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Web-only Exclusives
November 30, 2000

From Our Correspondent: Hirohito and the War
A conversation with biographer Herbert Bix

From Our Correspondent: A Rough Road Ahead
Bad news for the Philippines - and some others

From Our Correspondent: Making Enemies
Indonesia needs friends. So why is it picking fights?

Asiaweek Time Asia Now Asiaweek story

Cutting the Need for Glasses

But laser eye surgery may have its downsides


ELIZABETH GO DIDN'T LIKE wearing glasses in high school. As soon as she got the chance, she switched to contact lenses. Then at age 45 the Philippine businesswoman decided it was time to get rid of those too. She booked an appointment with an ophthalmologist in Manila who said her severe myopia (nearsightedness) made her a perfect candidate for one of the most popular procedures now sweeping the region. A few weeks later, she underwent laser eye surgery. "It was ecstasy for me," she says.

Maybe not the operation itself, but the result: 20/20 vision in both eyes. Go can't find enough superlatives. "It was worth every minute of my life," she exclaims. Equally delighted is Shauna Stonehouse, 34, a Hong Kong-based executive: "I hated wearing glasses so much I'd take them off whenever I could. This [operation] was a godsend for me."

The cause of the craze is a much-vaunted operation that reshapes the cornea, the transparent, dome-like structure at the front of the eye. Vision becomes blurred when the cornea curves too much or too little, requiring either corrective lenses or surgery. One older form of the latter is called radial keratotomy (RK), a procedure in which a specialist makes spoked-wheel-like cuts into the cornea with a tiny blade. More common these days is photorefractive keratectomy (PRK), in which a laser is used on the cornea's center to remove some of its inner layer. Both methods correct the curvature of the cornea, allowing the eye to focus better.

The latest technique, called LASIK (laser-assisted in-situ keratomileusis) was developed to correct moderate and high levels of myopia such as Go's. Dubbed the "flap-and-zap" technique, it entails surgeons slicing off 90% of the top of the cornea so that the laser can remove a thin layer from the exposed tissue underneath. The "flap" is then dropped back into place and the eye heals without stitches. It sounds stomach-turning, but isn't.

The patient, in fact, is awake throughout the procedure. The only anesthetic needed is applied in a people-friendly eye-drop solution. The eyelids are rigged open, making blinking impossible. Then an automated carving blade, called a microkeratome, slices a flap from the cornea. While focusing on a fixed point, the patient undergoes an approximate 15-second laser pulse. The procedure emits a burning odor, but this is the most unpleasant aspect of the operation. It is over in minutes.

Despite its simplicity, things can go wrong. During LASIK, a surgeon could over-cut the cornea or slice it off altogether. Then, the top flap could "become lost or difficult to put back on the same way," says Dr. Agnes Tse, a Hong Kong Medical Association ophthalmologist. Apparently, no one has ever been blinded during the procedure, but there is a chance that a surgical blunder could cause impaired vision. The same goes for patient blunder: keeping the eyes absolutely still is crucial.

But even if all goes well during the surgery, there is no guarantee that results will be perfect. Some patients report glare, haze or a halo effect that makes, say, driving a car difficult. Others claim their eyes feel permanently gritty. And more seriously, the longterm effects are still unknown. As we age, eyes become naturally hyperopic (farsighted), and the surgery seems to hasten this. In other words, a patient could go through an operation to have one impairment corrected only to have another accelerated.

Some of the doctors who perform the surgery choose not to undergo the procedure themselves. Contact lenses or glasses still correct vision to a finer degree than surgery, they say. "As an eye surgeon," Dr. Tse says, "I'm not a good candidate. But a movie star, whose work doesn't require perfect vision, is more suitable." A movie star's salary would also help: the cost per eye is approximately $2,000.

-- By Catherine Shepherd


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