FOR MANY, THE ABILITY TO SEE CLEARLY IS SOMETHING TAKEN FOR GRANTED.  Glasses and contact lenses are no longer technological marvels or oddities, but a fact of life. What about those problems not easily solved by such superficial remedies? SRQ sat with local eye surgeons to discuss new technologies and solutions bringing 20/20 vision into the 21st century. 

SRQ: What are the most common eye conditions you see that require  surgery? Dr. Brian Foster, The Eye Associates: The most common is cataracts. Other conditions that are common are corneal dystrophies that require corneal transplantations and then refractive surgery for people that are near-sighted or far-sighted who want to see without glasses or contacts. Dr. William J. Lahners, Center For Sight: Being corneal specialists, we tend to focus on surgical diseases of the front part of the eye, the cornea–corneal diseases, corneal infections, cataracts (which is the number one cause of blindness in the world)–but in addition, eye doctors treat other age-related conditions most commonly. Additionally, as a refractive surgeon I spend a lot of time correcting vision using techniques like All-Laser LASIK in patients who are interested in decreasing their dependence on glasses.

What causes these conditions?  Lahners: A cataract is a normal part of the aging process of the human lens. The human lens, which is one of the focusing elements of your eye, sits right behind your pupil. It’s nice and clear and very flexible when you’re born, in most cases, and it stays that way until around the age of 40, when it starts to stiffen and that’s when people start needing reading glasses. Somewhere in the 5th, 6th or 7th decade of life, we start seeing cloudiness in the lens, and we call that cataract. When that begins to inhibit the visual performance of the eye, we recommend removing it. Foster: One of the biggest advances in corneal surgery in the past decade has been partial thickness corneal transplants, and the most common disease that we treat with that surgery is Fuchs Dystrophy. It’s actually fairly common and it’s often very visually disabling. In some ways it is similar to a cataract; it causes reduced contrast, foggy vision and can really affect vision. The treatment has now gone from about a year recovery to about a six-week recovery with the newer techniques. That has been a huge advance in the last 10 years. It’s amazing.

How major is eye surgery considered these days? Lahners: Eye surgery is definitely considered major surgery. The eye and the structures surrounding the eye are extremely delicate and they’re extremely important to our performance in everyday life. Most of us probably wouldn’t be able to hold down a profession or even be able to take care of ourselves without our eyes. It’s without a doubt an extremely delicate and extremely important organ system, and as such it commands a serious amount of respect. The good news about eye surgery though, is that with today’s technology the surgery is a very enjoyable experience. Most of the eye surgeries that we do are painless, take only a few minutes and patients recover very quickly. We tend to let people go back to exercising, lifting weights, running and biking the next day after surgery.  Foster: It’s interesting that a lot of people have stories of relatives 30-40 years ago that were in the hospital for a week after cataract surgery and because of the technology we have now, we’re doing tiny incisions where you don't have to be on bedrest. You’re very active very quickly, even with removing the cataract and even more major eye surgeries like the new corneal transplants. We’re not having to keep people in the hospital, it’s completely outpatient. It takes a few minutes, you go home then we see you the next day. Lahners: Laser cataract surgery has been compared to manual cataract surgery and in every study that I’ve ever seen it is more precise than what we can do with our hands. It really adds an element of precision to certain steps of the procedure.

How common is LASIK surgery these days?  Lahners: LASIK surgery has been done in the US since 1991. There are over a million people per year in the US who get LASIK. So there have been over 20 million people in the US alone who have had LASIK now. It has been one of the most extensively studied surgeries ever done on human beings and it’s considered the most successful elective surgery that we’ve ever done. LASIK is a very mature surgery now and it’s a very popular surgery. With today’s modern equipment, LASIK surgery is really a great experience and one of the most gratifying things that I do as a cornea specialist.  Foster: I would consider LASIK one of the modern medical miracles. You basically have a patient whohas a healthy eye but because of refractive error they’re severely near-sighted or are having a lot of vision issues and relying on glasses or contacts. You take that patient, do the procedure and even the same day they notice a dramatic improvement in their vision. Then you see them back the next day and they’re often in tears because they see so much better and they’re not tied to the glasses or the contacts anymore. It’s painless with a very quick recovery. It’s just a wonderful thing.

