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Near- and Far-Sightedness
No two sets of eyes are the same. Some eyeballs are too long, or have too much focusing power, causing myopia (nearsightedness). Others are too short, or have too little focusing power, causing hyperopia (farsightedness). Some eyeballs have uneven curvature, called astigmatism. Ways to correct such “mechanical” problems include eyeglasses, contact lenses or refractive surgery. Other vision problems are caused by disease or injury, and are not correctable by these means.
Increased Nearsightedness among Americans
A study released in late 2009, conducted by the National Eye Institute, shows that the rate of nearsightedness, or myopia, in Americans has increased from 25% in the ‘70s to 41% this year. The study included people with a range of myopia from mild to severe. Myopia occurs if the eyeball is too long or if the cornea, the clear lens in the front of the eye, is too curved. Under these conditions, the eye can’t correctly focus the light entering the eye, making distant objects look blurry. Typically, myopia occurs in childhood and can continue to worsen until early adulthood.
The study did not point to specific causes other than to note that the increase may be due to genetics, poor outdoor lighting and an increase in close eye work done on computers, video games, and interactive digital tools, such as texting. Improved access to vision screening and treatment may also be a contributing factor.
The study’s author and research epidemiologist, Susan Vitale of the National Eye Institute, said more research is necessary, and that identifying the problem was an important step. Myopia is easily treated, but when so many people are impacted - perhaps as many as 40 or 50 million people - it could end up costing the U.S. about $2 to $3 billion annually to diagnose and treat. The three most common treatments are eyeglasses, contact lenses and refractive eye surgery, such as LASIK.
Eyecare professionals have debated the role of genetics in the development of myopia for many years. Some believe that a tendency toward myopia may be inherited, but the actual disorder results from a combination of environmental and genetic factors.
What can you do to help avoid becoming nearsighted?
- Spend more time outdoors so that your eyes have a chance to utilize their far vision function by looking at things in the distance.
- Take frequent breaks away from the computer screen and associated computing tasks to relieve your eyes from close work.
Commentary from Francis Price, Jr. M.D. “This is really an important study from the NEI. Over the last few years, many researchers in the United States have downplayed the association of reading/education with the development of nearsightedness/myopia. Many animal studies have shown nearsightedness can be caused by limiting vision tasks to things up close, or by imposing conditions of poor contrast. Likewise, a number of studies from Asia downplayed the old belief that genetics causes nearsightedness; instead, education was shown to be correlated, or linked, to myopia development. We have always thought that very high levels of myopia were caused by genetics. However, based on studies from Asia, education may also play a key role even in high levels of myopia.”
Laser Vision Correction
LASIK is an acronym for Laser Assisted In-situ Keratomileusis and has been deemed by the American Society of Cataract & Refractive Surgery and the Eye Surgery Educational Council to be a safe and effective treatment for a host of common vision disorders. Such disorders include myopia (near-sightedness), hyperopia (farsightedness) and astigmatism.
During the past ten years, LASIK has become the safest, most popular vision correction procedure ever developed. Since 1995, more than 10 million people worldwide have had their vision corrected through LASIK.
A number of laser manufacturers have developed laser vision correction systems approved by the FDA (Food & Drug Administration) in the U.S. Many of these systems have been upgraded over the years and are now in their 5th and 6th generation but only one was specifically designed for LASIK: the WaveLight ® Allegretto Wave ® Excimer Laser System. Designed and developed in Germany, its unique patented beam profile, eye tracking system and consistent results make it the laser of choice among some leading LASIK surgeons like Dr. Francis Price, Jr., founder of the Cornea Research Foundation of America.
The Ideal Candidate for LASIK
The individual should meet the following criteria and discuss them with their eye care professional:
- Be at least 18 years of age.
- Have a stable prescription for glasses or contacts for at least two years.
- Have adequate corneal thickness.
- Have naturally occurring myopia, hyperopia, and or astigmatism.
