Doctors Answers Questions About Eye Surgery

Dr. Soloway: Most surgeons that are using the lens replacement method would not consider you a candidate for that surgery because your distance uncorrected vision is so good. The surgery to increase the working distance of the muscles around the eye (tighten them so to speak) is currently under investigation in the United States. One of the advantages of this surgery is that so far during the clinical trials, distance vision has been unaffected. During the investigation time of this surgery prior to FDA approval it is imperative that the patient return at regularly defined intervals to collect information on how they are performing. The name of the company sponsoring these trials is Refocus group based in Dallas. I am the medical director of these trials and the nearest investigators to you would be Richard Yee, MD, in Houston and Larry Lothringer, MD in San Antonio.

Mark Smith of Saint Paul, Minn., asks: Is eye surgery available for those with keratoconus?

Dr. Soloway: Keratoconus is one of the true contraindications to excimer laser based vision correction surgery. I have used Intacs successfully in some patients with keratoconus and this is an accepted (but not approved) method of treatment (The FDA granted Addition Technology an HDE (humanitarian device exemption for this) for people with mild keratoconus. In advanced stages, such as when there is scarring, corneal transplant surgery is typically advised.

Denise of Queens, N.Y. asks: My question has to do with my grandmother. She is 90 years old and has been recommended for cataract removal surgery. She does not have severe loss of vision, so I'm thinking at her age she really doesn't need the surgery. What are your thoughts? Thanks.

Dr. Soloway: Because cataracts alone do not typically cause any permanent eye damage, cataract surgery is rarely mandatory and is typically performed when patients are not happy with the level of vision they have. Some of the other reasons that surgery might be indicated are if there are signs of other eye pathology that can't be diagnosed or treated, or rarely if the cataracts are causing other eye health problems. If your grandmother is driving, her vision might need to be improved to continue this. If she is happy with her vision, sees well enough to read and do the things she likes to do, then you may be thinking correctly. If her vision is impacted and she is in otherwise good health, you (and she) might reconsider and think towards having the surgery as it is safer to perform it earlier, better to do when the patient is in relatively good health, and the benefits can be substantial.

Jamie Noe of Alexandria, Minn., asks: Do these lasik/laser surgeries on the eyes create scar tissue as in regular surgeries and, if so, do they have potential to create problems as well later down the road?

Dr. Soloway: In almost all cases, there is minimal to no scarring in LASIK or other vision correction surgeries. LASIK has been performed regularly in the US for over a decade now without problems arising in those patients that have had it done years ago. Some of the problems that we are overcoming has to do with the calculation of lens power after cataract surgery on eyes that have had lasik, but this is improving and will continue to improve going forward.

Stewart Pomerantz of New York asks: What surgical options are available for "high myop" people who are now experiencing midlife presbyopia?

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