Need Your Eyes Fixed?

Published September 06, 2005

| Smart Money

We'll examine the four main options — and help you decide which one is best for you.

Christine Grau, a 32-year-old mother of two from Boca Raton, Fla., knows how difficult it can be to rely on glasses or contact lenses. Three years ago, she was violently attacked just a few yards from her front door. The attacker grabbed her from behind and pushed her to the ground so forcefully that her contact lenses popped out, leaving her nearly blind and utterly defenseless. Once she recovered, she swore she would never be so vulnerable again. "It was an absolute feeling of helplessness," she says.

A few months later, Grau underwent laser eye surgery (also known as Lasik surgery). The procedure was painless, and Grau suffered no side effects. Her vision went from a diopter (eye glass prescription) of -8.00 to -0.50 — a dramatic improvement. Now, the only time she needs glasses is if she's driving at night or watching television.

Would Grau advocate Lasik surgery for others? Absolutely. "I would say do it," she says. "I would recommend it for anyone." Now she feels confident that, should an emergency arise, she won't need to fumble around for glasses or contacts before she can protect herself and, more important, her kids. Dr. Dimitri Azar, director of corneal and refractive surgery at Massachusetts Eye and Ear Infirmary, says the newest generation of Lasik procedure is safer for patients than soft contact lenses.

But not everyone is ready to go under the knife. (Despite the name, laser surgery does involve some real cutting.) Jeffrey Gopen, a 37-year-old physical therapist from Swampscott, Mass., chose a simpler, less invasive procedure called corneal refractive therapy, also called accelerated orthokeratology, to correct his nearsightedness. Here's how it works: Patients wear special contact lenses at night that temporarily reshape their corneas while they sleep. That's it. After just a week of CRT, Gopen found he no longer needed to wear his glasses during the day. His vision is now 20/15 in his left eye and 20/20 in his right. The only catch is that if he stops wearing his lenses at night, his eyesight will eventually revert back to its original state.

With such compelling alternatives these days, might eyeglasses soon go the way of the ear trumpet? After all, why would someone continue to wear old-fashioned spectacles when experts across the country continue to sing the praises of newer, relatively painless alternatives?

For one thing, there's the price. Restoring your 20/20 vision could set you back several thousand dollars — money most financial planners would argue is better suited for your retirement account. And don't expect any help from your insurance company. Most of them deem such procedures to be cosmetic, and won't pick up the tab. Plus, even if you do shell out the money, you aren't guaranteed perfect results. Not all laser surgeries are successful — and some even produce unwanted side effects.

So what should you do? Read on as we compare Lasik eye surgery and CRT to the old standbys, glasses and soft contact lenses. The results might surprise you. Once you have all the information, you can decide which is best for you — and your pocketbook.

Lasik
If you're looking for a permanent vision solution, laser surgery might be the answer. So-called customized Lasik surgery, the most advanced procedure today, is 25% more accurate than its predecessor, traditional Lasik surgery. And it has greatly reduced the incidence of glare and "halos," or blurred images of lit objects at night, says Dr. Neil Martin, a spokesman for the American Academy of Ophthalmology, who is in private practice in Chevy Chase, Md.

How does it work? A surgeon, using what's called a wavefront measurement, maps the unique imperfections in a patient's optical system. Then the doctor cuts the thin flap of tissue in front of the cornea and folds it back. Next, a laser is used to remove tissue and flatten the cornea, which improves vision. Within days, patients usually report greatly improved eyesight.

Be warned: A very small percentage of patients — 1%, according to Massachusetts Eye and Ear Infirmary's Azar — experience side effects ranging from impaired vision to infection. Most of these problems will correct themselves after a few months, but there's no guarantee. And as is the case with any medical procedure, the better the doctor, the better the outcome. Don't try to save a few bucks by letting some hack zap your baby blues. Once your eyesight is altered, it could be changed forever.

The biggest disappointments, doctors agree, come to those with inflated expectations. While many people can achieve 20/20 or better eyesight, it's more realistic to expect that the surgery will reduce but not eliminate the need for glasses, says Massachusetts Eye and Ear Infirmary's Azar. "I personally wouldn't operate on any patient who expects to have perfect vision afterward," he says.

What does it cost? A customized Lasik procedure costs between $4,000 and $6,000. This includes all office visits before and after the procedure.

