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After ten years of living behind lenses, Cardinale decided to try a new
procedure called Laser in Situ Keratomileus (LASIK).
"I was tired of seeing cloudy faces from a distance." said
Cardinale.
For people needing a large amount of visual correction, LASIK -
approved in the United States only three years ago - may be the
quickest way to achieve clear, natural vision.
During this procedure, a precise surgical instrument called a
microkeratome is used to cut a fine, circular flap in the cornea -
the clear covering of the eye. The flap is then folded back and a
laser is used to sculpt the interior part of the cornea. The surgeon
directs the laser beam toward the center of the cornea.
The laser changes the corneal curvature to allow light to focus more
clearly. The flap that was cut with the microkeratome is put back in
place and heals without stitches.
Because problems like near-sightedness, far-sightedness and
astigmatism result from irregular curvature of of the cornea, this
process allows the cornea to better focus light so that vision is
returned to normal.
"The patient sees as if a contact lens has been permanently
molded on to the front surface of the eye," said Dr. John
Kung, a corneal specialist at Staten Island Ophthalmology,
Eltingville, who performs the process at the Somerset Eye Institute,
N.J.
Elm Park resident Donna Jakubowski, a patient of Dr. Kung,
agrees that having the operation done is much like wearing a
permanent contact lens but without the hassle.
"That's one less bag I have to bring with me when I go on
vacation." she said, referring to the contact lens solutions
she used to carry around with her.
The actual procedure takes only about five minutes per eye, but the
patient should expect to be in the operating room for about 45
minutes from the time the surgeon administers a local eyedrop
anesthesia. The cutting of the flap takes only 20 seconds and the
laser is applied to the eye for less than a minute in most cases.
A slight pressure may be felt during the surgery and some patients
feel a mild discomfort and dryness of the eyes for a few hours
afterward.
"It didn't hurt at all. I just felt a little discomfort, but I
was more nervous than anything else," said Cardinale, a patient
of Dr. Joseph Mermelstein, also a corneal specialist, at the Eye and
Laser Institute of Staten Island, Meiers Corners.
Ophthalmologists can judge a person's eligibility for the procedure
with a preliminary exam called a corneal topography. The patient
will be asked to look into a lighted cone as the computer analyzes
the shape of the cornea.
"This procedure allows the doctor to check for disease and to
measure the degree of refractive error," said Dr. Mermelstein,
who operates at the New York Eye & Ear Refractive Surgical
Center in Manhattan.
All people, however, are not eligible for the procedure. Patents
with glaucoma, cataracts and any sort of eye disease are not
candidates for the LASIK procedure.
But those who are qualified seem to be quite pleased with the
results.
Robert Muino of Eltingville was legally blind before LASIK. His eyes
were damaged after years of wearing contact lenses, but he still
achieved 20/40 vision thanks to the procedure.
"I would do it again in a second," said Muino, a patient
of Dr. Mermelstein.
In 1998, over 450,000 LASIK operations were performed nationwide. By
the end of this year, more than 900,000 people will have undergone
the procedure, said Dr. Kung, who believes that "LASIK
will soon be as common as getting braces."
One of the major drawbacks of the procedure, however, is the cost.
LASIK is not covered by insurance, as it is considered a cosmetic
procedure, and it typically costs about $4500 to $5500 for both
eyes.
However, some feel it's a small price to pay for restoring their
vision.
"Cost was never a factor for me. Not when it comes to my
eyes." said Cardinale.
Patients usually maintain clearer vision for the rest of their
lives, but perfect vision is not guaranteed.
However, Island ophthalmologists like Dr. Robert D'Amico, of Bayley
Seton Hospital's Sister Loretto Bernard Vision Care Center, boast
high success rates.
"Ninety-percent of my patients achieve 20/40 vision or
better," said Dr. D'Amico.
Significant complications are rare, but the procedure does involve
some risk. Serious risks include undercorrection, overcorrection and
abnormal healing. These risks occur in less than five percent of
cases, according to Dr. Mermelstein.
In these rare cases, some doctors note they will perform a second
operation free of charge to bring the patient's vision even closer
to normal.
There is also a slight risk of infection, which can be controlled
with medications with little or no effect on the quality of vision.
Most doctors apply an antibiotic to the eyes prior to surgery as a
preventative measure.
Dr. Deborah Rosenthal, director of advanced Vision Care Associates,
Staten Island University Hospital (SIUH), who also performs the
procedure, said that LASIK is not simply meant to get patients to
throw away their glasses.
"Our goal is to reduce the patient's dependency on
glasses," she said.
Patients over the age of 40 who wear reading glasses will still need to wear
them to see clearly up close. This is because the need for reading glasses
is caused not by irregular corneal curvature, but by a weakening of muscle.
According to Dr. Mermelstein, a procedure to eliminate the need for reading
glasses is in the works and may be available in a few years.
LASIK can give a patient clearer vision for all the other focal distances,
regardless of age. Staten Island ophthalmologists have successfully treated
patients ranging in age from their early 20's to late 60's.
After the procedure, patients are urged to take extra precautions to avoid
wrinkling of the flap area.
"To protect the cornea as it heals, I place a shield over the
eye." said Dr. Kung. Patients are also given one or more types
of eyedrops to help control pain, prevent infection, and promote healing.
Most eye care centers provide free transportation to and from the location
of the surgery, as patients will not see clearly enough to drive home
directly after the surgury.
Island LASIK surgeons most often operate at facilities in Manhattan and New
Jersey, which offer the appropriate laser equipment. All preliminary and
follow- up appointments are given in Staten Island.
Follow-ups will most likely be schedules for the first few days after the
surgery and possibly one to two weeks later. Many patients drive to their
follow-up appointment the morning after surgery, but this should be
considered on an individual basis.
"Patients with a higher degree of near-sightedness may require more
time to heal fully," said Dr. Kung.
Some patients even return to work the next day.
Dorn Amato of Great Kills, a patient of Dr. Kung, had worn glasses
since the age of seven and could not see two fingers held up two feet away
from her prior to surgery.
"I drove to work the next day." she said.
Five months after the surgery, she still has perfect 20/20 vision.
"It's completely changed my life. I didn't realize how handicapped I
really was," she added.
Patients
should initially wear sunglasses when outdoors because the treated eyes may
be sensitive to bright light until they heal. Touching or rubbing of the
eyes may prevent the healing layer of cornea from reattaching properly.
Dr. Kung discourages hit patients from swimming, playing active
sports, wearing eye makeup, or sitting in smoky rooms until he feels the eye
is fully healed.
Although many patients feel significant difference within a few hours, full
healing time differs for each individual and can range from a few days to
several months.
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