Are there any concerns about the long-term effects of LASIK?  Lahners: The long-term questions about LASIK have really been answered at this point, because LASIK surgery is what we call a Lamellar-based surgery – we’re altering the layers in the cornea. It is based on Lamellar surgery that was done in the 40s and 50s, of course back then it was all done by hand. So we have patients who had Lamellar surgery 50-plus years ago and they’re absolutely stable. When we do it with laser technology, we’re working at a more superficial and precise level than they used to have to work at with manual techniques. So the surgery, if anything, has gotten more reproducible and safer and I don’t think that there really are any long-term concerns about LASIK at this point. Foster: I agree completely. It’s been extensively studied and it’s incredibly safe.  Lahners: That being said, there are people who are not candidates for the surgery, and unfortunately, as a refractive surgeon, one of your big tasks is to determine who really are good candidates for the surgery and who aren’t. If you’re a good candidate for the surgery, there’s very little long-term risk. The selection of candidates is one of the most important things that we do as refractive surgeons.

What makes someone a good candidate?  Foster: Some people have eye diseases that make them inappropriate candidates. Significant dry eye would often make someone not a good candidate for LASIK, a refractive error that’s outside the range of the FDA-approved range of the laser, other conditions like keratoconus or certain diseases that weaken the actual structure of the cornea - and if you perform LASIK on a weakened cornea, you can cause some instability and create more problems. That’s our job as a LASIK surgeon, to consider everything, look for any possible factors that would limit a person’s successful outcome, and essentially rule them out as a candidate or consider another surgical modality such as clear lens replacement to meet their vision needs that would be safer for them. Lahners: LASIK and laser cataract surgery have gotten so sophisticated and so technologically-advanced now that it really has increased the level of precision, the level of accuracy in the end result and the level of safety–there’s no question about that. But ultimately, what it really comes down to–like everything else–is not so much the technology, but the doctor: the experience and training of the doctor and the ability of the doctor to assess the patient and to figure out who is the right candidate for the right technique and to deliver that result. As much as we love talking about technology, the ultimate most important link in this whole chain is still the physician.

What are the risks associated with eye surgery and what kind of recovery times can people expect?  Lahners: Despite all of the technological advancements, whenever you do surgery on an organ system, there are always going to be risks, and those risks in the eye are always going to include things like loss of vision and loss of function of the organ system. Complications following the routine surgeries that we perform are actually quite uncommon. Foster: There are a few serious risks that we always are worried about, but the serious risks are extremely rare, like retinal detachment or infection within the eye. You’re talking about a one-in-several-thousand chance for some of these major complications. The good news is that even these complications are treatable and that’s why we see folks for follow-up visits after surgery. And essentially it’s an open-door policy–if you have any issue at all, if you have any concern about your eye after surgery, we want to see you right away just to make sure there’s nothing serious going on.  Lahners: The recovery from most of these surgeries is fairly rapid. Some people take a few days to get some of the swelling out, to start getting really clear vision and some people still take a couple weeks to recover. For the most part, this is really fast recovery surgery. Because it’s essentially pain-free surgery, the recovery is not a bad experience. That’s probably the most important thing. Whether it takes a day or whether it takes a few weeks, during that time the patient is not laid up or unable to go to work.

What other advancements have come recently? Lahners: With cataract surgery, it has been many steps along the way culminating with the laser cataract surgery and the more advanced lens implants that can correct distance and near vision in both eyes. These implants are modified versions of lens implants that we’ve been using for 11 years now. The other thing that has changed a lot through the years is the patient’s experience going through all of this. We numb the eye using topical anesthesia and the patient is comfortable. I can communicate with the patient during the procedure, tell them they’re doing great. They can communicate with us and tell us if they have any concerns or worries. The experience has changed a lot through the years. Foster: In the next few years we’re going to get a lot better at treating glaucoma. The standard of care for glaucoma surgery is 40 years old and we’re combining a lot of new techniques with cataract surgery to lower eye pressure to treat glaucoma. Even in the next couple of years we’ll have better lens implants to help people see even better than they do now without glasses. There are a lot of great things just available or becoming available. Lahners: There are new medications coming out for macular degeneration, new specialized telescopic implants available for patients that have become blind from macular degeneration and hopefully they’ll be seeing again. There are all sorts of new technologies, like implantable electronic chips, that they’re really working hard on to restore vision in people that have lost it from some of these real common diseases like glaucoma and macular degeneration. Foster: It’s called a retinal prosthetic, and it’s basically an implantable electrode that stimulates the nerves of the retina based on visual input from glasses that you wear.

