The Vision Thing

The business of vision correction surgery becomes more high-tech and competitive.

At 93 years of age, America’s second-oldest active mail carrier had a problem. He was in good health and loved his job. But after cataract surgery, he had severe astigmatism and started to experience difficulties driving his rural Kentucky mail route.

“People were starting to complain because his driving was so poor,” said Dr. Tom Abell, “They were afraid he was going to hurt someone. His dream was to be America’s oldest active mail carrier and they were asking that he retire.”

The mailman chose to have laser correction surgery in Dr. Abell’s clinic, AbellEyes, located in Lexington. As a result, his eyesight improved and so did his driving skills. “He was one of my favorite patients,” Dr. Abell said. “We were able to get him back on the road safely and he eventually became the oldest active mail carrier. As far as I know, he’s still out there somewhere, making his daily rounds.”

Other doctors have experienced the same satisfaction resulting from performing vision correction surgery.

“This kind of procedure makes coming to work on Saturday fun,” said Dr. Maurice John, a Louisville physician who has performed more than 40,000 cataract and vision correction surgeries. “In my office, LASIK vision correction procedures are usually done on Friday. Most of our patients have vastly improved vision within 24 hours and they’re excited when we see them the day after. Often, on the way to my office, they drive their car for the first time in their lives without glasses or contacts. It’s fun for my staff and I – it gives us sort of a high to help people see.”

Both Dr. Abell and John said that the resulting enthusiasm of their patients results in a lot of new patients coming in their doors.

“It’s like they say – the best advertising is word-of-mouth,” John said. “By the time I see my patients in the day-after follow-up exam, they’ve called several friends and told them about it.”

Advancements in technology have made vision correction surgery both more acceptable and more easily available. Vision correction surgery has also become big business for eye doctors across Kentucky. The average cost of vision correction surgery is between $1,500 and $2,500 an eye. Thousands have taken advantage of the new medical technology and surgical procedures to see clearly without the aid of glasses or contact lenses.

Besides mail carriers, other professions where laser surgery for vision correction has been popular have been railroad engineers, actors and professional golfers. (Tiger Woods, Hal Sutton and Vijay Singh are three PGA professionals who have had laser eye surgery.) As an employee benefit, some companies, most notably some railroads and airlines, will pay for the laser vision correction surgeries of their workers.

One of the early practitioners of vision correction surgeries, Dr. Abell started performing radial keratotomy (RK) procedures in the mid-1980s. Because of the extended amount of time it takes for the FDA to approve of new medical procedures allowed in the U.S., Dr. Abell had to travel abroad to be trained to perform RK.

“I was one of the first doctors in the region doing RK and ended up teaching it to other doctors around the country,” Dr. Abell said. “I probably performed about 12,000 RK procedures during the 1980s. “With vision correction surgical technology being better than ever, doctors in my profession are making glasses and contacts archaic.”

John is another pioneer of vision correction procedures in Kentucky. He purchased the first excimer laser in the state for use with eye surgeries in 1989, taking part in an FDA study on the device. In October, 1995, the FDA approved using the laser for some vision correction procedures and John hired an attorney to research the legalities on using the laser for the more-modern LASIK (Laser In-Situ Keratomileusis) vision correction technique.

As the result of considerable research of FDA regulations, John’s attorney informed him that it would be legal to perform LASIK as an off label use of an approved medical device. He became the first physician in Kentucky to perform LASIK, which is now the most common and publicized procedure for ALK vision correction surgeries.

Using an excimer laser to reshape the cornea, LASIK is, more or less, the industry standard vision correction procedure. Coincidentally, the excimer laser was originally developed in Lexington, but not for eye surgery purposes. In 1966, engineers at the IBM plant in that city developed the excimer laser for use with an early laser printer. Its medical and optical uses were developed shortly thereafter.

“The excimer lasers are very precise and we get wonderful results,” Dr. Abell said. “About two-thirds of the time my patients have 20-15 vision – which is superior to 20-20 vision – or better after the surgery. The percentage of my patients who have 20-20 or better vision is in the high 90s.”

Dr. Abell has now performed more than 35,000 refractive eye surgeries.

Even more impressive technology is on its way. LASIK and other treatments correct three different optical parameters of the human eye – nearsightedness/ farsightedness, astigmatism, and axis of astigmatism. A computer-tuned German machine called Wavelight Allegretto treats these and 30 other parameters using wavefront technology. Wavefront technology projects 169 individual rays of light into the eye. The lights are focused by the optical system of the eye and reflected back into the device, where a beam-splitter sends them into a computer, which analyzes how the light compares with the way it would be if it were coming from a healthy eye. Dr. Abell at his Lexington clinic is currently testing one of only 10 such lasers in the U.S.

“This is borrowing technology from the astrophysicists,” Dr. Abell said. “When they study the stars they look at the polynomials of their telescope’s optics. Wavefront technology works with the optic polynomials of the human eye.”

The new technology that excites John is a recently-approved lens implant that helps people past the age of 40 deal with farsightedness.

“One of the exciting surgeries I’m doing now is a multifocal lens implant, called the Prelex. The lens was developed by Allergan and has just received FDA approval,” John said. “The procedure for implanting the new lens is called a clearlensectomy and it gives patients young eyes again. With it, farsighted people can see at all distances.

“It’s a revolutionary procedure to deal with the farsightedness that naturally occurs with aging. It’s going to be very popular, because the procedure is incredibly predictable and safe.”

According to both Dr. Abell and John, potential patients wanting vision correction surgery need to be picky.

“Many consumers think all doctors are equal,” John said. “And that’s simply not true. It’s important that they go to an experienced physician who is specializes in the kind of procedure they want, rather than doing it as a sideline. That way, the physician will know how to deal with a wide variety of situations and complications, if they occur.”

“They need to go to a well-established physician who specializes in vision correction,” Dr. Abell concurred. “The potential patient needs a doctor who will accurately analyze their eyes – that’s the number one priority. There are some people who shouldn’t have this kind of surgery and a responsible physician is willing to tell them that. These people, who have abnormal corneas or other optical problems, are at a higher risk for something going wrong.”

Another thing to look for is a doctor who keeps his equipment in top shape. One thing that’s been very frustrating that’s happening in this industry is that some corporations have realized the tremendous economic benefit of performing this surgery. They try to discount their prices and it leads to cost cutting that sometimes is to the detriment of the patient. To keep an excimer laser tuned costs maybe $200,000 a year. If the laser is not tuned on a regular schedule, serious problems can result.

“Also, the blades on these machines, which are used for the corneal incision, should be replaced with each patient. The patient should ask if the blades are being reused or not. If they are, then it would be wise to find another doctor.”

This article was originally printed in The Lane Report

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