Visions of the Future: Advances in eye care

Eye specialty clinics in the city are offering new procedures and products to treat eye ailments.

Laser precision

St. John’s Clinic Eye Specialists recently upgraded its laser vision correction equipment. The clinic’s new equipment, the German-designed Allegretto Wave System, allows doctors greater precision when performing laser procedures, including the two most common types: laser-assisted in-situ keratomileusis, or LASIK, and photorefractive keratectomy, or PRK.

Dr. Shachar Tauber, director of ophthalmology research for St. John’s, said he and fellow eye specialist Dr. Jim Gessler were so impressed with the improvement in the Allegretto system that they couldn’t wait for the hospital to find funding or get a grant for the $400,000 equipment – so they purchased it themselves.

“The technology had reached a new level,” Tauber said, “and it was something we wanted to go with starting today.” The clinic began using the new technology in late November.

While the system works in essentially the same way as previous LASIK procedures (see box on page 24), the new laser is more precise, creating fewer instances of enhancements – follow-up procedures for minor sight imperfections caused by the LASIK procedure.

“Our rate was about 8 percent – the national average was about 12 percent – and we wanted to cut that down,” Tauber said of enhancements. “We talked to some of the surgeons who had used this new laser out of Germany, and their level was about 1 percent. That’s a huge difference.”

The additional precision comes with additional cost – Tauber said the procedure is about $200 more expensive per eye than previous techniques, though the clinic declined to disclose actual costs.

A January 2004 article in the Wall Street Journal reported that the cost of conventional LASIK ranges “from $500 to $2,500 per eye,” and health care publisher All About Vision reported that national cost averages stabilized in mid-2006 at around $2,000 per eye.

But, he said, the extra expense is worth it, especially considering the growing popularity of LASIK procedures.

“Some have made a commodity out of it – like a big-screen TV,” Tauber said. “You shouldn’t pay exorbitant fees, but it’s also not like buying a pair of shoes that you can throw out. If you make it a commodity, you reduce it to the lowest common denominator – who has the lowest price? You can continue to reduce the price to a point, but it gets to a place where you don’t challenge the quality anymore.”

The procedure certainly has become more popular – more than 3.5 million people have had some kind of LASIK vision correction since it first hit the American market in the mid 1980s.

A new lens

Cataract sufferers are also getting new options for treatment.

Mattax Neu Prater Eye Center began offering a multifocal lens implant for cataract patients in March 2006. Traditional lens implants allowed patients to improve their distance sight, though they still often needed glasses for near and intermediate vision.

The new lenses improve two fields of vision – distance vision and either near or intermediate vision. Similar lenses have been on the market for a little over a year.

Dr. Kenneth Neu of Mattax Neu Prater said the key to the new lenses is to know the individual patients and their needs.

“I had a pilot I worked on who said he didn’t read anything within 12 inches, so he was the perfect candidate for the intermediate and distance lens,” Neu said. “Then there are ladies who do a lot of cross-stitch, and they need the near and distance vision.”

The new lenses are expensive – they cost about twice as much as the older-style lenses, Neu said, adding that he didn’t want to quote a price, because the price changes regularly.

Neu also said Medicare will usually only cover the new lenses up to the cost of the original – the additional cost must be covered by the individual or by private insurance.

But, Neu added, the procedure has been gradually decreasing in price over recent years – about 5 percent annually over the last decade.

Dr. Paul Arnold of Arnold Vision said his clinic began offering similar multifocal lenses in early 2006. Patient cost, he said, varies depending on how much is covered by insurance and Medicare, but the average patient will pay $1,000 to $2,000 per eye.

Arnold said his clinic also recently began offering lenses to correct astigmatism and other vision aberrations.

The new lenses, like any others, come with some risk, as a small surgical incision is required. Patients also run a slight risk of developing glaucoma, a problem typically associated with cataract treatment.

“The risk is the basic baseline risk for any intraocular procedure,” he said, noting infection, which is “usually less than one in 1,000 patients.”

But for most patients, Neu said, the benefits far outweigh the drawbacks.

“In the old days, people were bedridden for months – they had to sleep with their head between sandbags to keep their head from moving,” he said. “That’s all changed. This is a 10-minute, outpatient procedure, and the patch comes off the next day.”

About 10 percent of the cataract treatments Mattax Neu Prater does are with the new lenses.

What is LASIK?

LASIK permanently changes the shape of the cornea, the clear covering of the front of the eye. A knife, called a microkeratome, is used to cut a flap in the cornea. A hinge is left at one end of this flap. The flap is folded back, revealing the stroma, the middle section of the cornea. Pulses from a computer-controlled laser vaporize a portion of the stroma and the flap is replaced.

Source: U.S. Food and Drug Administration Centers for Devices and Radiological Health

Cataract lens replacement

The procedure for inserting a new lens for cataract patients is basically the same regardless of which lens is used. After the eye is numbed, the physician makes a small incision – less than 3 mm – and the cataracts are removed. The new lens is then inserted, “rolled up like a taco,” according to Dr. Kenneth Neu of Mattax Neu Prater Eye Center, through the opening. The lens unrolls itself and locks into place. Patients are given antibiotics before and after the procedure and wear an eye patch for one day to prevent accidentally rubbing or scratching of the eye.[[In-content Ad]]