LASEK: A New Way To See Without Glasses By Stephanie Whyche In second grade Cheryl Seifert wore unattractive brown-framed eyeglasses that she loathed only slightly more than all the other eyeglasses that followed. Contact lenses, which she struggled to wear as a young woman, suited her no better. Glasses or contact lenses? "I couldn't stand them," Seifert says. Six months ago Seifert had LASEK eye surgery, liberating her from such visual aids. The outpatient procedure changed the curve of her corneas to correct severe myopia (nearsightedness). Today Seifert sees far and away better than she ever did with visual aids. "It made my vision great," says the 53-year-old wife, mother and grandmother who operates a retail flooring business with her husband just outside Kansas City, Kansas. "I still find myself reaching over to put on my glasses," she says, glasses she no longer needs. "It had become a habit after 48 years." The letters in LASEK stand for laser-assisted epithelial keratectomy. The procedure is the latest that uses a high-powered laser to permanently reshape the curvature of the cornea to minimize myopia (nearsightedness), some forms of hyperopia (farsightedness), and astigmatism. Specifically, microscopic amounts of tissue in the deeper layers of the cornea are vaporized (or ablated) with a special laser that emits pulses of cool ultraviolet light. The technique also is called "surface ablation." Cost of the surgery is about $1,700 per eye, on average across the country, though some eye surgeons charge as little as $499 an eye and other places charge as much as $3,000 per eye. The procedure typically is not covered as a basic employee health-insurance benefit. LASEK surgery is not the same as another similar-sounding refractive eye surgery called LASIK. In LASIK (which stands for laser assisted in situ keratomileusis), laser technology also is used to reshape the cornea to correct nearsightedness, farsightedness or astigmatism. But LASIK surgery differs from LASEK surgery in an important way: In LASIK surgery, it's the tissue underneath the cornea (not on its surface as in LASEK) that is reshaped through laser ablation. LASIK carries higher risks but entails a much shorter recuperation time. LASEK results in more discomfort and slower healing, but its risks are smaller. Developed about three years ago, LASEK eye surgery is actually the newest version of another laser-assisted eye surgery, called PRK (photorefractive keratectomy), says Dan Durrie, M.D., the Kansas City ophthalmologist who operated on Cheryl Seifert's eyes. But he says LASEK surgery appears to have fewer complications than PRK. "The procedure didn't take long at all and it didn't hurt at all," Seifert says. The only thing I can remember is kind of like the flesh burning, you know, from the laser," says Seifert, who started wearing glasses as a second grader for severe nearsightedness. "I was just lying there with my eyes open, and you see this light come at you and it's kind of a red color and a swirl — and it's a laser! And it's kind of remarkable how this works. It's just in and out." She went home wearing protective bandages similar to a pair of contact lenses. She wasn't able to do very much, and there also was some pain. She also had to wear goggles to protect against things like the wind. And at night she taped a plastic eye shield over her eye sockets for extra protection, she says. "The first few days I did go through a lot of discomfort, " says Seifert. "Things were blurry at first. There would be no way to drive in the beginning." But gradually her vision improved. "It just got slowly better and better,' she says. "Then the distance vision began to come in. Within a month's time there was a significant change. It was exciting. It was neat not to have to wear glasses." Seifert had wanted to have the surgery ever since she heard about it. But each time she asked her own eye doctor — not trained to perform the surgery — about it, he was hesitant. She says he was concerned that the procedure hadn't been around long enough to develop a track record. "When I went in last fall, just out of the clear blue he said, "Well if you think you want to do this, this is a good time." He referred Seifert to Dr. Durrie and she never looked back. "I didn't hesitate," she says, "except for the morning I went over to have the surgery and read all the things that could go wrong: You could lose your vision, your tear ducts could be affected, you could have bad discomfort — I just took a deep breath and said, 'Yes I am going to do it!' " How do you decide if LASEK is right for you? You do it, as Seifert did, with the help of an ophthalmologist who has a track record of success in doing this and other refractive eye surgeries, says Dr. Durrie, a spokesman for the American Academy of Ophthalmology. Factors that must be weighed, says Dr. Durrie, include, the type of refractive error you have and its severity, the health and condition of your cornea, previous eye surgeries and lifestyle considerations. For instance, refractive surgeries like this typically aren't approved for people younger than 18, because their eyes and vision may still be developing. It's also usually not recommended where there is refractive instability. Refractive instability is fluctuating vision caused by such conditions as pregnancy, breast-feeding, hormonal changes, disease or the taking of certain medications, such as steroids. "People need to sit down with their doctor and ask, 'Am I a candidate?'" says Dr. Durrie, whose refractive eye surgery clientele consists of 80 percent who had LASIK surgery and 20 percent who had LASEK. He says you should ask your doctor " 'is the technology that is available today right for my eyes, and since there are different procedures, which procedure is right for me?' " Dr. Durrie says generally speaking, from the surgeon's point of view, people who suffer from dry eye or who have problems wearing contact lenses are good candidates for LASEK surgery, as are people whose cornea — in terms of shape or thickness — make other refractive eye surgeries more risky to do. On the other hand, Dr. Durrie says people who tend to find this surgery attractive are those who want the safest procedure and are willing to put up with more discomfort and blurry vision during a recuperation period of three to four days or longer. "Surface ablation has more discomfort," he says, "and vision returns more slowly." In contrast, LASIK surgery is for people who are willing to accept the small-added risk, Dr. Durrie says. They want to minimize discomfort and have clear vision immediately. Some patients, Dr. Durrie says, "like the idea that they can go in one day and see better the next day without much pain." "The only problem I am having now is a kind of pulling sensation kind of like I'm squinting but I'm not," says Seifert. "I'm going to check that out. It might be part of the healing process." "That slight pulling is not uncommon for young persons who have surface ablation," says Paul Petelin, M.D., an ophthalmology fellow studying with Dr. Durrie. He says the pulling sensation reflects the fact that the eye is slightly overcorrected in the initial postoperative period. "That's a common place to be from a refractive standpoint, and there is a tendency for the refractive error to drift back toward the original target as the cornea heals," Dr. Petelin says. Related Stories: Last updated August 29, 2006 | 