Corneal Refractive Therapy
If the idea of permanent surgery scares you, corneal refractive therapy, or accelerated orthokeratology, might be a more appealing solution. This method involves patients wearing rigid, gas-permeable contact lenses while they sleep. (These lenses allow more oxygen to enter the eye than soft lenses.) The special lenses reshape the cornea and temporarily correct one's vision. During the day, most patients will be able to see perfectly, without the aid of glasses or contact lenses. The downside is that if a patient stops wearing the lenses — say one falls down the sink — the cornea will revert back to its original state.

While patients like Gopen are thrilled with the results, some ophthalmologists aren't so keen on it. As we mentioned earlier, the procedure is only temporary, and some doctors don't understand why patients would choose it when there's a safe surgical alternative available. Moreover, some doctors are concerned that sleeping while wearing lenses increases the risk of infection and corneal ulcers.

But Dr. Marjorie Rah, of the New England Eye Institute, says that outcome is rare if the lenses are worn and cared for properly. Of the 300 patients she has seen, only two have developed the condition. One was wearing them 24 hours a day, while the other wore them while swimming, exposing them to bacteria.

And remember the upside here: Patients who aren't happy with the lenses can stop wearing them at any time. This treatment can cost anywhere from $900 to $1,500 for fittings and lenses, though replacement lenses are just $100 to $200.

Disposable Contact Lenses
People who have success with soft contact lenses love them. And the disposable ones are safer than ever. Just when a set starts to build up protein and dirt — say, in two weeks' time — the user can simply throw them away.

Soft contact lenses aren't the panacea some say they are, however. Anytime someone wears soft lenses, they're increasing their chance for irritation, infection and corneal ulcers. "It doesn't necessarily take abuse," to suffer these ailments, says Dr. Donald Schwartz of Long Beach, Calif., a spokesman for the American Academy of Ophthalmology. The key to minimizing the risk is to limit the amount of time you wear the lenses. And never sleep with them. With proper care and eye exams, however, they're generally very safe, say most doctors.

The best news: Disposable soft contact lenses are cheap. A box of six costs just under $20, and generally lasts up to six weeks.

Glasses
Newer isn't always better. Ophthalmologists agree that the most conservative and healthiest way to correct your vision is still old-fashioned spectacles. "With glasses, you're minimizing the risks," Azar says. "There's no risk of infection or allergy." And if you aren't happy with your prescription, you can change it at any time, he says. Glasses can also make quite the fashion statement.

Glasses are also safer than ever. Special ultraviolet coatings protect eyes from harmful sunrays, and plastic lenses greatly reduce the risk of injury. The price? That's up to you. National chains, such as LensCrafters, often run $99 specials. Designer frames with fancy coated lenses can run upward of $400.

Lasik
Description: A surgical procedure that permanently alters the shape of the cornea to provide better vision. Wavefront Lasik is customized to provide even better results.

Pros: More than 90% of patients report 20/20 vision after surgery.

Cons: The procedure is irreversible. Some patients also report problems with halos, blurred vision and dry eyes.

Cost: $4,000 to $6,000 for both eyes.

Corneal Refractive Therapy
Description: Rigid, gas-permeable lenses are worn at night to temporarily reshape the cornea.

Pros: After a few weeks, most patients can see without glasses during the day. CRT is also reversible: the cornea goes back to its original shape as soon as the patient stops wearing lenses at night.

Cons: Some ophthalmologists worry about an increased risk of infection, since the patient is sleeping with a foreign object in the eye.

Cost: $900 to $1,500 for two sets of lenses and fittings.

Disposable Contact Lenses
Description: The most commonly prescribed disposable lenses can be worn daily for up to two weeks and are then thrown away.

Pros: Eyes tend to suffer from less irritation than with conventional soft lenses, since there's less time for harmful proteins to build up on the lens.

Cons: Contact lenses increase the risk of infection and corneal ulcers.

Cost: $19.95 for a box of six lenses.

Glasses
Description: Call them spectacles. Most glasses today are made of lightweight plastic, and come with a special UV-protection coating that protect the eyes from harmful ultraviolet light.

Pros: The healthiest option for correcting both near- and farsighted vision. Older patients also say glasses hide swelling and wrinkles.

Cons: Not ideal for sports; can fog up in the rain.

Cost: The average pair of glasses sells for $99 at national chain LensCrafters. Designer frames and lenses with fancy coatings can push the price of $400.

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