- Have no medical disease or vision impairment that could reduce the effectiveness of the procedure.
- Be adequately informed of the benefits and risks of the procedure.
- Have a desire to reduce their dependence on corrective eyewear.
- Have reasonable expectations.
What You Can Expect from LASIK
Following a LASIK surgery, the majority of patients with low to moderate levels of nearsightedness, farsightedness and astigmatism achieve 20/20 vision or better. That translates to being able to pass the vision portion of their driver’s license test without glasses or contacts and enables them to perform the daily tasks of life. (In Indiana the level of vision required to drive without glasses is 20/40.)
The majority of patients also report that the quality of their vision after LASIK is better than what they saw previously with their glasses or contacts. Each person’s goals are determined by their age and the general health of their eyes, and any special needs should be addressed candidly with the laser surgeon prior to surgery. If these goals are not fully reached after LASIK, an enhancement follow-up procedure may be able to be performed to further improve vision.
As with any surgery, there are post-operative instructions and steps to be followed as directed to ensure a complete and successful recuperation and results. LASIK, and related surgeries like PRK and advanced surface ablation, can also be used to treat nearsightedness (myopia), farsightedness (hyperopia) or astigmatism after cataract surgery, corneal transplants, other eye surgeries or corneal injuries.
Finding the Right LASIK Surgeon
The results of LASIK will directly relate to the overall experience of the surgeons and staff within a practice. To get optimal results, seek a surgeon who:
- Has completed fellowship training in LASIK
- Is a corneal specialist
- Is an active member of the American Society of Cataract and Refractive Surgery
- Is certified and trained on the latest laser technology
- Has a proven history of refractive surgery
- Understands the intricacies of laser vision correction
- Continually monitors surgical outcomes (LASIK results) and makes them available to patients
- Is able to provide continuity of pre- and post-operative care after LASIK
What can be done for extreme near-sightedness?
Implanting a small lens inside the eye is a very accurate way to correct extreme levels of near-sightedness and provide more functional vision. Two lenses are approved for this use in the USA, the Verisyse and the Visian ICL. The Verisyse was the first phakic intraocular lens approved for use in the USA; Dr. Price and the Cornea Research Foundation were participants in the clinical study that led to approval of the Verisyse lens. Currently, we are participating in a clinical research study to evaluate a foldable version, known as the Veriflex, which can be inserted through a smaller incision.
Veriflex Lens Implant Study & Verisyse
Lora Nehrig has one of the most challenging jobs in healthcare: she is an R.N. who works nights in an Intensive Care Unit, a place where patients, families and doctors interact frequently over life and death matters. Five years on the job, Lora loves the fast-paced environment and the close involvement with families facing challenging circumstances. Working nights has taken its toll on her eyes, however; they are often tired from the strain of reading and writing on computers under the turned-down lights of the evening shift.
When Lora was referred to Dr. Price she hoped to be a candidate for LASIK to treat astigmatism (a condition where images lose their sharpness and crispness). Having worn glasses since the third grade and contacts since the sixth grade, Lora’s eyes were often itchy, and dry. She was initially disappointed to find out that she was not a candidate for LASIK, but then was excited to be offered the opportunity to participate in a clinical trial for a new lens called the Veriflex lens.
The lens is for people under age 45 that are extremely near-sighted and it is foldable so it can be implanted through a small incision. Dr. Kathy Kelley is managing the study, just as she managed the earlier study of the Verisyse lens, which is rigid and goes through a larger incision.
Dr. Kelley explained to Lora that, in this trial, each patient will receive the investigational foldable lens in one eye and the FDA-approved rigid lens in their other eye. Participating in the study also provides a helpful chance for patients to benefit from this lens who otherwise might not be able to afford it.
