Episode Transcript
Dr. Miller: You don't want to wear your glasses and you don't want to use contacts. Are there other options? We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.
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Dr. Miller: Today I'm here with Bala Ambati and he is a professor of ophthalmology here at the University of Utah. Bala, what's the story? If you don't want to wear glasses and you're sick of even trying contacts or you can't wear them for whatever reason are there other options?
Dr. Ambati: We now have options for patients at almost any age to get rid of the need for glasses or contact lenses. In the young adult population, I'd say between the ages of 20 and 45 the primary option of course is LASIK or laser vision correction. In patients that have very high near-sightedness we can do what's called and intraocular contact lens, placing a lens inside the eye between the iris and the lens.
Dr. Miller: Let's go back for a second. LASIK, so that's actually a laser that cuts into what, the cornea, the lens? What does it do?
Dr. Ambati: LASIK, laser vision correction relies on creating a flap within the front quarter of the cornea, laying that flap off to the side and then reshaping the remaining cornea, the bed of the cornea, and then putting the flap back on.
There are some patients who are very near-sighted who would not be candidates for LASIK because the amount of laser would be too much for their eye. And in that situation we can offer what's called the intraocular contact lens where you can actually go inside the eye and place a contact lens in between the iris, the colored part of the eye, and the lens, and that has also been around for several years and works very nicely for the very high near-sighted population.
Dr. Miller: Well, it sounds great that we can use Lasik in some people to relieve them of the need of glasses or contacts but are there any downsides to the LASIKs procedure?
Dr. Ambati: I would say that any time you consider doing surgery you should get a careful screening. You want to make sure you don't have something called keratoconus. We do cornea scans to look at the shape and thickness of the cornea. We'd want to see if you have any other eye problems inside the eye.
Dr. Miller: If you had keratoconus I'd suppose LASIKs would not be a procedure you would prefer.
Dr. Ambati: Yeah, I would definitely not do laser vision correction on a patient with keratoconus. It is important to remember that after age 40 the lens in the eye weakens just due to increasing wisdom and maturity and when that happens
Dr. Miller: What a nice way of putting that.
Dr. Ambati: When that happens, you start needing reading glasses. And so, if you have Lasik at age 22 or 23 you would need reading glasses at age 40. But if you never had LASIK, at age 40 you would need bifocals.
Dr. Miller: I see. That makes sense.
Dr. Ambati: Exactly. And then, as I mentioned, in the older population, in patients over 55 or 60, the options at that point to get rid of glasses or contacts would be what are called multifocal or accommodating lens implants. Lens implants that can be placed inside of the eye that can give both distance vision and near vision. That usually happens at the time of cataract surgery. And that's a wonderful technology that's come out in the last five or six years.
Dr. Miller: It sounds like we can customize vision internally now almost.
Dr. Ambati: Absolutely. Anything in the front of the eye, the cornea, the lens, we can reshape or replace and customize it based on the person's eyes and visual goals and lifestyle.
Dr. Miller: One question I had from a patient not too long ago was if you had LASIK surgery, does that prevent you from having cataract surgery later in life? Is that a problem?
Dr. Ambati: It doesn't prevent cataracts or any other eye condition. So if you have LASIK at 25 and you're going to get cataracts when you're 70 or macular degeneration when you're 90, those things are still going to happen. And you can still undergo the usual procedures for those.
Dr. Miller: What you mentioned is that LASIK is not for everybody. There are some patients that couldn't receive LASIK, you mentioned keratoconus was one of those conditions. You mentioned this intraocular lens implant. How often are you using that lens implant now as compared to LASIK surgery? Is that becoming more popular?
Dr. Ambati: I would say that in patients with more than eight or nine diopters of near-sightedness, the intraocular contact lens is probably a better option.
Dr. Miller: Are there more risks with intraocular lens implantation than with LASIK? And if not, do you expect the lens implantations to become more popular than LASIK at some point?
Dr. Ambati: Every surgery has risks. Because the intraocular contact lens involves going inside the eye, there is a higher risk of bleeding or infection inside the eye than laser vision correction which stays just on the surface of the eye. But that said, the risks are extremely low, less than 1%.
Dr. Miller: It sounds like the first you would recommend would be LASIK surgery and if the measurements for the cornea weren't quite right for that the next step would be recommending intraocular lens implants.
Dr. Ambati: First, I would talk to the patient and see what phase of their life they're in and what their visual goals and needs are. Somebody who is 70 years old is probably going to be better served with removing an early cataract and putting in a lens implant at that time. But in a patient who is between 21 and age 45 the best thing for their eyes would be LASIK, assuming they're a good candidate. And that's what we would screen for.
If they're not a good candidate because their cornea's too thin or their cornea's not the right shape then there are all of these options like PRK, lasers without the flap, intacs if they have keratoconus, or the ICL, the intraocular contact lens if they're a very high near-sighted or a stigmatism patient.
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