VISIONARIES

By ROBYN NORWOOD

April 25, 2000 12 AM PT

Times Staff Writer

Greg Maddux lay on an operating table last July as an Atlanta eye surgeon leaned over the Braves pitcher and used an instrument called a microkeratome to slice a thin flap on the cornea of the four-time Cy Young Award winner’s eye.

With Maddux awake but immune to pain because of numbing eyedrops, Dr. Alan Kozarsky peeled back a sliver of the cornea, the transparent tissue that covers the iris and pupil. Creating a flap that looked almost like a contact lens still hinged to the eye, he then used a computer- controlled laser to reshape the exposed part of the cornea in about 30 seconds.

The surgeon carefully replaced the flap, removed the device that held the eye open, applied antibiotic and anti-inflammatory eyedrops and proceeded to the other eye.

In about 15 minutes--a while longer than it usually takes Maddux to retire a side-- Kozarsky had corrected vision once so poor Maddux jokes that when he used to throw on off-days without his contacts, “I could see the catcher, but I wasn’t sure who was catching me.”

Two days after the surgery, Maddux pitched for the first time without the contacts that used to itch and make him want to rub his eyes during games. He gave up one run over eight innings in a victory over Boston.

“It was the first time I didn’t come out of the game and go take my contacts out,” said Maddux, who used to wear librarian-like glasses when he wasn’t on the mound and calls the surgery “easily the best thing I ever bought myself.”

“I didn’t mind wearing glasses. I hated contacts.”

The American Society of Cataract and Refractive Surgery estimates that 750,000 people this year will undergo the laser eye surgery known as LASIK, an acronym for laser in-situ keratomileusis.

Professional athletes are turning to laser eye surgery with increasing frequency, and though many report extremely positive results, it is not without risk.

The chances of blindness are remote, but up to 5% of patients experience such complications as blurred vision, “ghosting,” glare, halos or poor night vision. Serious infection occurs in 1 in 5,000 patients. Up to 15% require a second procedure or “enhancement.” And less than 1% emerge with vision that even with contacts or glasses is not as good as their corrected vision was before surgery.

But the nightmare case of a prominent athlete’s career being affected or even ended by complications from laser eye surgery hasn’t happened.

“I’ve got to say, fortunately, no,” said Dr. Mark Whitten, the Bethesda, Md., eye surgeon who performed LASIK surgery on Tiger Woods last year. “I’m sure it will happen in the future. It hasn’t happened yet. I’m sure it will, if enough are done.”

Kozarsky echoed Whitten.

“It’s going to occur eventually. Statistics catch up,” Kozarsky said.

The key to limiting risk is careful screening of candidates, as well as surgical skill.

“You have to pick the right people,” Whitten said. “You can’t pick people with huge pupils and a huge prescription. You can’t willy-nilly do anybody and not take a look at the patient first. That’s how we avoid problems--before they start.”

The number of athletes choosing to undergo laser eye surgery is growing rapidly.

Tired of the irritation and unpredictability of contact lenses-- from problems with wind, dust or pollen to shifting lenses and dryness--athletes from an array of sports have undergone LASIK surgery.

Woods had the procedure in October to correct nearsightedness so severe that without contact lenses, he couldn’t see the big E on the eye chart--or even see the chart at all.

After the surgery, Woods won his next five tournaments, part of his stunning six-tournament PGA streak.

“I certainly can’t take credit for any part of his golf game,” Whitten said. “I can only say when you don’t have to think about your vision any more, it gives you the ability to think about other things.

“If there’s wind, rain, or you’re in a sand trap and there’s sand flying around, if you have allergies, if your contact lens moves, that all clouds your mind. I believe this surgery gives you freedom to move on to something else.”

Houston Astro all-star Jeff Bagwell underwent LASIK surgery in December.

Seventeen games into the season, he is batting .323 with six home runs.

“My whole goal in this thing is, when you wear contacts, you see 20/20, but you don’t see 20/20 all the time,” Bagwell said. “They move, and you get dust and the junk that’s in your eye on the contacts.

“I tell people I think I lost 50 at-bats a year because of that. That’s a lot.”

