LASIK is the latest in a series of ingenious eye surgeries developed over the past three decades to treat refractive disorders -- vision difficulties such as:

• Myopia (nearsightedness)
• Hyperopia (farsightedness)
  
• Astigmatism (irregular curvature of the cornea)

The development of new wavefront technology in recent years makes it possible to measure refractive errors 20 times more precisely than before. Utilizing these detailed measurements, ophthalmic surgeons can create treatments precisely tailored to each patient's corneas.

For people who, due to severe eyesight problems and other eye conditions, aren't candidates for LASIK, implantable lenses may offer an appealing alternative. Though now widely available, vision correction surgery is not always high quality; these exacting procedures demand specialized expertise to ensure good results.

Active Lifestyles, Corrective Lenses May Not Mesh

Duke Athletic Director Joe Alleva was tired of fussing with the eyeglasses and contact lenses he'd long needed for any activity that required distance vision. Nearsightedness was even more of an annoyance for Duke assistant basketball coach Mike Jarvis. Because Jarvis also had astigmatism, he couldn't be fitted for contact lenses. And, he says, "It's hard to run around a basketball court when your glasses are fogging up and slipping off your nose."

Both men were recently able to sideline their spectacles after receiving successful LASIK surgery at Duke's Center for Vision Correction from Duke ophthalmic surgeon Terry Kim, MD. Kim also serves as the consultant ophthalmologist for Coach Mike Krzyzewski, his team, and his staff.

"I had thought about LASIK over the years but always chickened out," Alleva says. "But when I met with Dr. Kim, I felt more confident." Kim told Alleva that he doesn't treat 20 percent of the prospective patients who come in -- a statistic that impressed Alleva. "He said he wouldn't do my eyes unless he was sure things would come out right, and that gave me peace of mind."

Immediate Results, Lasting Benefits

LASIK is designed to treat refractive disorders -- vision difficulties such as myopia (nearsightedness), hyperopia (farsightedness) and astigmatism (irregular curvature of the cornea). The microkeratome (a tiny surgical device) once used to create the protective corneal flap has now been replaced with innovative femtosecond laser technology, which enables the surgeon to precisely program flap diameter and thickness while minimizing the risks of flap complications. This laser provides many attractive advangages over the traditional microkeratome blade including, most importantly, enhanced precision and safety. After the flap is lifted out of the way, pulses of light from an excimer laser -- so precise it can remove a mere 1/100,000th of an inch of tissue in 12 billionths of a second -- reshapes the cornea to improve vision. The flap is then repositioned and quickly begins to reseal itself without sutures.

The entire procedure takes less than 15 minutes for both eyes; afterwards, patients are instructed to keep their eyes closed for the rest of the day and go to sleep that night as usual. When they awaken the next morning, the world is suddenly a much clearer place.

Alleva, who had his LASIK procedure three years ago, was so pleased with the results that he encouraged his two grown sons to undergo the procedure. By the time they got around to it, the technology had become even more sophisticated. "We now offer customized laser surgery, thanks to new wavefront technology that can measure refractive errors 20 times more precisely than was previously possible," Kim says. "We can utilize this detailed measurement to provide a treatment that's precisely tailored to each patient's corneas. In addition, we have now incorporated femtosecond laser technology to create the flap, making the entire LASIK procedure bladeless. Our patients have expressed increased satisfaction and decreased anxiety now that our procedure is performed entirely by lasers. The results have been phenomenal."

Alleva's sons, J.D. and Jeff -- both professional baseball players and Duke alumni -- received custom LASIK procedures from Kim and now have better than 20/20 vision in both eyes. Jarvis also had custom LASIK and is very glad he did: "Being able to see without glasses gives you back your freedom."

Expanded Options for Aging Eyes, Special Conditions

As people reach their mid and late 40s, presbyopia (aging of the lens and muscles of the eye) makes it hard to shift focus between distant to close objects. While some LASIK patients are content to use reading glasses as presbyopia sets in, others choose monovision -- which corrects one eye for closer work, the other for distance vision. This approach, Kim says, allows many nearsighted people well into their 60s to give up corrective lenses after LASIK.

LASIK isn't for everyone. The two in 10 prospective patients whom Kim determines aren't good candidates for the procedure are usually ruled out due to severe refractive disorders, cataracts, and other conditions of the lens and cornea. The rapidly evolving technology of implantable lenses, however, may offer an appealing alternative.

Accommodating or pseudoaccommodating intraocular lenses (such as FDA-approved ReSTOR® and ReZoom® lenses) replace the eye's natural lens and mimic its ability to focus on objects both near and far. Intraocular contact lenses (such as the recently FDA-approved Verisys® lens), which do not replace the natural lens, can sharpen the vision of younger patients with extreme refractive disorders.

"As a cataract and refractive surgeon here at Duke, I feel privileged to offer this exciting technology to my patients," Kim says. "They often comment not only on their improved vision, but on their improved quality of life.

Expertise Essential to Positive Outcome

Excellent results may not always be the case, however, when these exacting procedures are performed by less expert practitioners. "LASIK is now offered so widely that some health care consumers are starting to look at it as a trivial procedure," says Kim. "But that's not the case -- it's still a surgery with potential complications. Some of the places that offer LASIK at discount prices don't do thorough screenings because they're trying to get patients in and out too quickly. And the procedures may be performed by people who are not fully qualified to do them."

By contrast, Kim says, "As part of a respected tertiary care center, our highly trained, award-winning refractive surgery team has tremendous experience with a large variety of cases. We give prospective patients a comprehensive, two-hour exam not only to evaluate them medically, but to get to know them and find out their needs, expectations, and concerns. This 'Duke difference' has a direct impact on the successful outcomes we have been experiencing here.

"Our approach minimizes the risks that are always present in any type of surgery, including LASIK," Kim adds. "And that's important, because complications from poorly done procedures are not always reversible."

Alleva is convinced that, for his family, the benefits of insisting on quality far outweighed the cost. "Eye surgery," he says, "is not something you want to do on a cut-rate basis."