What are the best ways that people can take care of their eyes as they get older? Is the sun of special concern in Florida?  Lahners: The ultraviolet exposure is terrible for your eyes, just like it’s terrible for your skin. The eye can get skin cancer just like the rest of the body can, and we do see skin cancers pretty routinely on the eye. The sun also has been linked to damage inside the eye, and certain levels of light exposure may contribute to things like macular degeneration. We very strongly recommend having ultraviolet protection any time you’re outside, particularly in Florida.  Foster: There are some eye diseases that you’d never know you have until they’re really bad, and once they’re really bad there’s nothing you can do. The most common disease like that is glaucoma. It can take away vision in the periphery, and your brain is really smart, it can fill in defects in the peripheral vision and use one eye to fill in for the other, so you don’t even realize there’s an issue until it is really serious. So anybody with a family history of glaucoma or if you’ve never had your eyes checked, it’s wise to get checked. Lahners: There are nutritional things you can do to care for your eye too. If you’ve been told that you have any degree of macular degeneration, there have been two 10-year-long studies done in the US, AREDS and AREDS 2, that have demonstrated a profound benefit of being on a certain combination of antioxidant vitamins for the eye and the fallout from those studies might save the vision of millions of patients.

Should people be concerned about staring at screens all day, like their phones and computers and TVs?  Lahners: Modern screens emit very little in terms of damaging radiation. They’re not like the old cathode-ray tubes that used to deliver a fairly dangerous amount of energy at close distances. Today’s screens are fairly safe and the biggest problem we see with screens is that people don’t blink as much when they’re working on computer screens and it tends to aggravate dry eye, which is a very common condition that we see. Reminding yourself to take blinks, to take pauses when you’re working on your computer and the use of artificial tears to support your tear film, but if you’re someone that uses screens a lot, seeking out the advice of your eye doctor can probably help you out quite a bit. Foster:  It’s exceedingly common for our patients to be working on screens 12-14 hours sometimes. That’s alright - just use tears and take breaks every now and then. It’s going to be an even more recognized occupational hazard over the next few years because everything’s moving in that direction. 

How often should people be getting their eyes checked?  Foster: It varies. There are different recommendations based on age. In general, once you get into your 50s or 60s or if you wear contacts lenses or glasses, we’ll usually recommend a once a year check just to make sure the glasses are appropriate, and if there’s any early cataract developing, we like to monitor that. In the younger ages and even as a child, the typical recommendation is: if there’s any issue with vision screenings in school you definitely want to get checked, or if the parents have any noticing anything unusual about their kid’s vision, they definitely want to get checked. And then, of course if you’re wearing contact lenses, you definitely want to play by the rules and follow the directions exactly, because if you don’t, you can develop corneal ulcers and get into trouble. 

What warning signs should people be aware of? Lahners: The big things we get concerned about are: any sort of sudden change in your vision or any sudden amount of discomfort in the eye. Other things that don’t hurt necessarily and may not affect your vision right away are things like flashers and floaters, which can be a clue that you might be having a retinal problem like a retinal tear or detachment. Those are the big things that would trigger a more urgent visit, but if you really are careful with your eyes and you follow the proper screening protocols, then that can keep most people out of trouble. Foster: There’s always some fear associated with having your eyes operated on, but in general, it’s a wonderful thing. I’m a LASIK patient myself, it’s the best thing I ever did. 


CONTACTS:  Brian Foster, M.D., Ophthalmologist and Cataract and LASIK Surgeon, The Eye Associates Dr. Foster received his medical degree from the Emory University School of Medicine where he then completed his medical internship. Dr. Foster went on to an Ophthalmology Residency at Wake Forest University Eye Center and received his fellowship training in cornea and external disease at the Eye Consultants of Atlanta. Dr. Foster is experienced in bladeless laser cataract surgery, clear lens replacement and modern corneal transplantation and LASIK. Dr. Foster has also successfully fulfilled the requirements for Maintenance of Certification to be certified as a Diplomate of the American Board of Ophthalmology, dedicated to lifelong learning and improvement. 941-923-2020.

William J. Lahners, M.D., FACS Board-Certified in Ophthalmology, Board-Certified in Refractive Surgery, Fellowship-Trained Cornea Specialist and Cataract and LASIK Surgeon, Medical Director and Director of Laser Vision Services, Center For Sight. A specialist in All-Laser Lasik, cataract and glaucoma surgery, Dr. Lahners earned his medical degree with honors from Louisiana State University, as one of only six in his class able to complete the demanding program. Following a residency at Emory University and a fellowship at Phillips Eye Institute, Dr. Lahners has gone on to be named a “Top Doctor” by Castle Connolly Medical, and recently received the American Academy of Ophthalmology’s Achievement Award. He currently also serves on the editorial board of Cataract and Refractive Surgery Today magazine. 941-925-2020.