SURGERY CAN REDUCE NEED FOR EYEGLASSES

After years of performing eye surgeries for patients, Dr. Richard Kies decided to become a patient himself.

In July, Kies, a Cape Girardeau ophthalmologist, underwent radial keratotomy surgery to correct his own nearsightedness.

Over the summer, Kies was involved in a fellowship with Dr. Charles Casebeer, a leader in radial keratotomy surgery. Kies' experience convinced him to have the procedure done.

"I sat there in the waiting room and talked to patient after patient," Kies explained. "I didn't tell them who I was; I just asked about their results with the procedure. "They dispelled my skepticism. When I left there I had decided not only was I going to do it, I was going to have it done. I've been delighted with the results."

Kies and a growing number of other local opthamologists are performing the microsurgery that allows some patients freedom from glasses or contact lenses. For others the surgery can reduce their dependency on glasses.

The procedure is done to correct nearsightedness (myopia) or astigmatism.

"It's refractive surgery," Kies explained. "We are changing the way the cornea focuses light. We surgically change the way the cornea is curved."

Basically, the surgeon makes a series of microscopic incisions in a radial or spoke-like manner on the cornea of the eye. The incisions cause the cornea to flatten, which allows the eye to focus properly.

The surgery is done in the office and takes about five to 10 minutes. Patients are awake during the procedure. Anesthetic drops are used in the eye.

Some pain is likely the first night so a painkiller is prescribed. Following the first night, the eye irritation experienced is described as having an eyelash in the eye. That goes away within a few days.

Kies said patients can see a difference in their vision immediately -- as soon as they sit up on the surgical table following the procedure. By the next day most see quite a change.

"I got up the next day and went sightseeing," Kies said.

Results depend on a number of variables, including the age of the patient and the degree of correction needed.

For persons wearing eyeglasses that resemble Coke bottles, the surgery probably won't free them of glasses. "But they may be able to select a more fashionable frame," Kies said.

"Someone who is not as nearsighted would have a good chance of being free of glasses," he said.

"If a person is expecting to walk in here, have it done and never wear a pair of glasses again, they will probably not be happy," Kies said. "But, if they would like to be free from some of their dependence on glasses and have a more normal function, this might be for them."

People who are involved in sports find glasses and contact lenses a nuisance. In careers like law enforcement or firefighting glasses can be a liability.

"In my case, I enjoy outdoor sports," Kies said. "I still wear glasses for some things, but I'm not totally dependent on glasses."

The procedure was first developed in the early 1970s in the Soviet Union. In the late 1970s and early 1980s, Kies explained, a study raised some questions about the radial keratotomy procedure.

"The data showed it was effective but unpredictable," said Kies.

Kies said that over the years changes in the procedure, including varied lengths of incisions and smaller blades, have made results more predictable.

"In the old days you could see the incisions," Kies said. "But now the incisions are about a couple human hairs in thickness."

Radial keratotomy is no longer considered experimental; instead it is elective. That means only a few insurance carriers cover for the surgery.

"People will always need glasses," Kies said. "The question is how dependent you want to be on glasses."

In September Kies performed the surgery on Diane Petzoldt, administrative assistant at his office.

"I wore contacts, but it was getting to the point that I wasn't going to be able to wear them any more," Petzoldt said. "And I couldn't function without glasses."

She enjoys playing volleyball and an occasional softball game. "Sports glasses are too heavy and they caused a lot of sinus problems."

Following the surgery, Petzoldt said she can watch television, drive a car, play volleyball and do many other things without her glasses. She still wears glasses periodically to sharpen what she sees. "But I don't have to wear glasses," she said.

What are myopia and astigmatism?

The eye functions on the same principle as a camera: The cornea (the clear window of the eye) and the lens, located behind the pupil, focus light rays from the object viewed onto the retina in the back of the eye.

Myopia, or nearsightedness, is a condition where light rays entering the eye are focused in front of the retina instead of directly on it. This condition causes blurred vision when looking at objects at a distance while close objects are seen clearly. Myopia is an inherited condition caused by an excessive length of the eye or by the cornea being too steeply curved.

Astigmatism is a condition where the curve of the cornea is uneven and not entirely spherical in shape. This irregularity makes it difficult for a person to clearly focus on an object, causing a doubling or ghosting effect.

What is radial keratotomy?

Radial keratotomy is a microscopic surgical procedure that reduces the amount of nearsightedness by flattening the cornea of the eye. During the procedure, a series of microscopic incisions is made in a radial or spoke-like manner on the cornea of the eye. This allows images to be more properly focused on the retina. For astigmatism, incisions are made in the steeper part of the cornea.

Who are the best candidates for surgery?

Patients who have eyeglass prescriptions and have been stable for approximately 12 months; a disease-free cornea; a small to moderate amount of nearsightedness; problems wearing contact lenses; problems with glasses interfering with professional or social lifestyle; no other problem which affects the general health of the eyes.