a mild sedative, he said.

According to Fyodorov, many types of energy were tested to find which produced the best results--heat, laser, shortwave and magnetic-field applications were performed on animals before human patients received the treatment.

“Heat applications are the most effective because this type of energy can not go through the cornea. It’s absorbed, and absorption creates new situations, which enable people to see better,” he said. “After proving RTK works, we are ready to give this technology to the rest of the world.”

Although the introduction of this surgery at the eye surgeons’ meeting took most members by surprise, one American surgeon was present with Fyodorov to confirm his findings. Dr. Andrew Caster, an ophthalmologist who practices in Beverly Hills, was recently in the Soviet Union and performed the procedure under the auspices of Fyodorov. Caster is the only American who has been trained to perform RTK.

“RTK works because it changes the shape of the cornea. The heat effectively penetrates the area and creates the necessary curvature,” Caster said. “Other procedures to correct hyperopia have been performed in the United States but these methods aren’t as reliable. When performed in the right pattern, RTK results in a decrease in farsightedness and astigmatism which appears to be permanent. This is an evolutionary procedure.”

To assist surgeons performing RTK, Caster said, computer programs have been developed to help determine the appropriate patterns: “There are a number of applications for this procedure . . . farsightedness with or without astigmatism, presbyopia (the need for reading glasses), overcorrection of radial keratotomy (a surgery that corrects nearsightedness) and improper strength of cataract implants.”

More Desirable Than Glasses

Caster said that some patients with presbyopia can have monovision so that they don’t need glasses for distance or reading. This type of correction can involve doing RTK on one or both eyes. Many middle-age and elderly Soviet patients find this solution more desirable than wearing glasses.

Fyodorov stressed other reasons for having the procedure done.

“I’ve seen many women in Russia who are over 30 get married right after they’ve had RTK. Probably in part because they don’t need glasses but also because these women can start wearing makeup. . . . They can see what they are applying. And these women now have beautiful sight.” Fyodorov said that the youngest Soviets to have RTK are 8-year-olds who have had “fantastic results.”

When asked about complications, Fyodorov said that the most common problem is undercorrection or overcorrection, which he said can often be eliminated with a second, fine-tuning procedure.

“The heat applications look bad directly after surgery, but they fade away quickly as the eye heals,” Fyodorov said. He said that RTK, which is done on one eye at a time, is extremely safe in the hands of the proper surgeon and that patients can return to work within a few days.

“Surgeons must be very attentive, clever. . . . They must have good equipment, good assistants, good climate in the operating room and most important, proper training.”

Reactions from the ophthalmologists on hand for Fyodorov’s announcement ranged from excitement to cautious optimism. “The concept is rational, conservative,” said Dr. Spencer Thornton, who practices ophthalmology in Nashville. “It has been shown to be very predictable in the hands of the pioneer of techniques in lens implants and radial keratotomy.

“It seems as though RTK will become an important procedure here in the United States, but I will go to the Soviet Union to study with Fyodorov before I do any such cases. . . . It’s very important that eye surgeons understand the new procedures even if they don’t plan to do them, so they can fully prepare patients to make informed decisions,” Thornton said.

More Questions

Ophthalmologist Britt Buckley, who practices in Colorado Springs, Colo., was curious to learn more about RTK: “The highlight of the meeting was correction of hyperopia. It’s very encouraging . . . my first impression was ‘He’s burning the cornea.’ But clinical photos and computerized photography show that the eyes stabilize very quickly.”

Miami surgeon Michael Hoff was more guarded in his response: “It’s too new for me, for my liking, and I’m someone who’s done a lot of RKs (radial keratotomy, a form of eye surgery to correct nearsightedness that was also introduced by Fyodorov). It does have practical applications, but before I did my first RK I waited until tens of thousands of cases had been done and the procedure had been studied carefully.

“I can’t imagine offering RTK to my patients until a lot more work has been done. But I do look forward with great anticipation to seeing what comes from this procedure,” Hoff added.

According to Dr. Frederic Kremer, an ophthalmologist who practices in Philadelphia, refractive surgery potentially benefits one-third of the population.

Fyodorov, who is responsible for the success of assembly-line techniques in the Soviet Union, is not worried that his procedure won’t be readily accepted: “I’ve been given $150 million by Gorbachev’s administration to build satellite clinics throughout the Soviet Union. . . . They are convinced the RTK will restore the vision of millions. That’s worth more to me than the money.”