Refractive surgery techniques to correct vision problems, like RK and LASIK, have allowed millions of people to free themselves of dependence on glasses or contacts.

But until now some had been left in the fringes: those with extreme near- or farsightedness, for example, or people with high degrees of astigmatism, or those who simply needed reading glasses.

With the constantly increasing knowledge in the field of refractive surgery-what Dr. Jonathan M. Frantz of Florida Eye Health in Naples and Fort Myers calls "an explosion of new technology"-more options than ever are available for those with less than perfect vision.

Conductive Keratoplasty

As baby boomers age, more people than ever are suffering from presbyopia, or the inability to easily focus on near objects. Most people, when they hit their 40s and 50s, suddenly find themselves needing reading glasses for up-close vision. It's a natural part of the eye's aging as the lens loses flexibility.

Conductive keratoplasty, or CK, is a relatively recent technique for correcting this problem. The surgeon uses radio frequency energy instead of a laser, thus avoiding cutting the tissue.

CK is the first FDA-approved procedure to treat the problem of presbyopia, and it's had excellent results, with few complications and side effects. During the surgery, radio frequency energy is used to heat and shrink the collagen around the cornea to steepen its surface and compensate for the flattening that occurs with age and which causes presbyopia. Frantz likens the procedure to tying a belt around the tissue.

In clinical trials, 87 percent of patients experienced 20/20 vision after the surgery, and no longer needed reading glasses even for fine print.

Dr. James Croley, with the Cataract and Refractive Institute of Florida in Cape Coral, Lehigh, Bonita and Naples, was the first surgeon in Southwest Florida to perform the surgery after its approval for presbyopia. He had it done to correct his own vision a year and a half ago. "I'm certainly very happy with where my vision is," he reports. The technique (which can be performed on one eye or both, depending on the patient) can offer a more blended vision than monovision techniques, in which one eye is treated for near vision and the other left untreated for distance vision.

The operation takes only a few minutes, and most patients can go back to work the same day. But as eyes continue to age, the cornea will continue to lose flexibility, making further surgeries a possibility down the road. "It turns the clock back, but the clock keeps ticking," says Frantz. But the surgery is easily repeatable as the years pass, if needed.

Still, for millions of people forced to keep reading glasses nearby at all times, CK offers a convenient alternative. "I really believe this is going to be the next LASIK in terms of popularity," says Frantz.

custom views

LASIK remains the gold standard for vision correction. But it also has benefited from better technology and increased knowledges. A system called CustomVue allows doctors to diagnose eyes with greater accuracy than ever, meaning eye surgeons can customize the procedure to allow the best possible results for each patient.

"Every eye is unique; it's got its own fingerprint," says Frantz, the first doctor to perform the procedure in Southwest Florida. The CustomVue system uses technology originally developed for use in high-powered telescopes to create a map of sorts of the eye that can be up to 25 times more precise than standard measurements used for vision correction.

The information is then transferred to the laser used in the procedure to allow for greater accuracy. "We're designing a procedure specifically for an individual's eye," explains Croley.

In an FDA clinical study of the technique, one year after having laser surgery using the CustomVue system, 100 percent of patients could pass a driving test; 98 percent could see 20/20 or better, and 70 percent could see better than 20/20.

The procedure also seems to have fewer incidences of traditionally common LASIK side effects, like glare or the halo effect-some patients in clinical trials even reported better night vision after the surgery than before.

Although the technique is not yet applicable for patients with hyperopia (farsightedness), it does allow those with higher degrees of nearsightedness and astigmatism than ever before to undergo LASIK surgery.

implantable lenses

There are also a variety of lenses implanted directly into the eye to help correct certain conditions. Advances in this technology are among the fastest of the refractive surgeries.

For those over 40 who need their near and distance vision corrected, the PRELEX procedure may be their best choice. In this surgery, a multifocal intraocular lens is inserted through a small incision, and the natural lens is removed. The technique has been used by cataract patients to replace the removed cataract (a procedure often approved by insurance), but it can also be used on pre-cataract patients.

For patients with no sign of cataract, there is the Verisyse lens, also inserted through a small incision, but the natural lens is left intact. This technique is currently pending FDA approval, but is expected to receive it this year. Frantz says that he will be the area's first doctor to offer the procedure.

Used for those who are nearsighted, the Verisyse lens may carry some increased risk of cataract development. But other risks are low, and the procedure may help those who are not good candidates for LASIK.

Dr. John Snead, of Eye Physicians and Surgeons of Florida (with offices in Naples, Fort Myers, Port Charlotte and Bonita), has performed intraocular contact lens (ICL) surgery in the Caribbean, where the procedure has already been approved (as well as in Europe and South America).

Both nearsighted and farsighted patients are candidates for ICL, a similar type of lens implant, which may carry some increased risk of cataracts. The procedure requires only a tiny incision-"it's almost like injecting it into the eye," says Snead-and no changing of its shape. Early reports indicate that there is less risk of glare and halo effects.

Best of all, the procedure may correct far higher degrees of near- and farsightedness than other surgeries: up to a -20 and a +20, respectively (compared to a nearsighted cutoff of about -10 to -12 for LASIK, for example). Snead has successfully performed the surgery on a child with a -18 degree of nearsightedness in one eye and a -20 in the other. "LASIK couldn't touch that," he says.

The implantable lens technology is still in its infancy, but Snead sees it as the future of refractive surgery. "Until now, LASIK has been the only tool," he says, "and we're adding more tools now." He foresees the development of newer and better lenses as research continues.

Croley agrees. "I think the wave down the road is to get an implant that truly will do everything," he says. "Eventually the trend is going to be toward having a functioning, focusing eye for your whole life."