New Laser procedure at local eye center

In the low-lit room, a monitor showed a human eye. It took only a few seconds for a laser to move across the eye, leaving behind an explosion of bubbles. Around the room, nurses went about their work, and Dr. Marnix Heersink focused on his patient.

Heersink has performed LASIK surgery since the 1990s and cataract surgery since the 1980s. But this particular procedure was a fairly new experience for the Dothan eye doctor. Instead of using a blade, this LASIK procedure was done only with lasers.

“The laser is so precise,” Heersink said. “You get a very precise, perfectly aligned cleaner cut.”

All-laser LASIK, or bladeless LASIK, has been around for several years. The potential outcome is basically the same as traditional LASIK, an acronym for laser-assisted in situ keratomileusis. But it seems to be another step in the evolution of a procedure that has become more and more common.

At 29, Charla Rhodes had considered LASIK for years, but cost and fear about the outcome kept her from having the surgery. As the mother of three young children ages 3, 4 and 6, the elective surgery wasn’t a priority.

“I couldn’t even see the ‘E’ on the eye chart,” Rhodes said of her vision.

When Rhodes’ contact lens and eyeglass prescriptions reached a point that her lenses had to be special ordered and cost more, her husband suggested she reconsider the vision correction surgery. On April 28, Rhodes became part of Eye Center South’s study of the bladeless LASIK.

Heersink and Dr. Tyler Hall are using the all-laser technique for 60 days to look at patients’ outcomes and determine whether they want to continue using the technology. The particular bladeless technology Eye Center South is using is iLASIK (the brand name given by the company that markets that particular laser).

Rhodes’ vision was really cloudy for a couple of days after surgery. But she could see.

“I was able to see right away,” Rhodes said.

Since the 1970s, the number of Americans with myopia, or nearsightedness, has increased 66 percent, according the National Eye Institute. But even before the 1970s, eye surgeons have been trying to correct people’s vision problems.

The earliest vision correction surgery to reach the masses was radial keratotomy, or RK, in the 1980s. RK involved a diamond knife used to cut slits into the cornea and was followed by other vision correction techniques, such as photorefractive keratectomy, or PRK. But in 1998, the Food and Drug Administration approved the first laser for the vision correction surgery commonly called LASIK. Today, as many as 700,000 Americans have LASIK each year.

The cost varies with the surgeon and technology, but can range from $1,400 to $2,000 per eye. That hasn’t stopped patients who want more freedom from glasses or contacts.

No matter the type of technology, LASIK procedures are basically the same. A thin flap is created on the outer part of the cornea with a hinge left so the flap can be folded back. An excimer laser is then used to reshape the corneal surface under the flap. The surgeon replaces the flap, which basically heals itself over time without stitches.

Creating the flap is what differentiates one laser technique from another. In traditional LASIK, a microkeratome blade is used. In bladeless LASIK, the flap is created with a laser keratome, which is different from the excimer laser used to reshape the cornea.

Use of the second laser adds to the cost of the procedure and requires the doctor to move the patient from one laser to another during surgery. But Heersink said he’s hopeful that the future will bring one laser that can create the flap and repair vision.

Both Hall and Heersink said they have been impressed with the outcomes of the all-laser LASIK. Patients have been healing faster, with less pain and gaining vision quicker, Heersink said.

“It’s really about the expectations the patients have,” Hall said.

LASIK has a high success rate, but like any surgery there are risks. Patients could experience glare, halos or starbursts around lights and increased sensitivity to light, according to the American Academy of Ophthalmology. Other side effects include hazy vision, poor night vision, and dryness of the eyes and reduced sharpness of vision. There’s a small chance that a patient’s vision will not be as good after surgery even with glasses or contacts. Patients may still need glasses later as their vision changes with age, and some people may not be good candidates for LASIK.

The Food and Drug Administration has partnered with the National Eye Institute and the Department of Defense for the LASIK Quality of Life Project to examine patient outcomes. The project is currently in its third phase and should assist doctors and patients in making better decisions about the surgery.

While the FDA only regulates the lasers and not their use, the agency does provide information on its website to help consumers decide if LASIK is right for them.

“The success of LASIK both in its aggressive marketing and in its success creates an impression of its infallibility that does not exist,” said Glenn Hagele, executive director of the Council for Refractive Surgery Quality Assurance.

The council certifies doctors and provides consumer information on LASIK and other vision correction surgeries. Hagele himself had PRK done to correct his own vision but describes the council as neutral when it comes to whether or not people should have such procedures.

In a survey conducted by the council, 99 percent of LASIK patients said their quality of life after LASIK was as good as or better than expected, and 98 percent would recommend the surgery to family and friends. Ninety-seven percent would have the surgery again, and 96 percent reported that their overall vision without corrective lenses was as good as or better than expected compared to their vision before surgery.

The all-laser LASIK is more appealing to patients who fear the blade, Hagele said, but its higher price tag could keep it out of reach for many patients. The responsibility lies with doctors, Hagele said, to make sure patients understand the risks and have realistic expectations.

“Every good surgeon has had a bad outcome,” Hagele said. “There is always going to be an element of risk, although relatively small.”

Charla Rhodes is happy with her results. The day after her surgery, she drove herself from her home in Fort Rucker to her follow-up appointment in Dothan. Not even a month after her surgery, the cloudiness in her vision has continued to improve. She wakes up with dry eyes and uses drops in the mornings. She compares the dryness to waking up after falling asleep in her contact lenses.

“Every morning I think, ‘Darn it, I slept in my contacts again,’” Rhodes said. “I just can’t get over the fact I don’t need them anymore. And I still reach for my glasses in the morning.”