News & Events
Correcting Laser Vision Surgery
BY SHARON W. LINSKER
FRED SHARP, 67, OF CHAPPAQUA, N.Y., HAD LASIK VISION correction so he could play golf and tennis without the hindrance of glasses or contact lenses. But instead of the clear vision he had hoped for, Mr. Sharp said everything after surgery looked as if it were under water.
After an attempt to correct his wrinkled flap, the patient was referred to Dr. Richard E. Braunstein, the Miranda Wong Tang Assistant Professor of Clinical Ophthalmology and director of refractive surgery. The Columbia surgeon smoothed out the flap, sutured it in place, and used a bandage contact lens to help heal the flap. Delighted with the results, Mr. Sharp says, “I have the freedom of vision that’s close to 20/20.”
The goal of excimer laser surgery is to sculpt the cornea so light rays reach their intended target, the retina. During the past decade more than 2 million people have sought laser vision correction surgery to remedy nearsightedness, farsightedness and astigmatism. The vast majority gets excellent results. But in a small percentage of cases, the outcome may not be completely satisfactory and further surgical adjustment is necessary.
Dr. Braunstein is a nationally recognized expert in performing refractive surgery and correcting poor patient outcomes. He has served as principal investigator for three clinical trials that led to FDA approval of the excimer laser for use in farsightedness and farsightedness with astigmatism. He is now studying excimer laser use in correcting eyes with suboptimal results from refractive surgeries and using new visualization technologies.
The two forms of refractive surgery widely used are PRK and LASIK. PRK (photorefractive keratectomy) uses the excimer laser to reshape the outer surface of the cornea and allow light rays to hit the proper point on the retina. In LASIK (laser-assisted in situ keratomileusis), an adaptation of PRK, surgeons use a motorized blade, or keratome, to cut an ultra-thin, circular flap of tissue from the cornea. The flap is lifted, and the laser treatment is performed on the exposed corneal surface. The flap is then replaced and functions as a protective cover and smooth optical surface reducing patient discomfort and improving visual recovery.
Less than 1 percent of Dr. Braunstein’s own LASIK and PRK patients experience complications from laser vision correction surgery. He attributes his low complication rate partly to the fact that many people who come to Columbia do not get the surgery they want. Dr. Braunstein will not perform the surgery on the very nearsighted or farsighted, on those who have very large pupils, dry eyes, occupational concerns, other eye disease or some medical conditions, or on those with unrealistic expectations.
Dr. Braunstein’s approach to laser surgery differs from the highly commercialized one prevalent today. Patients can get the treatment in a same-day procedure at a mall or from doctors with less expertise. “Over time we have reined in the patients we treat, but the number of complications seen nationwide has increased with the volume of procedures performed,” says Dr. Braunstein.
Dr. Braunstein is able to easily fix some outcomes that create overcorrected or undercorrected vision. Other problems are more complex, such as repairing a wrinkled flap, the complication that plagued Mr. Sharp. Another poor outcome is keratectasia, in which the laser weakens the cornea during LASIK and a corneal bulge occurs. Patients also can suffer from corneal infections that do not respond to conventional medical treatment and result in corneal scarring.
Patients come to Columbia from around the world to consult with Dr. Braunstein and Dr. Stephen Trokel, vice chairman of ophthalmology. Dr. Trokel pioneered the use of the excimer laser in vision correction. “Columbia and the world owe a great deal to Dr. Trokel for his groundbreaking work in vision correction,” Dr. Braunstein says, “and his ongoing development of new technologies in refractive surgery.”