Vision Quest

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The ability to see perfectly is something we all want, and technology is bringing us within sight of that possibility.

Ilsa Hess was mad as heck about her eyesight and she wasn’t going to take it anymore. I had worn glasses since I was about 4 years old. My eyes were horrible, says the web developer.

Three years ago, a trio of co-workers who had undergone LASIK treatments from Leonard Newman, M.D., encouraged Hess to make an appointment. Newman, an ophthalmologist, performs thousands of laser eye surgeries every year at his offices in Sacramento on Auburn Boulevard and in Hercules.

They said he had payment plans without interest, Hess says about the then-$1,800 elective surgery. With the recommendations of my co-workers, the low monthly cost and the thought of not having to wear glasses for the first time, I had the procedure done.

LASIK, a thankfully pronounceable acronym for laser-assisted in situ keratomileusis, takes only a couple of minutes per eye. During the procedure, the surgeon anesthetizes the eye with drops, creates a flap on the surface of the cornea, uses a laser to remove tissue from under the flap, then returns the flap to its original position, where it heals naturally.

To say Hess was impressed with how things went with her LASIK surgery would be an understatement.

It was mind-blowing how quick the procedure was, how painless, and how I could already see right afterward, says the 36-year-old midtown resident. I took some pain meds and felt fine the next day. The only thing that took some time to go away was the feeling of dryness in my eyes. It was helped with eye drops, but finally completely went away after one month.

Twelve years ago, Keith Liang, M.D., of the Center for Sight on J Street became the first ophthalmologist to perform LASIK in Sacramento. It was exciting because no one else believed in the procedure here, says Liang, who received LASIK-surgery training in Mexico and China. I have patients from 1996 who are still 20/20, and they could not get a better result today.

Vision care has not plateaued since the mid-1990s, however. Progress, quite literally, is everywhere to be seen. People of all ages, for a variety of reasons, have opened their eyes to laser treatments: Every year, more than a million Americans have laser-assisted eye surgery. Not only is vision improved, but traditionally crippling ailments such as cataracts and glaucoma are being dealt with briskly and effectively thanks to developing technology. Recently, Newman, Liang and a few other eye doctors spoke with Sacramento magazine about the status of early 21st century vision care.

You Can’t Fight Change. Or Can You?

Life after age 40 has its challenges. For example, the day inevitably comes, at home while looking at a letter’s fine print or at the supermarket when checking a product’s list of ingredients, when we squint to read. We rub our eyes, hold the item close to us or move it to arm’s length, and still . . . fuzziness. What the heck is going on?

In a word: presbyopia. It’s from the Greek word presbyteros, which means elder. Talk about jolting and unwelcome surprises! We still may fancy ourselves as young and then all of a sudden are being defined, at least in one sense, as old.

What has happened, explains Bruce Chin, O.D., of Laguna Creek Optometry in Elk Grove, is we have lost our ability to focus our internal lens, which makes it so we cannot read fine print without the aid of correction vision.

What Chin means by correction vision, for those whose eyesight never before has been an issue, is reading glasses. And for those of us who already have been wearing glasses or contact lenses, it’s time for bifocals.

Can LASIK surgery in one’s 20s or 30s preclude the need for bifocals later in life? You might want to close your eyes before you read the answer.

Reading glasses are as predictable as death and taxes, says Liang. Everyone will get older and will wear them whether they have the surgery or not.

Newman, the surgeon who treated Hess and her co-workers, elaborates.

The laser does not change anything about the normal physiological changes the eye undergoes with aging, he says. Overall, our patients in their 40s and older are quite pleased with the fact that they can do most things except read small print without reading glasses. They can usually see their computer monitors, menus or cell phones at arm’s length without any glasses, and that is exciting.

Richard Lewis, M.D., a Sacramento ophthalmologist and former president of the American Glaucoma Society, offers some hope for the future. His Arden-area office is serving as an investigator for U.S. Food and Drug Administration trials of an artificial lens for cataract patients that simulates what natural lenses do in 20- to 25-year-olds: It changes position and thickness depending on what the eye is focusing on.

