New Options Mean More Homework for Patients

Consumers now have so many ways to correct vision through surgery that they may ultimately regret their choice if they don’t do their homework first.

Besides the dominant Lasik, usually used for nearsightedness, and the new Sunrise Hyperion Laser Thermal Keratoplasty surgery for farsightedness, there are also corneal rings, improved lens transplants and the upcoming conductive keratoplasty.

“People tend to think that the new thing is now the best thing. But we are still going to be doing Lasik in five years,” says Dr. Jonathan Davidorf, a West Hills ophthalmologist. “You would hope that surgeons know all the options . . . so that they know what is best for that patient.”

That includes knowing about procedures that might be worth waiting for.

One such procedure for farsightedness is called conductive keratoplasty. Refractec, an Irvine company, is conducting final clinical trials for its device, which uses radio-frequency energy to shrink corneal tissue and correct farsightedness. Unlike Lasik, neither LTK or conductive keratoplasty involve cutting tissue.

“Both LTK and conductive keratoplasty are improvements in that we’re not invading the center optical zone,” says Davidorf, the lead West Coast investigator for conductive keratoplasty. “That is good for obvious reasons: We’re not making a flap [in the cornea] that can cause possible problems.”

There are no comparison studies yet among Lasik, LTK and conductive keratoplasty for treating farsightedness. But investigators of conductive keratoplasty say the correction may last longer than with LTK.

“Conductive keratoplasty uses radio waves to get deeper in the cornea, and we hope it will resolve the problem of the effect wearing off,” says Dr. Robert Maloney, who has participated in the clinical trials for conductive keratoplasty. “The short-term stability results look excellent. And we’re hopeful about the long-term results.”

Still other surgeons are enthusiastic about the use of corneal rings, which are small plastic crescents inserted in the cornea through an incision to treat very low levels of nearsightedness.

Another option favored by some surgeons is contact lens implants, in which lenses are inserted for correction of nearsightedness.

Leading refractive surgeons also say that some patients might benefit from a combination of procedures, such as LTK followed by Lasik to tweak the correction, or a lens implant followed by Lasik.

“We really have to counsel patients carefully because there are so many different ways to correct vision now,” says Dr. Brian S. Boxer Wachler of the Jules Stein Eye Institute. “Some doctors will offer them all and some will offer just one thing. It’s the patient’s responsibility to learn about the procedures and talk to doctors who know about more than just one procedure.”