New focus in vision treatment


December 10, 2004|By Mary Beth Regan | Mary Beth Regan,Special to the Sun

When Cheryl Flood's husband had laser eye surgery to correct poor vision a few years ago, she was more than envious. "I was downright resentful," said the 40-year-old mother of two. "He qualified for the surgery, but I didn't. It seemed unfair."

Like many people, Flood wasn't a good candidate for conventional LASIK or other laser procedures because of corneal irregularities.

Still, she persevered in her quest for a glasses-free existence. She called her doctor, Sheri Rowen, every few months for nearly three years. She plunked money into her tax-free health care spending account in the hopes that a new technology would come along.

Eventually it did.

Two days ago, Flood was one of the first people in the United States to receive newly approved implantable lenses in a surgery by Rowen at Mercy Medical Center in Baltimore.

A second patient, with severe nearsightedness not treatable by laser procedures, will have the same surgery at the Johns Hopkins Wilmer Eye Institute later this month, performed Dr. Terrence O'Brien, a principal investigator during the lens' U.S. clinical trial.

The synthetic lens, widely used in Europe for more than a decade, was approved by the Food and Drug Administration in September. It will be marketed under the brand name Verisyse by Advanced Medical Optical Inc. of Santa Ana, Calif. A second lens by another company is expected on the market in the spring.

"These implantable lenses are the wave of the future," said Rowen. "They have the ability to correct vision with exact precision without altering the shape of the cornea." And unlike laser procedures, which do alter the shape of the cornea, implantable lenses are permanent, although they can be removed if there are problems.

Flood, an energetic woman with auburn hair and bright blue eyes, arrived at Mercy Medical Center Wednesday morning with her sister, another LASIK patient whose vision was corrected several years ago.

"I'm excited," said Flood, whose uncorrected vision was worse than 20 / 400. "And I can't wait to get rid of these," she added, motioning to her thick glasses.

By 1 p.m., Flood had been lightly sedated and prepped for surgery on her left eye. In most eye surgeries, it's standard procedure to operate on only one eye at a time, in case there are complications. Her right eye will be done next month.

"No rock 'n' roll music," she said, joking with Rowen.

"Not while I'm operating," responded the 51-year-old surgeon.

Rowen cut the bottom of Flood's cornea, and suctioned up some blood. Then she slid surgical instruments beneath the cornea into the inner chamber of the eye.

Next, Rowen used tweezers to lift a synthetic lens from an operating table. The lens looked no different from any contact lens, except that it was slightly smaller. She then lifted the corneal tissue and placed the lens across the iris, over Flood's pupil.

In 10 minutes, the lens was in place. Rowen lifted muscle from the iris to anchor the lens. Then, using tweezers, she sewed the cornea back together with nylon thread thinner than a human hair.

"That should do it," she said.

Advances in treatment

The arrival of implantable lenses marks a departure from recent advances in corrective eye surgery. In the 1990s, doctors pioneered conventional LASIK treatments, which use lasers to reshape the cornea for sharper vision.

In recent years, computer and other technologies have refined the precision of laser surgery. In addition, doctors have begun using surficial ablation procedures, such as LASEK and Epi-LASIK, which correct vision by reshaping the cornea without making any incisions in the eye.

But implantable lenses piggyback on an entirely different idea that has been around since the 1940s to correct cataracts, the clouding of the natural crystalline lens that causes blindness. Doctors have long treated cataracts by replacing the eye's natural lens with a synthetic lens.

This approach saves vision, but manmade lenses are not as pliable or responsive as the eye's natural lens.

Two decades ago, researchers in the Netherlands got the idea of placing an implantable lens into the eye to correct vision without removing the natural lens.

Today, researchers are working on these lenses, called phakic lenses, to cure a host of vision problems. Eventually, doctors hope to be able to inject a substance into the eye to create lenses, which could then be altered by light rays to exact vision prescriptions. That technology is years off, Rowen said.

The Verisyse lens that Flood received is approved for use only on people who are moderately or severely nearsighted.

Market analysts estimate that roughly 20 percent of Americans have vision problems that can be corrected with surgery. Most people opt for laser procedures because they are cheaper, treat common vision problems and have proven track records.

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