It sounds very exciting, and the patients have done very well with it, Lewis says. Down the road, the lens may be appropriate for presbyopia rather than cataract patients. But if I was 40 years old, would I want this? I’m not sure yet. It’s still too early to know what happens, you know, 10, 20, 30 years with this kind of lens. And maybe the next step in technology will be better yet.

Liang says he tells young people who are considering LASIK surgery, but are concerned about still needing glasses for reading later on, that 20 years from now there may be a way to cure presbyopia. Meanwhile, he adds, I can now implant a lens into 50- or 60-year-olds that allows them to see both at distance and up close without glasses. This is of major interest to baby boomers.

Don’t Be Blind to the Dangers

Not every laser procedure goes well. I recently heard, secondhand, about a woman who, following LASIK surgery, complained that her eyes felt as though they were permanently imbedded with dry contact lenses. Some medical professionals don’t care for high-tech vision care, either. Joseph Mercola, D.O., an Illinois-based health activist who has developed an extensive following through his website (mer
cola.com), says that LASIK does absolutely nothing to treat the cause of your vision loss. Complications of LASIK, though rare, include incomplete correction of vision, dry eyes, seeing halos around lights or glare at night, and failure of the flap to adhere correctly.

The local ophthalmologists I spoke with are more upbeat about LASIK.

Ninety-nine percent of our patients can drive themselves to the (next-day) post-op appointment, Newman says. Combining our current technologies with an experienced surgeon creates a very safe and predictable result.

I think you always have to be concerned about technology, Lewis says. Sometimes it sounds very sexy and appealing, but there’s always a risk any time you intervene or perform surgery. So, balancing the risks and benefits, there are some exciting things, but you still have to be very careful. ‘Do no harm’ is an important concept of medicine.

Richard Grutzmacher, M.D., an ophthalmologist who has been business partners with Lewis for 19 years, specializes in laser vision correction. He downplays the dangers.

We’ve now gone to fairly short operations with eye drops, commonly without any injection, and fairly quick, painless procedures, he says. For example, cataract surgery is probably easier than going to the dentist. That seems humorous, [but] it’s actually almost true.

Robyn DeLong, a local real estate agent, had been nearsighted since the third grade. A decade ago, she summoned the courage to have laser surgery on her left eye. The change was extreme and I could no longer read anything or even see anything easily close-up, she says. A year later, Grutzmacher performed the more sophisticated LASIK procedure on her right eye; she was a lot happier with that result.

I don’t think I realized how much I was adapting to poor vision until I got the surgery and was free from glasses, says DeLong, a baby boomer who prefers her exact age not be printed. Scratchy, tired eyes are a dim memory. I fuss about the reading glasses and small print, but wouldn’t go back [to before the surgery] for anything.

 

Treating Cataracts and Glaucoma

Cataracts, which are the clouding of an eyeball’s natural lens, develop frequently as we grow old. Sixty percent of 65-year-olds have them, and 90 percent of us have cataracts after we turn 75. They vary in type and location and are not brought on solely by aging: Certain steroid medications also can trigger the disease. No surefire prevention has been proven, although ultraviolet-protecting eyewear and the regular intake of antioxidants, such as vitamins C and E, may be helpful. In 2005, 2.8 million cataract surgeries were performed in the United States.

Glaucoma occurs when drainage that regulates pressure of fluids inside the eyeball is somehow compromised. This can damage the optic nerve and, ultimately, produce blindness. Lewis says glaucoma, which on very rare occasions strikes the very young, usually starts to be a threat in middle age. By the time we turn 80, we have a 10 percent chance of developing the disease, which is more common among diabetics and African-Americans. Again, scientific research has yet to identify effective preventative steps.

Both partners in Grutzmacher & Lewis have noticed a change not so much in the frequency of eye diseases, but in the zest with which patients want those diseases remedied.