Professional golfer Laura Davies had the surgery in February, shot a 67 the next day in the first round of the L.A. Women’s Championship at Wood Ranch Golf Club in Simi Valley and went on to win the tournament.

“In the past, the ball was just a haze,” said Davies, who had been playing without contacts or glasses, sometimes asking her caddie where to aim. “I literally couldn’t see the edge of the hole.”

Golfer Jesper Parnevik was debating the surgery two weeks ago, expressing concern about how little is known about the effects of the relatively new procedure in 25 or 30 years.

He went for a consultation last week and underwent surgery the same day.

“For people who wear contacts and glasses, it’s just amazing how much better I can see,” said Parnevik, who struggled so much with pollen when he wore contacts he often stood over putts he could only see with one eye.

“It’s weird to just brush your teeth and not have to fuss around with contact solutions,” he said.

Three days after the surgery, he shot a first-round 69 in the Greater Greensboro Classic. He finished tied for eighth.

Important warning: Your results may vary.

If you struggle to break 100 before undergoing LASIK surgery, said Gary Jonas, an executive vice president for industry-leading TLC Laser Eye Centers, then after the surgery, “I would say you’d probably shoot about 100 or more.”

Whether the surgery can actually enhance performance or not, the list of sports figures who have had laser eye surgery is impressive, from golfers Woods, Davies, Se Ri Pak, Steve Elkington, Fred Funk, Mark Brooks, Hale Irwin and Tom Kite to baseball players Maddux, Bagwell, Wally Joyner, Al Martin, and retiree Wade Boggs.

Basketball players include Patrick Ewing and Matt Geiger. In football, Troy Aikman, Gus Frerotte and Rodney Peete. In hockey, Jeff Reese and Bob Rouse. Among race-car drivers, Jimmy Vasser and Bryan Herta. In soccer, Marco Etcheverry. Among Olympic gold medalists, Derrick Adkins, Charles Austin, Tom Dolan and Amy Van Dyken.

While we’re at it, throw in UCLA football Coach Bob Toledo too.

“I watch so much tape, so many hours, I used to have to wear my glasses sometimes and then go put in my contacts. It was a hassle,” Toledo said. “There are times in games when the wind comes up, and one time the contact blew out of my eye.

“I took a chance after wearing contacts for 26 years. I was tired of it. It went great. Painless. Piece of cake.”

Comfort or Competitive Edge?

What explains sports figures’ openness to a relatively new surgery much of the population still views with wariness?

It might be partly that the approximate $5,000 cost for both eyes is no obstacle to wealthy athletes--and in fact many get the surgery either free or at a greatly reduced rate.

Perhaps more important is that athletes compete under circumstances that often cause problems with contacts, and they also make high demands of their vision.

“The nature of athletes is competition. I think their instincts are to optimize any competitive advantage,” said Dr. Bob Lingua, the Brea eye surgeon who performed procedures on Davies and Peete, the NFL quarterback from USC.

“They’re already tuned in to the best clubs, the best putter, the best ball. It’s ‘How can I make myself any better to compete better?’ Clearly having great vision is one of the best competitive advantages you can have.”

But does laser eye surgery actually give athletes an advantage?

Dr. Robert Maloney, a Los Angeles eye surgeon, believes the procedure contributed to the improvement of baseball player Jose Offerman after he left the Dodgers and points out that the surgery sometimes provides vision better than 20/20, as well as improved depth perception.

“We’ve heard stories over and over of better athletic performance after LASIK,” Maloney said.

Maddux isn’t so sure.

“I don’t think for one second it made me a better baseball player,” Maddux said. “Not for one second. I did it strictly for personal reasons and convenience. Quality of life. It turned out better than I ever thought.”

Even if his new 20/16 vision isn’t what makes his fastball move, Maddux acknowledges that not wearing contacts has an effect.

“I don’t think there’s a big physical advantage, but I do think there’s a big mental advantage,” he said. “And if you ask people what percentage of their game is mental, they almost always give you a number. Some say 20%, some say 90%, but they always give you a number.”

The implications vary not only from sport to sport--not wearing contacts helps a swimmer in a different way than a race-car driver--but also from position to position.

