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Rolling the dice on RK: controversy surrounds radial keratotomy, but thousands of Arkansans take the risk.

THE THOUGHT OF CUTTING into a human eye makes anyone but an ophthalmologist cringe. It's a procedure traditionally reserved for ocular disease and trauma -- conditions that leave no choice but surgery. In the absence of infirmity, most people would prefer to keep all sharp objects away from their peepers, thank you very much.

So why is it that thousands of Arkansans have paid $1,000 an eyeball to subject their corneas to radial keratotomy, a relatively new and somewhat risky surgery to correct nearsightedness?

The answer, of course, is freedom.

Freedom from heavy, awkward glasses that rub their noses, fall off during basketball games and fog up in winter. Freedom from annoying, shifting, abrasive contact lenses, which can feel like breakfast cereal in the eyes and occasionally bring grown-ups to their knees when they slide into a tear duct.

The trouble is, RK guarantees no such freedom.

"The main problem is the unpredictability of it," says Dr. Michael Roberson of the Little Rock Eye Clinic, an ophthalmologist who frequently performs the procedure.

"Nobody has ever obtained 100 percent success with radial keratotomy. You are doing a statistical operation."

Surgery by the numbers, so to speak.

The root cause of the trouble is nearsightedness. Also called myopia, it's a condition in which incoming light rays are excessively bent or refracted by a misshapen cornea, causing the rays to focus in front of the retina rather than directly on it.

Fully 25 percent of the population in Western countries suffers from this condition. Most cope by wearing glasses or contacts.

For those who shun tradition, there is radial keratotomy.

The RK surgeon makes 4-16 radial incisions in the cornea with a diamond blade, with each cut emanating from the rim of the eye to the center without extending over the pupil.

The incisions cause the edges of the cornea to spread and the center to flatten. The flattened cornea moves the focus of incoming light backward -- to the surface of the retina, it is hoped -- theoretically producing focused vision.

But it is rarely that simple.

Statistics Bare Studying

Two studies conducted in the 1980s found that only 76 percent of the eyes that underwent RK surgery achieved visual acuity of 20/40 or better, the level of vision needed to pass a driver's license test in Arkansas.

Patients who have lived with very poor vision might consider 20/40 a miracle. But fully 24 percent of the patients studied didn't fare so well, meaning they would once again be required to wear glasses.

RK patients are sometimes left with vision that fluctuates under different conditions, requiring more than one lens prescription.

For a few weeks after the procedure almost all patients experience a "starburst" or "halo effect" when they go from darkness to light. Sometimes the effect can linger.

The operation sometimes over-corrects an eye, sending it into farsightedness, or presbyopia.

And, in rare cases, the surgery can be downright dangerous.

"It is not universally safe," says Dr. Hamp Roy of Little Rock. "There have been some eyes that have been lost -- perforated with the diamond knife and infected."

Roy performs RK surgery, mostly for elderly people who have had cataracts removed and are more nearsighted than they would like to be.

As a result of these problems, many ophthalmologists are careful about whom they approve for the procedure.

The candidates must not be too nearsighted, lest they prove incurable, and their vision can't be better than 20/40, in the event RK actually makes it worse. The successful candidate also must have a realistic attitude. Anyone expecting perfect vision is usually pointed to the eyeglasses department.

The RK procedure begins with a dosage of Valium and anesthetic drops for the eye. A special device restrains the eyelids from blinking, and another device marks black lines on the cornea where the cuts will be made.

The entire surgery can last as little as 10 minutes.

To date, health insurance plans generally have snubbed the surgery, considering it unproven and unnecessary.

Why Take the Chance?

The rap on RK is that it is a procedure done on healthy eyes -- an elective procedure that can't possibly improve vision over the glasses or contacts already available. If patients choose RK surgery, they are taking a chance, however small.

But to some, the chance is definitely worthwhile.

Wendy Bush, a 31-year-old certified public accountant from Sherwood, underwent RK last year.

"I'd do it again in a heartbeat," she says, recalling how her extreme myopia was transformed to 20/20 vision in one eye and 20/25 in the other. She had worn glasses since age 5.

Bush had to undergo "enhancements," however, meaning follow-up visits to improve the results of the original surgery. The first time, in March, her vision was corrected to only 20/40. In August, Dr. R.E Hardberger of Little Rock retraced the incisions, making them slightly deeper.

Fred Vanpool is not so sure of his results.

Vanpool, 30, a Fayetteville computer programmer for Tyson Foods Inc., had the surgery two weeks ago at the clinic of Dr. J.E. McDonald II in Fayetteville.

"One of my eyes sees a little better than the other and it throws me off," he says. "I wouldn't have had it done if I thought I would still need to wear glasses." The effect, he has been told, may be temporary.

There are alternatives to RK.

Through a technique called orthokerateology, optometrists can fit myopic patients with special contact lenses that actually change the shape of the cornea over time.

Dr. Jerry Shue, an optometrist in North Little Rock, says he also has had success with young, highly motivated patients in using biofeedback therapy to help them relax the muscles that focus the eye to the point that near-20/20 vision can be obtained.

This method only works for a limited number of patients, however. Shue says it is particularly good for pilots, who must maintain near-perfect uncorrected vision.

There are a few RK giants in the state -- clinics that advertise heavily and can boast of thousands of procedures. Chief among them are Hardberger-Capps Eye Center in Little Rock, Dr. James R. McNair in Little Rock and Newport, Eye Care-Surgical Associates in North Little Rock and the McFarland Eye Surgery Center in Pine Bluff.

Some of the big-time RK clinics offer free seminars and videotapes for those considering the surgery and vans to ferry the patients back and forth from the clinics.

Dr. Frank Teague of Hot Springs is hoping to join that company. Teague began performing RK in June, but already he is flooding the evening airways with testimonial ads and offering to send videotapes to any tentative viewers.

"We charge $850 an eye," Teague says. "I think some people have lowered their prices to be like us."

But, in all his enthusiasm, Teague has not forgotten the No. 1 rule:

"We never talk anyone into RK."
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Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Health Care Update; eye surgery for nearsightedness
Author:Haman, John
Publication:Arkansas Business
Date:Jan 25, 1993
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