Eyeglass and contact lens users who hear Tiger Woods' radio commercial endorsing LASIK eye surgery might think "Hey, if Tiger would risk his eyes, why not me?"

More than 3 million Americans have undergone surgical procedures to correct their vision, but an estimated 55 million more are candidates. What's holding them back?

"Fear and money," responds Dr. David Schneider, an ophthalmologist and founder of the Midwest Eye Center, which has multiple locations in Greater Cincinnati.

Many people shudder at the idea of an eye being cut, or are anxious about blindness. And the cost of corrective or "refractive" eye surgery by the best ophthalmologists may range from about $750 to $1,500 per eye.

Schneider empathizes with concerns. "Any normal person should approach all surgery with some fear. Nothing is 100 percent in medicine.
"The good news is that blindness [from eye surgery] is almost unheard of," he continues, adding that the risk is about the same as something randomly flying into your eye and blinding you.

On the up side, virtually every patient responds the same after corrective surgery, Schneider says: "God, why didn't I do this earlier?"

TECHNOLOGY KEEPS ADVANCING

The jargon of eye surgery can be confusing: CK, LASIK, LASEK, IOL and PRK and more. Many people say LASIK ("laser assisted in situ keratomileusis") to mean eye surgery to correct myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. The basic concept involves cutting a thin flap in the cornea and either sculpting the underlying tissue or implanting an intraocular lens (IOL) to correct vision errors.

Since its introduction in the late 1990s, the market for this surgery was roaring until it flattened out after Sept. 11, 2001. But much has changed in five years. The technology called wavefront-guided LASIK gives surgeons a precise map of eye physiology and function. This means much less room for error in reshaping a cornea or implanting an IOL (intra-ocular lens, which adjusts lens power inside the eye).
A huge breakthrough came in 2004 with approval of the InterLase laser, the first "bladeless LASIK" device. Instead of using a micro blade to reshape the cornea, this computer-controlled system delivers rapid light pulses to a pre-programmed depth and position. Clinical research shows this delivers better vision with much fewer side effects, and has made far more patients eligible for the procedure. And the newer "Phakic" IOLs now make refractive surgery possible for people with high degrees of myopia or hyperopia.

Another advancements is in cataract surgery, where the clouded lens of the eye is replaced with a clear artificial lens. Now older patients who undergo this common procedure can opt to have other vision aberrations corrected at the same time.

Schneider and other ophthalmologists warn people to be cautious about eye centers or doctors who promote heavily discounted surgery. Schneider, for instance, has performed more than 50,000 vision correction procedures, and participates in research trials required for approval of new technology. "Compare apples to apples, and the individualized surgical care," he advises. "Remember that surgery on your eye can affect your every waking moment. In my view, that's no time to scrimp."

If you're a candidate for corrective surgery, become educated and don't expect miracles. "The patients who do best are those who do not have unrealistic expectations," observes John Ciccone of the American Society of Cataract and Refractive Surgery.

One common misconception: refractive surgery can "cure" presbyopia, the age-related loss of ability to read small print. "Monovision" surgery can correct this temporarily. CK (conductive keratoplasty) uses heat, not surgery, to temporarily improve this condition. Schneider says most adults can have up to three CK procedures, and each one lasts about two to three years.

Just keep in mind that aging can continue to affect your eye function, including corrections done surgically.

BE WATCHFUL
It's one thing to correct vision problems that are genetic or caused by aging. It's another to let neglect put you at risk of permanent and severe vision loss. Eye care is like dentistry: according to respected research, an amazing number of educated, otherwise sensible people put off eye and dental checkups until they experience problems. But losing a tooth is nothing like losing eyesight.

Early detection raises the chances of success in treating degenerative eye diseases, according to Diana Gilbert, doctor of optometry at Cincinnati Eye Care Team (CET), which has offices in Clifton and West Chester. She specializes in the diagnosis and management of ocular diseases including glaucoma, cataracts, diabetic retinopathy and age-related macular degeneration. She also reminds parents of the importance of early childhood vision screening. (CET offers free assessments of infants under age 1.)

There is no cure for macular degeneration, the leading cause of severe vision loss among Americans over age 60, according to the Mayo Clinic. The disease can cause central-vision blindness, leaving a person with only cloudy peripheral sight. If you are at risk (especially if macular degeneration has struck in your immediate family), experts recommend you have annual checkups, don't smoke, add foods high in antioxidants to your diet and talk to your doctor about dietary supplements. Dr. Schneider at the Midwest Eye Center says some new treatments are in the investigation stage, but promise to be expensive. One being tried in Canada costs $19,000.

Aside from eye diseases, Gilbert says the good news is there are more options to surgery for simply improving vision. Advances continue in eyeglass lenses, frames and contact lenses. And now there's a bridge between lenses and LASIK: corneal reshaping therapy, or CRT.
It works like this: a nearsighted (mypoic) patient wears a special oxygen permeable contact lens while sleeping. It temporarily reshapes the cornea. During the day the patient can see in the distance without glasses or contact lenses. If the patient doesn't continue using the CRT lenses, vision returns to the way it was. "It's kind of like wearing a retainer at night for your teeth," Gilbert explains.

CRT works only for people with mild to moderate myopia. But it's becoming a popular option for people who are squeamish about eye surgery, for athletes (especially swimmers) and for children who are too young for refractive surgery. CRT also is an option for people who experience dry-eye syndrome"”like Gilbert herself. "I had a lot of redness and dryness with contact lenses," she explains. "Now I can't go back to contacts. The first night [wearing lenses while sleeping] was wierd, but now it's no big deal."