Wavefront expands treatment/ Now LASIK can repair aberrations

Gazette, The (Colorado Springs), Aug 4, 2003 by BILL RADFORD

Laser eye surgery has entered a new era.

Millions of people have undergone LASIK surgery in their desire to shed their glasses or contact lenses. Wavefront technology, a new way to assess vision problems, sets a higher standard for vision correction in LASIK patients.

Conventional LASIK corrects common vision problems such as nearsightedness and astigmatism, which involve the focusing power of the eye. Wavefront-guided LASIK also treats eye imperfections, known as higher-order aberrations, that affect the crispness of vision but are not measured in a standard eye test.

It's not just an advance in LASIK surgery, says Glenn Hagele, executive director of the nonprofit Council for Refractive Surgery Quality Assurance. "It's a new era in understanding the optics of the eye."

Wavefront technology was derived from astrophysics and used to fine-tune images produced by the Hubble Space Telescope. Eye surgeons now can use it to produce a three-dimensional map of the eye with all its imperfections.

"A traditional eyeglass prescription compared to a wavefront diagnosis is like comparing a state road map to a neighborhood city map," Hagele says. "Both give you a good idea where you are, but wavefront provides tremendously more detail."

During LASIK surgery, the wavefront map is used to program the laser, producing a more individualized and complex reshaping of the cornea.

"It basically kind of cleans up these unique imperfections" in people's vision, explains Dr. Britt Buckley of the Buckley Vision Institute in Colorado Springs. "And when it does that, they get better vision than they've ever seen with their glasses or contacts."

Buckley performs the VISX CustomVue wavefrontguided LASIK, which was approved by the Food and Drug Administration in May. Dr. John Wright, of the Wright Eye Center in Colorado Springs, offers Alcon Laboratories' CustomCornea, the first wavefront technology to win FDA approval. Both doctors still offer conventional LASIK as well.

Wright hails the new technology but stresses that not everyone has the higher order aberrations. He believes most people will do just as well with conventional LASIK. The wavefront-guided LASIK adds to the cost, anywhere from $100 per eye to several hundred dollars, depending on the center.

Hagele agrees wavefront-guided surgery should not always be preferred over conventional LASIK, but believes wavefront will become the standard as a diagnostic tool. Wavefront also will reduce the number of patients who suffer complications from LASIK, he says.

Three percent of patients who undergo conventional LASIK or other refractive surgery have complications after six months, such as dry eye or night-vision problems.

Wavefront may even be used to eliminate problems resulting from previous LASIK surgeries. Hagele's group has produced a sister Web site, www.complicatedeyes.org, to address that subject.

Mark Stallings can compare conventional and wavefront LASIK simply by closing one eye or the other. Buckley performed surgery on him June 20, using what Stallings calls "the new cool technology " in his left eye and conventional LASIK in the right. Stallings has mixed astigmatism in his right eye, a condition the new technology is not yet FDA-approved to correct.

Although both eyes are improved, distance vision with his right eye is slightly fuzzy - sort of like the old movies where the leading lady is bathed in a soft light, he says. But overall, his vision is now 20/10 and Stallings, who wore glasses for about 15 years, is ecstatic with the results.

Despite such success stories, patients should have reasonable expectations, Hagele cautions. Not everyone will achieve "superior" vision, he says.

And though the probability of complications becomes even less with wavefront, the possibility still exists.

"This is not getting a haircut," he says. "This is getting microsurgery on the eye."

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ABOUT 20/20

Having 20/20 vision means seeing at 20 feet what a normal person sees at 20 feet, as measured by lines on an eye chart. A bottom number larger than 20, such as 20/40, indicates diminished vision.

With wavefront-guided LASIK, the Buckley Vision Institute is offering a guarantee of 20/20 vision or your money back. But 20/20 vision is just one measure of success, cautions Glenn Hagele, founder and executive director of the Council for Refractive Surgery Quality Assurance. A patient, for example, may demonstrate 20/20 vision in a doctor's office but suffer from night-vision distortions.

Jim Van Dyke, marketing director for Buckley Vision Institute, says the 20/20 promotion is a way of touting the superior Wavefront technology without confusing patients with a barrage of technical terms.

"We don't really advertise CustomVue and Wavefront-guided technology and all those kinds of issues," he says. "We just advertise 20-20 or your money back. People just want to know how well they're going to see afterward."