R. Douglas Cullom, M.D., is a board-certified ophthalmologist specializing in refractive and cataract surgery and general ophthalmology. He is director of Cullom Eye and Laser Center and the Hampton Roads Center for Vision Correction. He is a member of Hampton Roads Eye Associates and Riverside Medical Group.

Advances in Vision Correction by R. Douglas Cullom, M.D. Published: August 2006 Many people are content wearing glasses or contacts for vision impairment, but for some, they’re an inconvenience. For others, they can be a safety issue. When I first opened my vision correction practice 12 years ago, while serving in the US Navy, I treated many members of the armed forces including Navy SEALS whose vision had deteriorated since they entered service. I still consult patients whose jobs and livelihoods thoroughly depend on their most valuable instruments – their eyes. For example, when a patient of mine, a Marine corporal, first went to Iraq, he wore thick, military-issue glasses. Prior to his return to the Middle East, he underwent LASIK vision correction. He later said he felt safer during that second deployment; he no longer had to depend on glasses that might scratch or collect dust and sweat. Another LASIK patient, Lieutenant John Brandon, just returned to Iraq for a second time. He told me that among the troops, vision correction is a safety issue. “I’ve had members of my platoon scratch and break their glasses. Contact lenses are out of the question because of possible eye infections and problems with sand,” he said. Nearly 100 million Americans wear glasses while another 70 million wear contact lenses for vision impairment. Glasses and contact lenses pose many challenges to the individual wearing them: fogging, scratching, lost or broken lenses, to name a few. Many people think new methods of vision correction are reserved for the younger generations, or for military and police officers, or athletes. But new tools for vision correction, such as implantable lenses, are allowing more and more patients to cease reliance on glasses and contacts. This includes patients over age 60 who need both distance and near vision correction, as well as patients as young as 18 who require considerable vision correction. In addition, until recently only one laser surgery technique was available to perform vision correction procedures. But recent improvements in laser technology have led to improved results and safety for patients. Today, there are several options for patients seeking laser vision correction. LASIK LASIK is the most popular vision correction procedure available. Many patients are candidates for today’s advanced LASIK procedure, in which a thin flap is made on the cornea using either a laser or a mechanical blade. The flap is then lifted, and, using a specialized laser, the surgeon reshapes the cornea. This procedure is quick and painless. LASIK is a great option for patients who require quick recovery. Many people can return to work as early as the next day. (Tiger Woods had this procedure, and then went on to win the Master’s!) LASIK treats all forms of refractive errors: nearsightedness (myopia), farsightedness (hyperopia) and astigmatism (a condition in which the surface of the eye is steeper in one direction, similar to the shape of a football). LASIK isn’t appropriate for patients with cataracts. However, it is suitable for patients ages 18 to 60-plus who require prescription glasses or contact lenses. Customized wavefront laser treatment (which is based on each patient’s unique eye shape) has resulted in the most significant breakthrough for fine-tuning patient results. According to the FDA, customized treatments result in a greater chance of obtaining better than 20/20 vision as well as improved vision amidst dim lighting. A second breakthrough, the femtosecond intralase laser, uses laser energy instead of a blade for making the flap, resulting in better safety and patient outcomes, according to many studies. Photorefractive Keratectomy (PRK) Photorefractive Keratectomy (PRK) goes by a number of other names: surface correction, epi-lasik, lasEK, and advanced surface ablation. Unlike LASIK, no flap is made on the cornea. Treatment is done on the corneal surface after the surface layer is removed with a brush or spatula. Because the top layer of the cornea grows back slowly, a patient’s vision recovers more slowly. Full visual recovery can take as long as one month. Results after six months are very similar to those after LASIK. I recommend PRK for patients with thin or irregularly shaped corneas. Patients whose jobs or hobbies subject them to eye trauma may have better success with PRK than LASIK. Implant Surgery Advances in lens implants over the last several years have created more options for patients who previously were not candidates for surgical vision correction techniques. Refractive lensectomy, a 10-minute procedure in which the surgeon removes the natural lens and replaces it with an implant, can correct the focus of the eye. A similar procedure can be used for those with cataracts that impair their vision. Refractive lensectomy is good for those over 50 who are beginning to develop nearsightedness and those with early cataract formation. Patients who are farsighted do especially well with this procedure. Patients requiring cataract surgery may also choose to receive lens implants, which can decrease their need for glasses. Both refractive lensectomy and cataract surgery procedures have improved via breakthroughs in implant technologies that can correct both distance and near vision. The Crystallens implant, and both the Rezoom and ReStor implants are all designed with these specific features in mind. Implants are also available that treat astigmatism. Implantable Contact Lenses Another new vision correction implant, the Staar Visian implantable contact lens (ICL) offers new hope for those with severe nearsightedness that could not be corrected with LASIK alone. Unlike refractive lensectomy, implantation of this artificial lens does not require removing the natural lens. Conductive Keratoplasty Also known as CK, this procedure is used to help eliminate a patient’s need for reading glasses, especially among patients age 50 and over who have good distance vision. During CK, radiofrequency energy is applied to eight spots in the outer cornea to tighten the cornea, thus improving near vision. Though these choices may not offer something for everyone, vision correction techniques are now available for a wide range of patients, from the avid golfer who needs both good distance vision and near vision to his daughter who’s no longer able to wear her contact lenses due to allergies, to even his college-age son who hates cleaning his contact lenses. It’s important to remember that a thorough eye exam can help determine which procedure is best for each individual. Understanding your options is important, no matter what treatment method you choose. In some cases, it may be best to stay with glasses; but now, more than ever, there may be an option for reducing your dependency on contact lenses or glasses.

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