Lora went home to think it over, and discussed it with the two physicians who had referred her to Dr. Price, and with her fiancée. Tired of reaching for glasses in the middle of the night before she could get out of bed, and tired of wearing contacts all daylong, Lora decided to enter the study. Her first eye surgery was successfully performed on March 17, just a month after her initial visit. On March 29, she had the second eye surgery and is now able to see 20/20 with both eyes corrected. “The surgery is quick, only about 15 -20 minutes long, and Dr. Price and his staff were just wonderful,” Lora said, “They did a great job explaining everything to me ahead of time so I was really well prepared and knew what to expect.”
For patients who are considering being part of a clinical trial or study, Lora cautioned, “Ask a lot of questions, consider your options carefully and once you decide, do whatever you can to improve your life. It’s worth it!”
For more information about the Study, please contact Dr. Kathy Kelley, the study manager at 317-814 -2859. You can read more stories of people of people with extreme nearsightedness in our book, Celebration of Light, which is available for a $20 donation to the Cornea Research Foundation of America. To order a copy, please go to http://www.Authorhouse.com or pick one up at Price Vision Group when you come in for your next visit. (You can also call Julie Benson at 317-814-2993 for more information.)
“Dr. Price and the Cornea Research Foundation participated in the study that led to recent FDA approval of a rigid lens that can be placed in the eye to give better vision to very near-sighted young adults.”
Verisyse Phankic Intraocular Lens
The FDA approved the first implantable lens for nearsightedness, giving people with extremely poor eyesight a new way to see the world around them. The lens is attached to the iris or colored part of the eye and is an alternative to glasses, contact lenses and LASIK surgery. Dr. Price participated in the approval study and has implanted over 150 of these lenses since 1998.
This lens has been used in Europe for over 20 years. Abbott Medical Optics distributes it under the Verisyse brand name in North America.
During surgery Dr. Price slips the tiny lens through a small incision and attaches it to the iris to hold it in place. Similar to a photographer bringing a camera lens into focus, the plastic lens helps create sharper images.
The implantable lens comes in different powers to fit the patient’s needs. The lens provides crisp and clear vision especially to those who have high myopia. 92 percent of the 662 study patients who had moderate or severe nearsightedness ended up with 20/40 or better vision.Over half of the study patients could see better after receiving the Verisyse lens than they could ever see with glasses or contact lenses.
Some people may still need glasses for night driving and other activities preformed in low light conditions even after the surgical procedure. There’s a risk of cataracts or infection with the procedure, but none of the patients in the U.S trials at our center developed cataracts.
People with thick glasses and corneas that are too thin for LASIK are among the best candidates for the new implantable lens.
Our LASIK and Refractive Surgery Publications
- Letko E, Price MO, Price FW. Influence of original flap creation method on incidence of epithelial ingrowth after LASIK retreatment. J Refract Surg. 2009;25:1039-41.
- Price FW. Re: central toxic keratopathy: description of a syndrome in laser refractive surgery. American Journal of Ophthalmology, 2007; 144:331-2.
- Hainline BC, Price MO, Price FW, Choi DM. Central Flap Necrosis after LASIK.(reply) J Refract Surg 2007;23:741-2
- Hainline BC, Choi DM, Price MO, Price FW. Central flap necrosis after LASIK with microkeratome and femtosecond laser created flaps. Journal of Refractive Surgery,2007;23:233-242.
- Price FW. Pressure-induced interface keratitis: a late complication following LASIK. Cornea, 2005; 24(4):505; author reply 505.
- Bowers PJ, Zeldes SS, Price FW, McManis CL, Price MO. Outcomes of laser in situ keratomileusis in a Refractive Surgery fellowship program. J Refractive Surgery, 2004;20:265-9.
- Thompson RW, Choi DM, Price MO, Price FW. Noncontact optical coherence tomography for measurement of corneal flap and residual stromal bed thickness after laser in situ keratomileusis. J Refractive Surgery, 2003, 19:507-515.
- Choi DM, Thompson RW, Price FW. Incisional refractive surgery. Current Opinion in Ophthalmology 2002;13:237-241.