“As a pitcher, you’re just looking for a couple of fingers,” Bagwell said. “As a hitter, you have to see spin and depth, all those kind of things.”

But the biggest issue is probably simply eliminating the unpredictable glitches that come with wearing contact lenses-- problems caused by such things as wind, dust and dryness.

“The count might be 2-2, everything’s great,” Bagwell said. “Then all of a sudden it’s 2-2, the guy’s in his windup, your contact moves a little bit, your eye twitches and the next thing you know, everything starts to get a little blurry.

“What I used to do is I would swing, automatically. I think it was like a fear thing, I didn’t know what was going on, and I’d swing at whatever I saw. Some people’s instinct would be to take it; I’d do the opposite, I’d just swing.”

Even after the surgery, there are adjustments that have to be made.

Bagwell had the procedure in the off-season and did well with it in spring training. But the first few games of the regular season, he admits, his vision wasn’t as good as he hoped.

“They were just a little blurry. I’d see well in spurts,” he said. “I won’t lie to you, it worried me a little bit. I went back to the doctor and had him check my eyes out again and he said, ‘I don’t see anything wrong. It shouldn’t be a problem.’ Then after that I went back out and everything’s been terrific.

“I really think it was just my eyes getting adjusted to playing at night. Like I said, we didn’t play at night during the spring.”

Joyner, a teammate of Maddux with the Braves, had the surgery in 1998 and says he couldn’t have found the plate without contacts or glasses. His vision went from severe nearsightedness he jokes was “20/3,000” to 20/15 in his right eye and 20/20 in his left.

“I saw 20/20 with my contacts, but that was with the way my muscles worked with contacts,” he said. “Now after this surgery, there are times when there are problems with depth perception. You have to train your eyes to see the way you want to see. I did some therapy after the surgery so I would start to focus quicker and crisper.”

The depth perception might be one of the most fascinating aspects of the surgery.

“Golfers get a different three-dimensional view of the green after LASIK,” said Whitten, who performed the procedure on Woods, Parnevik and Funk among others and also has had the surgery himself. “I’m able to see footprints on the green. You can see the grain. You don’t have to worry about which way the sun is making the grass grow. And you can see small indentations. It’s different. LASIK actually produces, instead of a spherical cornea, an aspherical cornea. It may be better [than normal vision].”

As if Woods needed another advantage, Whitten also says the surgery actually makes the cup look bigger to Woods.

“Nearsighted people see things smaller than a normal person. They just don’t know it because they’ve lived their entire lives with it like that,” he said. “So after the surgery, to someone severely nearsighted like Tiger, it looks huge. You can imagine someone with his skill level when it looks twice as big. He says, ‘I can make every putt.’ ”

Not for McGwire

One player who won’t be getting laser surgery--at least not before the end of his career--is Mark McGwire.

McGwire struggled for years to find the right contact prescription for his combination of nearsightedness and astigmatism.

It has worked out pretty well for the home run champion, so he’ll stick with it.

“Any ballplayer who can wear contact lenses comfortably that provide vision 20/20 or better, you don’t want to take the chance,” said C. Stephen Johnson, the San Ramon optometrist who has been treating McGwire for 11 years. “It could be a career-ending decision.”

McGwire’s vision is about 20/600 without contacts. Uncorrected, he can count fingers at about six feet--and can’t make out the pitcher from the batter’s box.

His custom-designed contacts are so precise that at times it has been difficult to find a manufacturer who could reliably produce them. Even now it takes two or three pairs of contacts to find a pair that is usable.

“We’ve been able to design contact lenses that correct his vision comfortably to 20/10,” Johnson said. “They’re also custom-tinted with a yellowish ‘sport tint,’ like shooting glasses for skeet shooters. It allows you to see the ball crisper and sharper and reduces glare, complementing the prescription.”

McGwire and Johnson discussed laser surgery before spring training, and they agreed once again: It’s not worth the risk.

“The risk [during his career] is high he wouldn’t get to 20/10,” Johnson said. “He might get to 20/20, but that’s not good enough. Plus the tint we put on them enhances the prescription even more.

“He didn’t have a real desire to pursue it. . . . He’ll wait till the end of his baseball career.”

