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A new look at some old eye surgery.


In our November report on the use of laser surgery to correct simple vision problems, we made reference to a procedure developed in the Soviet Union and introduced into this country in the early 1980s - radial keratotomy. We noted that, although it enjoyed brief popularity here, it was no longer in favor. This, we now learn, was not entirely correct, having been based on opinions of some eye surgeons highly critical of the procedure. These doctors charge that radial keratotomy too often overcorrects nearsightedness, converting it farsig htedness. There was even disagreement among eye surgeons doing the procedure as to how it should be done. Now, however, a recent report in The Journal of the American Medical Association says the procedure seems to have greater merit than was previously thought.

Nearsightedness results from too great a curvature in the cornea, the curved outer surface of the eye that, together with the lens inside the eye, focuses light on the retina. In radial keratotomy, the cornea is flattened by cutting a series of tiny slits in a radial pattern around the pupil. Part of the controversy over the procedure was disagreement as to how many slits were needed for the best results.

Ten U.S. eye centers began a collaborative study in 1982, all performing the same operation, using eight slits. All 435 patients studied were carefully followed for four years after the study. Ninety-six percent of the patients asked for the surgery hoping to eliminate their needs for glasses or contact lenses; others opted for it because their jobs required better vision or for cosmetic reasons alone. Of those who wished to rid themselves of eyewear, 64 percent were able to, and 76 percent saw well enough to be able to pass a vision test for a driver's license without glasses.

On the negative side, 28 percent were still nearsighted, and 17 percent had become farsighted as the result of overcorrection of the corneal curvature. In this latter group, most under age 40 could function without eyeglasses. In the 40-45 age group, many found themselves having to wear eyeglasses for reading, whereas before they could read simply by lifting the eyeglasses they wore for distant vision. Among those over 45 who became farsighted as the result of the surgery, many require eyeglasses for both near and far vision. Regretably, the surgeons were unable to predict which patients would fit into these various groups after surgery.

Odds of two-out-of-three for being able to rid oneself of eyeglasses may appeal to some, but others would probably find glasses not so much of a nuisance after all if the alternative was converting nearsightedness to farsightedness and having to wear glasses for both. Given the normal changes that take place with aging, a wait-and-see (no pun intended) attitude is probably the best at the moment, in the hope that the new laser procedures will provide more reliable prognoses.
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Title Annotation:radial keratotomy
Publication:Medical Update
Date:Apr 1, 1990
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