Surgery to Correct Vision Still Troubled by Uneven Results
More than a decade ago, when American doctors began performing surgery to correct nearsightedness--a technique called radial keratotomy--the procedure seemed a godsend to the Mr. Magoos of the world.
With a scalpel, a surgeon would make a few well-placed incisions to correct the abnormal curve of the eye’s cornea, and supposedly many patients would no longer need glasses or contact lenses.
But radial keratotomy’s results are still unpredictable, according to its latest evaluation, published in the Feb. 23 Journal of the American Medical Assn.
Only two-thirds of patients can get by without glasses or contacts after surgery, according to a four-year follow-up of almost 400 patients, written by a dozen researchers who have been evaluating radial keratotomy at nine centers nationwide.
It offered some good news: The few complications that developed after the surgery were not serious. Two patients, for instance, who developed infections were treated successfully with antibiotics.
But many patients reported glare problems, complaining of seeing radiating lines around headlights and street lights after the surgery, which now costs about $1,500 per eye.
Despite those costs and imperfect results, local doctors report that requests for the operation still run high--and that a buyer-beware approach is best.
Before deciding to undergo the surgery, a patient should discuss risks and benefits thoroughly with a doctor, advised a spokesman for the American Academy of Ophthalmology, which considers radial keratotomy a “developing procedure. . . . It’s impossible to predict actual results in individual patients. Short-term results are frequently quite good, but long-term results simply are not known.” After surgery, vision can improve, then worsen again.
To improve chances of success, potential patients should ask a doctor how many such procedures he has performed, said Dr. Robert E. Fenzl, a Garden Grove ophthalmologist and associate clinical professor of ophthalmology at UC Irvine School of Medicine. “Most surgeons are very good after they’ve done 100 cases,” Fenzl said. “A brilliant surgeon might be good after fewer, but you’re pretty sure you’re safe with a surgeon who’s done more than 100.”
The surgery isn’t for every nearsighted person, doctors agree. Those with moderate to moderately severe nearsightedness are the best candidates, most doctors say. About 50% of patients who inquire about it aren’t good candidates, Fenzl finds. Some are too nearsighted; others have eye diseases, such as poorly controlled glaucoma, that make surgery undesirable. In the JAMA report, the authors estimated that 11 million American adults are eligible for the surgery.
In the future, there may be another option.
Fenzl and others are studying a surgical technique called photo-refractive keratectomy, or PRK, in which an excimer laser recarves the cornea and corrects its abnormal curvature.
POINT/COUNTERPOINT: New federal guidelines now advise all Americans--not just those at high risk for heart disease--to pay attention to their cholesterol intake. The government panel issuing the guidelines recommends that Americans keep cholesterol intake at less than 300 milligrams a day.
Even diet-conscious Americans who can easily quote calories and fat content of specific foods get confused by cholesterol, dietitians say. So how does one cope with the new guidelines? Some dietitians say learning how to keep tabs on cholesterol intake isn’t all that difficult; others say there is a way to keep cholesterol intake under control without even thinking about it. Here are their comments.
Jody Lander Spector, registered dietitian, St. Vincent Medical Center, Los Angeles:
“Even healthy people should pay attention to cholesterol content of foods. It’s not that difficult to learn how to minimize cholesterol intake. The first step is to become aware of very high-cholesterol foods, like eggs or organ meats such as liver. Next, learn the cholesterol content of favorite or commonly eaten foods. (See accompanying chart, “Where’s the Cholesterol?”) Finally, find out your blood cholesterol level. Many people assume they are not at risk without even knowing if their level is high or low.”
Bonnie Modugno, Marina del Rey registered dietitian:
“Focus just on reducing fat intake; it’s easier. The most significant action a person can take is to keep fat intake to less than 30% of calories and to pay special attention to reducing saturated fats such as those found in high-fat dairy products. If people do that, dietary cholesterol typically is lowered too. That’s because dietary cholesterol is found in high-fat animal products. For most people, focusing on fat reduction is just as effective as worrying about both fat and cholesterol intake.”
SHOPTALK: Newcomers at a health club can feel as intimidated as a 98-pound weakling on a beach full of bullies. They may feel out of shape, not to mention confused about how to operate weight-training machines.
To the rescue comes Beginner’s Break, a 35-minute video that gives neophytes a head start in the privacy of their own home.
“The tape takes you, beginning to end, through what you will experience in a gym,” said a spokeswoman for Health for Life, the distributor of the $29.95 tape. (Information: (800) 523-9983.) “It describes how to use most weight training machines, for instance, and what muscle groups each machine works,” she said. “It’s not going to take the place of a personal trainer, but it will reduce intimidation for first-time gym-goers.”
“The concept sounds good,” said Mike Trexler, associate director of continuing education for the Institute for Aerobics Research in Dallas. He has two other tips for new fitness buffs: “Go to a reputable fitness center with trainers certified by the Institute or the American College of Sports Medicine. Ask a trainer to take you through the machines.”
WHERE’S THE CHOLESTEROL? For most Americans, cholesterol is a confusing dietary issue. To cut down to 300 milligrams of dietary cholesterol a day, as federal guidelines advise, consumers first have to find the cholesterol.
Here’s help:
FOOD CHOLESTEROL Rib roast (4 oz) 96 mg Skinless chicken, white meat (4 oz) 96 mg Halibut (4 oz) 70 mg Egg yolk 213 mg Butter (1 tbs) 31 mg Safflower oil (1 tbs) 0 mg
(Four ounces is a typical serving.)
Source: Jody Lander Spector, registered dietitian, St. Vincent Medical Center, Los Angeles