I think that the biggest change that has occurred, oh, over the last couple of generations, is that everyone is living so much longer and is living a better quality of life, Grutzmacher says. So many people now are coming to eye surgeries, like cataract surgeries, corneal transplants, even up into their 90s. . . . Twenty or 30 years ago, if someone were maybe in their 80s or certainly in their 90s, they would not have had an elective eye operation very often. A lot of people would have said, ‘I’m too old for this, and I don’t want to do that.’ Well, not anymore. Now people, even 90, may have a life expectancy or 10 years or more, and they want to function better.

If Laser Surgery’s Not Your Thing

Chin, the Elk Grove optometrist, is dedicated to outfitting his patients with the best corrective lenses possible. He says those who need bifocals often opt for the progressive design&emdash;rather than the lens having a distinct border between distance and reading correction, there’s an invisible transition. I find that most patients want this type of lens [because] they do not want to look like their parents, with lines on their glasses, he says.

Computer screens can pose a problem for bifocals wearers. Patients complain that they have to tilt their heads back in order to see their monitor, says Chin.  

He says the effectiveness of photochromic lenses, which darken upon exposure to sunlight, can be compromised inside automobiles, when the darkening sometimes does not occur. Researchers are tackling that problem, but so far results are sketchy. As for straightforward shades, Chin says, There are some very good sunglass lenses on the market, but the problem is that the consumer has no way of knowing how much protection a particular lens will provide, because there is no standardization in the sunglass industry.

LASIK success stories DeLong and Hess, however, are no longer concerned with such four-eyed matters as bifocals. I haven’t been to the eye doctor in years, DeLong says. Don’t know if that’s good or bad, but I used to have a prescription change almost annually.

Hess retains a small need for spectacles: as a prop for her social life. I kept my favorite pair of eyeglasses to use for reading glasses, she explains, because men I’ve dated say they love ladies who wear glasses.

Sight by the Numbers

Having 20/20 vision is not, contrary to popular belief, the best you can do. Consider this definition from allaboutvision.com:

Basically it means ‘good visual acuity at 20 feet.’ So if your vision is 20/20, you can read certain sizes of letters on a Snellen chart clearly at 20 feet or closer. But if your friend has 20/15 vision, his visual acuity is better than yours: You would have to stand 15 feet away from the chart to read the smaller letters that he can read while standing 20 feet away. Conversely, someone with 20/30 vision has worse distance vision than you.

Visual acuity at a distance isn’t the only measure of how good your vision is. You could have 20/20 distance vision but still have difficulty seeing at night because of poor contrast sensitivity. Or you could have near vision problems because you’re over 40 and experiencing presbyopia.

Framed!

• Vintage is in with these horn-rimmed Kata frames, made of heavy plastic in a rectangular shape that recalls the 1950s. Handmade craftsmanship ensures extra comfort. $294.
(Available at Granite Bay Vision Care Optometry, 6995 Douglas Blvd., Granite Bay; 916-791-5490)

• Handmade in Paris, these intricate La Font frames feature a delicate lace pattern on the stems and are embellished with Swarovski crystals. $474.
(Available at Eyes on J, 808 J St., Sacramento;  916-447-3000)

• No one’s a square in these Oliver Peoples frames. Handmade from plastic and titanium (which holds adjustments well), the hickory-colored glasses suit men and women. Extra depth allows them to be made into bifocals or sunglasses. $260.
(Available at Visions Optometry, 535 Fulton Ave., Sacramento; 916-925-5151)

• A beta-titanium alloy makes these Maui Jim frames lightweight and ultraflexible. Wraparound shades also are available as regular glasses, for men and women. $249.
(Available at Indivisual Eyes, 1200 K St., Sacramento; 916-444-3012)

• Inspired by nature, Morel’s Koali series frames offer intricate details, bright hues and free-flowing shapes. Starting at $200. (Available at EyeOptics Optometry Center, 7423 Laguna Blvd., Suite 100, Elk Grove; 916-684-6688) &emdash;Elizabeth Marxen