In addition to LASIK surgery, described in an earlier section, the following information will enlighten the reader on other surgical procedures that correct vision problems.

RADIAL KERATOTOMY

Professor Svyatoslav Fyodorov of the Moscow Research Institute of Eye Microsurgery, the largest eye institute in the world, developed the procedure known as radial keratotomy or RK for the correction of myopia.

Dr. Leo Bores introduced RK to the United States in 1978 when he performed the first such procedures at the Detroit Medical Center. Dr. Stanley Grandon of the Eye Surgery Institute of Dearborn assisted Dr. Bores at that time.

Since 1978, many hundreds of thousands of cases have been performed throughout the United States by trained micro-surgeons with a very low complication rate.

Prior to the development of LASIK surgery, RK was the best procedure available worldwide for the correction of myopia. In its time, RK was the preferred procedure. Today, however, LASIK is the preferred procedure for the correction of myopia.

ASTIGMATIC KERATOTOMY

Astigmatic keratotomy (AK), developed by Dr. Luis Ruiz of Mexico, is a variation of the surgery that corrects myopia. It was developed for the correction of astigmatism, a condition that causes blurring of objects in space. The Ruiz procedure, also known as trapezoidal keratotomy, consists of making a number of "flag" or transverse ("t") incisions on the surface of the cornea. Dr. Grandon made some modifications in Dr. Ruiz's procedure and found that they work better in certain situations. Today, astigmatism can also be corrected by LASIK surgery, and in most cases LASIK is the preferred procedure.

CATARACT IMPLANT SURGERY

Aside from wearing glasses, the only treatment available for cataracts is surgery. When the decreased vision caused by cataracts begins to interfere with a person's lifestyle, the operation should be performed.

Although there are different types of cataract operations, at the Eye Surgery Institute, phaecoemulsification is the preferred technique.

Before the operation, the patient receives medication to help him relax. Cataract surgery is generally performed under local anesthesia, although a general anesthetic is available, if needed. The patient is given twilight sleep for a few minutes before the local anesthetic is administered, so he feels no discomfort of any kind. Recently, some patients have been getting just topical eye drops for their anesthesia. In either case, the patient will not feel any pain at all. After the anesthetic has been administered, the patient's eye is held open by a lid speculum to enable the surgeon to easily access the eye.

During surgery, the ophthalmologist inserts a foldable silicone lens through a microscopic incision that requires one or no stitch to close. "No stitch" techniques are usually used; however, for better safety, Dr. Grandon prefers to use one stitch to close the tiny incision. Sometimes he uses one or a few safety stitches if he feels it is necessary.

The entire operation usually takes approximately 20 minutes or less. Following surgery, a patch is usually not used except with cataract and glaucoma combined surgery.

PHAECOEMULSIFICATION

This is a revolutionary type of extracapsular cataract surgery in which the lens nucleus, instead of being delivered out of the eye, is broken up and aspirated by using an ultrasound probe (high frequency energy). The back of the capsule is also left in the eye. The 2.5mm incision is the smallest of all types of cataract surgery.

In order to perform phaecoemulsification cataract surgery, the surgeon uses a special operating microscope with foot controls. This microsurgery has greatly improved the technique and results of cataract surgery. The equipment used is extremely sophisticated and requires considerable skill to use.

TRABECULECTOMY

Until recently, cataract surgery on patients with glaucoma posed some risk because postoperatively the eye pressure was quite often elevated.

Now, at the Eye Surgery Institute, Dr. Grandon combines phaecoemulsification cataract surgery with a glaucoma procedure known as trabeculectomy that uses a trapezoidal flap to help drain fluid from the eye so eye pressure will not build up. Combining the two operations is relatively new, but the results have been excellent. Patients will almost always see better, and the eye pressure will probably be better controlled. Usually, patients who have undergone this combined procedure will need to use fewer glaucoma eye drops, or none at all.

YAG LASER

Occasionally, after cataract surgery with phaecoemulsification, a secondary membrane or clouding of the lens capsule forms. This happens about 30 to 40 percent of the time. If it occurs, the YAG Laser safely opens the membrane and dispels the cloudiness.

A highly concentrated light beam, the YAG Laser enables the ophthalmologist to restore vision quickly and painlessly to patients who develop cloudy sight deficiencies following cataract surgery. During the five-minute procedure, the tissue parts like a curtain upon contact with the powerful YAG Laser light. Vision is restored quickly, painlessly, and with no danger of infection because there is no cutting or use of surgical tools, and no anesthesia is administered.

OPHTHALMIC LASER SURGERY

There is no cure for the most common involutional form of macular degeneration. However, ophthalmic laser surgery has been used to retard the spread of the less common exudative form, but only if this treatment is administered in the very early stages of the condition.

In this treatment, a focused intense beam of laser light is used to seal off leaking membranes and destroy new blood vessels. This reduces further loss of vision from progressive scarring of the macula and the surrounding retina.

Ophthalmic laser surgery is often recommended for individuals who have been diagnosed with diabetic retinopathy (macular edema, PDR, and neovascular glaucoma). Multiple laser treatments over time are sometimes necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.

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