Contact lenses can be problematic, but McGwire has perfected his approach.

“His eyes are chronically dry. You see him at the plate, he might blink his eyes and then kind of hold them open. That means they’re set perfect,” Johnson said. “He instinctively learned to do that.”

Though Johnson advised McGwire against surgery, he has recommended it to other patients.

“I’m not an opponent of laser surgery. If the vision can be as good or better than contact lenses, I totally support it,” he said. “But if contact lenses are comfortable and effective without complications, I’d look carefully at laser surgery.

“If we’re thinking of the athlete, and we should be, you don’t do that. If the results are marginal and they can wear contact lenses, it could be a career-ending decision.”

What Can Go Wrong

To get an unnerving sense of the risk involved in laser eye surgery, it is only necessary to visit the Web site of the Surgical Eyes Foundation at https://www.surgicaleyes.org.

There one will find testimonials posted by “Barry,” “Bill,” or “I Did Everything Right and Still . . . “ that tell of debilitating complications of LASIK such as haze, starbursts in dim light, “ghosting” and flap dislocation.

The site also includes simulations of how various complications of LASIK and other refractive surgeries affect vision, as well as brief biographies of the foundation’s executives and board of trustees, all of whom suffer from complications.

“I’ve heard some horror stories,” Maddux said. “But all the horror stories I heard were from people whose eyes were really bad going in.”

That’s partly because the higher the refractive error--the higher the prescription, that is--the higher the risk. (In some cases, that is a reason not to have the surgery. Farsightedness combined with astigmatism is why a receptionist in Lingua’s office still wears glasses, awaiting new technology capable of correcting her vision.)

Although golfer Irwin is pleased with the results of his LASIK surgery, his daughter, Becky Meyer, had complications because of a wrinkled flap and has double-vision in her left eye.

“I’m so pleased with my right eye and so displeased with my left,” said Meyer, who has undergone a second procedure to try to fix the problem and expects to undergo another. “I had very bad nearsightedness. I think for people whose eyes are worse, there’s more risk.”

Another risk factor is unusually large pupils, which can lead to a permanent halo effect.

Diabetes, glaucoma, pregnancy and autoimmune disorders such as lupus or AIDS are contraindications for the surgery. Young, healthy athletes who are nearsighted are often good candidates.

But potential patients need to be aware of many issues as they consider refractive surgery. Up to 15% will require a second procedure or “enhancement” to achieve the desired vision--Woods was at a 20% risk of needing a second procedure because of the severity of his nearsightedness, but didn’t require a follow-up.

Then there are the cases in which the surgery produces vision that is not as good as the vision corrected by glasses or contacts was before surgery.

“I think, first of all, people need to recognize that the goal is to be able to function [without glasses or contacts],” said Brian S. Boxer Wachler, director of the UCLA Laser Refractive Center at the Jules Stein Eye Institute.

“You can’t guarantee perfect vision. People who insist on perfect vision, that’s kind of a red flag. The reality is most people don’t need perfect vision to do everything they need to.”

The needs of athletes are often more exact.

Boxer Wachler also points out that there are options other than lasers, especially for an athlete who is vulnerable to eye trauma such as a boxer.

The solution for boxer Everton Davis was new removable corneal implants known as Intacs, approved last year by the FDA.

The common experience of almost everyone who considers eye surgery is fear.

“You’re messing with somebody’s vision,” said Joyner, who finally decided to go ahead with the procedure because of advances in technology in recent years.

“My first question was, ‘How safe is it?’ Obviously, my profession along with others is based on being able to see. The doctor I went to looked at me and said, ‘I had it five years ago.’ ”

One of the remarkable aspects of the procedure is that when it’s over, patients can see immediately.

“There was a clock in the room and they said, ‘What time is it?’ ” Joyner said. “And I said, ‘9:27.’ And they said, ‘Another successful surgery.’

“It’s like any surgery,” Joyner said. “It’s minor until you’re the one having it.”

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Some Sports Figures Who Have Had Laser Eye Surgery

Golf

Tiger Woods

Laura Davies

Se Ri Pak

Steve Elkington

Fred Funk

Mark Brooks