- Price FW, Price MO, Zeh WG, Dobbins K. Pain reduction after laser in situ keratomileusis with ketorolac tromethamine ophthalmic solution 0.5%: a randomized, double-masked, placebo-controlled trial. J of Refractive Surgery, 2002; 18( 2):140-4.
- Price FW. Topical corticosteroids after keratorefractive surgery. J Cataract Refract Surg, 2002; 28(8):1307.
- Price FW, Willes L, Ries J, Lyng A, Price M. A prospective, randomized comparison of the use versus non-use of topical corticosteroids after laser in situ keratomileusis. Ophthalmology, 2001;108(7):1236-44.
- Price FW. “Lasik”. Focal Points; clinical modules for ophthalmologists, American Academy of Ophthalmology. 2000; XVIII (3).
- Price FW, Koller DL, Price MO. Central corneal pachymetry in patients undergoing laser in situ keratomileusis. Ophthalmology 1999; 106(11):2216-2220.
- Price FW, Belin MW, Nordan LT, McDonnell PJ, Pop M. Epithelial haze, punctate keratopathy, and induced hyperopia after photorefractive keratectomy for myopia. J Refract Surg, 1999; 15(3):384-7.
- Faktorovich EG, Maloney RK, Price FW, ARC-T Study Group. Effect of astigmatic keratotomy on spherical equivalent: results of the Astigmatism Reduction Clinical Trial. American Journal of Ophthalmology March 1999; 127(3):260-9.
- Riddle HK, Parker DAS, Price FW. Management of postkeratoplasty astigmatism. Current Opinion in Ophthalmology 1998;9(IV):15-28.
- Whitson WE, Price FW, Chang KC, Procope JA. Automated lamellar keratoplasty. Cornea Vol 3, Chap 172;1996:2165-2179.
- Steinert RF, Storie B, Smith P, McDonald MB, van Rij G, Bores LD, Colin JP, Durrie DS, Kelley C, Price FW, Rostron C, Waring III GO, Nordan LT. Hydrogel intracorneal lenses in aphakic eyes. Arch Ophthalmol 1996:114:135-141.
- Price FW, Whitson WE, Gonzales JS, Gonzales CR, Smith J. Automated lamellar keratomileusis in situ for myopia. J Refract Surg 1996;12:29-35.
- Price FW. Central islands of corneal steepening after automated lamellar keratoplasty for myopia. J Refract Surg 1996;12:36-41.
- Price FW, Grene RB, Marks RG, Gonzales J, Arc-T Study Group. Arcuate transverse keratotomy for astigmatism followed by subsequent radial or transverse keratotomy. ARC-T Study Group. Astigmatism Reduction Clinical Trial. J Refract Surg 1996;12:68-76.
- Price FW, Grene RB, Marks RG, Gonzalas JS. Astigmatism reduction clinical trial: a multicenter prospective evaluation of the predictability of arcuate keratotomy. Evaluation of surgical nomogram predictability. ARC-T Study Group.Arch Ophthalmol 1995;113:277-282.
- Smith JA, Price FW. ALK; high hopes for high myopes. Review of Optometry, 1994;77-83.
- Price FW. Keratomileusis. In: Nordan LT, Maxwell WA, Davison JA. (eds) The Surgical Rehabilitation of Vision “An integrated approach to anterior segment surgery” New York, NY, Gower Medical Publishing 1992.
- Price FW. Keratomileusis. In: Stamper RL, Thompson KP, Waring GO. (eds) Ophthalmology Clinics of N.A.“Contemporary refractive surgery” Philadelphia, PA, W.B. Saunders 1992, 5(4):673-681.
- Price FW, Whitson WE. The art of surgical correction for postkeratoplasty astigmatism. In: International Ophthalmology Clinics Smolin G, Friedlaender MH, eds. Refract Surg Boston, Little, Brown & Co., 1991; 31:59-67.