Blind World

Ophthalmic advances aid those with vision problems.

January 03, 2005.
Brownsville Herald, Texas.

McALLEN, Jan. 3, 2005 - Norma Leal had Crystalens eye surgery after a cataract in her right eye worsened and she could no longer type on her computer or read.

"I was scared of killing someone while driving," the 50-year-old Edinburg housewife said as she sat in the pre-operating room of the Rio Grande Surgery Center in McAllen waiting to have her left eye undergo the 20-minute outpatient procedure. "I restrained myself because I could have an accident."

A cataract is a clouding and hardening of the eye's normally clear and flexible lens. Light cannot reach the retina in sharp focus, causing blurred vision and glare, and can eventually lead to blindness.

The Crystalens procedure involves the replacement of the cataract-damaged lens with a man-made lens that is attached to the eye muscle, allowing patients to have both near and distance vision. Standard cataract replacement limited the patient to either near or far-vision after surgery, but not both.

Crystalens surgery is one of the newest developments in eye surgery, joining PRK, LASIK IntraLase procedure, and thakic lenses to help those with deteriorating vision see again.

"All the advances we have are helping us in many respects," said Victor Gonzalez, an ophthalmologist and retina specialist at the Valley Retina Institute in McAllen. "Therapies are helping us to stabilize the vision and recover the vision that's been lost. It's an exciting time."

Gonzalez and other area eye doctors said the advancements are especially important in the Rio Grande Valley, where diabetes causes a slew of eye maladies.

Diabetes, which results from the body not producing or improperly using insulin, affects between 25 and 40 percent of the Valley, said Amir Elsayed, chairman of the board of the American Diabetes Association's Upper Valley Council.

The disease has debilitating effects on all parts of the body, and is the leading cause of blindness in the Valley in the productive years between 20 and 60, Gonzalez said.

"This is a disease I deal with every day and I hate it," he said. "Diabetes is our plague down here and it affects so many people and so many ways."

Leal developed cataracts when she was diagnosed with diabetes in 1980. But she also has a family history of poor vision, having worn her first pair of glasses in second grade. Her mother, father and four sisters all wear glasses.

With a family vision history like that, Leal sees the new procedure as a godsend.

"They're giving me life because I've been a blind bat for a while," she said, cracking a smile.

20/20 No More

Diabetes is not the only factor behind cataracts; eye injuries, smoking and age are other culprits.

James Long, who developed a cataract two years ago in his right eye, frowned when he mentioned the reading glasses he has worn for 10 years.

"I hated glasses all my life," said the 64-year-old Edinburg resident, adding he had 20/20 vision and 20/15 vision until he turned 50. "I have to have glasses to drive and to read. Glasses cut my reading by half."

He rested his hands on his large chest while lying in Rio Grande Surgery Center for Crystalens surgery. "And I used to love to read," he said.

The loss of near-vision between the age of 40 and 50 is called presbyopia. Muscle fibers surrounding the lens lose their elasticity, so the eye has a harder time focusing on close objects.

Long said he began having trouble reading the newspaper and doing hobbies at 50.

"I couldn't deal with contacts. And I want to see real bad," he said.

He said he thought about the Crystalens surgery after his wife got cataract surgery three years ago.

"I was amazed at what the surgery did," he said, adding she did not have Crystalens done because it was not available at the time.

"To me, it's a no-brainer. If I'm going to have people stick something in my eye, this is going to be it."

Like any medical procedure, Crystalens surgery has its risks, said ophthalmologist Carlos Manrique of the Manrique Custom Vision Eye Center in McAllen. "There is a risk of bleeding, needing more eye surgery and risk of losing your eyesight."

Cataract surgery is one of the most common surgeries performed in the United States, said John Ciccone, director of communications for the American Society of Cataract and Refractive Surgery in Fairfax, Va.

"About 2.2 million this year will have a cataract surgery," he said. "Sixty percent of people aged 65 and over have cataracts nationwide, and that (percentage) increases with age."

Long could have also been eligible for conductive keratoplasty, or CK, where a controlled release of energy, instead of a scalpel or laser, is used to reshape the cornea so images are centered on the retina.

"CK is for people who never needed glasses and once they reach 40, they have presbyopia," said Raul Peña of the Peña Eye Institute in McAllen.

The procedure, which was approved by the U.S. Food and Drug Administration two years ago, allows a person "to see distance, near and far, and in between," Peña said.

After the surgery, bifocals or other eyewear might be needed for watching, driving, crocheting or using a computer, said Rogelio Cantu, a therapeutic optometrist at the Valley Eye Center in Edinburg.


Cataract surgeries might be the most common procedure, but LASIK IntraLase surgery is rapidly gaining ground as one of the quickest and most painless methods to treat myopia, or nearsightedness.

In Laser-Assisted In Situ Keratomileusis, or LASIK, a flap is created in the cornea, the clear covering of the front of the eye, so a laser can change its shape. The first LASIK laser was approved in 1998, according to the FDA's Web site.

The LASIK IntraLase procedure differs slightly from the standard LASIK procedure in that it is blade-free and much safer, Manrique said. "One out of 300 candidates have a problem with the blade (used to create the flap)," he said.

Another LASIK option called Zyoptix Custom Wavefront LASIK involves applying a laser on the irregularities of a person's cornea, Peña said. "Each treatment is specialized to a person," he said. "All the hills and valleys (on the cornea) can be corrected."

LASIK is an updated form of PRK, or photoreactive keratectomy, where the top layer of the cornea is scraped away to correct near-sightedness. PRK also uses a laser to change the curvature of the cornea, but the shape of the cornea is changed on the front surface, as opposed to creating a flap in LASIK and working on the corneal bed.

PRK's healing process is longer, taking up to a week as the cornea regenerates.

"It can cause discomfort, blurry vision and even pain," Manrique said.

But the advantage of PRK is that it "actually produces a better quality of vision than LASIK," Ciccone said.

For those with a thin corneal top layer, LASEK can be done as an alternative to PRK. In LASEK, the rim of the corneal top layer is melted with a laser and then peeled off.

LASIK draws a diverse crowd, Peña said. "I've done several soldiers, some going to, some coming from Iraq," he said. "They don't want to get sand in their contacts or lose their glasses in war. I've worked on doctors, lawyers, mechanics and family members."

LASIK surgery is recommended for those 21 and over. A corneal pathology, such as keratoconus, or progressive thinning of the cornea, could disqualify an applicant, as the laser procedure itself thins the cornea, Cantu said.

Diabetics are also discouraged from having LASIK because changing blood sugar levels can affect their vision, Cantu said.

He added that LASIK does not guarantee a person will not become blind if he or she suffers from other eye conditions such as glaucoma, a group of eye diseases that form when there is damage to the optic nerve. Also, LASIK recipients might suffer from dry eyes or temporary halos or glare after surgery.

Both Manrique and Peña charge $2,300 for LASIK IntraLase.

Maria Carmona of Harlingen said her blurry vision convinced her to have LASIK. "I could barely see," she said, a thin, clear plastic shield covering her eyes after the procedure. She had to wear the shield for a week after the surgery.

"I wanted to stop wearing glasses," she said.

Her daughter, Amanda Carmona, watched her 47-year-old mother through a pane of glass as the surgery was done.

"It's so neat," she said. "If she can go through it, then I can."

Her daughter added the surgery hinged on a bet: If her mother would not have surgery, he'd a get a huge $4,000 TV," she said, referring to her father, who pressed his face against the glass and grinned. "He got a 32-inch (TV) instead."

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