25 Years in Myopia: Surgical Advances Improve Vision

When ophthalmologist Dr. James Salz first saw Nancy (who requested that only her first name be used), severe myopia left her completely reliant on glasses and contacts. Without them, the Los Angeles city employee and mother of two had vision so poor that she couldn't even recognize her children.

"When I woke up in the morning and they ran up to me, I couldn't tell who was who," she said. "When I was at the beach, I couldn't see where my family was. I basically was pretty paralyzed without my contacts or my glasses."

That's how things would have stayed 25 years ago.

Surgery that could eliminate the cause of nearsightedness by changing the curvature of the cornea was still a highly criticized idea in 1984, remembered Salz, who led some of the early studies and went on to be involved in every form of refractive surgery since then.

VIDEO: Nearsightedness Cases Up Across the Globe

Today, refractive surgery is one of the most common of all surgical procedures, second only to cataract surgery in the United States.

This rapid revolution not only provided a cure for myopia but altered how we think about nearsightedness itself.

Seeing Deeper

In 1984, Nancy's eyes would have been considered healthy, just with refraction on the far spectrum of normal, like the range of human height from short to tall.

"At a typical exam, we'd say, 'Oh, your eyes are perfectly fine. You just need glasses," said Dr. Penny Asbell, director of the cornea service and refractive surgery at Mount Sinai School of Medicine in New York City.

Glasses and contacts remain the most common option for managing myopia. And there have been substantial improvements over the past quarter century in both, noted Salz, now of Cedars-Sinai Medical Center and the University of Southern California, both in Los Angeles.

Thinner, more attractive progressive bifocals and disposable, gas-permeable contact lenses have made visual correction easier on patients than ever, he said.

But it was only after refractive surgery offered a treatment that could actually get to the cause of the problem that "we started to realize that for many people myopia is, in fact, a disability and one they would rather not have if they had a choice," Asbell told MedPage Today.

Crude Measures

It's little surprise that operating on what was considered an otherwise healthy eye was once controversial. Early attempts to cure myopia were disastrous.

During World War II, a Japanese professor pioneered a form of eye surgery called radial keratotomy in which he cut through to the inner surface of the cornea to flatten out its curvature and thus reduce nearsightedness.

The procedure produced initially good results in the many young men -- who, for all intents and purposes, were experimented upon – as a result of the tremendous pressure to increase Japan's fighting force.

But over the next four to five years, their vision dramatically deteriorated as the cornea weakened.

"It wasn't really appreciated that the endothelial surface of the cornea, the interior surface of the cornea, those cells were important to keeping the cornea clear," explained Dr. Jay Pepose, an ophthalmologist at Washington University in St. Louis.

Russian surgeons revived the procedure in the 1970s with a technique that used radial incisions into the outer surface of the cornea, avoiding the problem of damage to the endothelial cell surface.

But the procedure was still crude, involving a razor blade fragment held freehand with a depth gauge used to determine how far to incise.

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