You Have a Question
About Your Eyes, Click on a Topic Below.
following frequently asked questions (FAQs) are excerpted from the book
"Lessons from the Practice-The Gift of Sight"
M. Kershner, M.D., F.A.C.S.
1994-2003. All Rights Reserved.
Not to be reproduced by any means,
mechanical or electronic without
the written permission of the author.
Contacts - Where'd They Go?
History of Refractive Surgery
History of Cataract Surgery
Lessons from the Practice-The Gift of Sight
What's All This Talk About Laser Vision Correction?
Clear Corneal Incision
of the Lens
The Lens in the Capsule
You at Risk for Glaucoma?
and Eye Strain
A Common Eye Problem
Eye and How It Works
When Should You
Get Yours Eyes Examined?
The Eye Examination
About How Your Eyes Do What They Do
Do We Require Reading Glasses After We Turn Forty?
Wearing Eyeglasses Make My Eyes Dependent Upon Them?
Wearing Contacts Slow Down the Deterioration in My Vision?
I Need to Keep Changing Eyeglasses are My Eyes Getting Worse?
is Amblyopia or "Lazy Eye"?
Should a Child's Eyes Be Examined?
My Child's Eyes Are Crossed, Will He Grow Out of It??
I Need to Wear Eyeglasses Will My Child Need Them Too?
Eye Exercises Really Help?
About Pinhole Eyeglasses, Do They Improve Your Vision?
About Those Lenses that Block Out Blue-Light?
Ophthalmologists Transplant an Eye?
are Corneal Transplants?
About KeratoRefractive Vision Correction Procedures
Am I Dependent Upon Eyeglasses?
What is Myopia or
What is Hyperopia or Farsightedness?
What is Astigmatism?
Can I Reduce or Eliminate My Need for Glasses and Contacts?
Am I A Suitable Candidate?
Tell Me About The Procedure
Can I Expect After Laser Vision Correction?
How Can I
Find Out If I Am A Good Candidate?
History of Modern Cataract Surgery
Do I Need Cataract Surgery?
and Answers About MicroIncision Cataract Surgery
of the Retina
DEGENERATION (ARMD) and The Role Of Nutrition
Nutritional Content of Vegetables
Factors For Developing Age-Related Macular Degeneration (AMD)
You Can Do to Limit Your Risk of Developing AMD
to Do To Maximize Your Vision With AMD
Who to Call For Low
is a Pterygium or Pinguecula?
How Can I Tell If I
Have Dry Eye?
of Sun Exposure
Diseases and Your Eyes
What is a Laser?
Are Lasers Safe?
How Long Does the
Laser Treatment Take?
How Does Dr.
Kershner Aim the Laser?
Will The Laser
Treatment be Painful?
Will I Experience During the Laser Treatment?
What If I
Move My Eyes or Close My Eyelids?
My Vision be Blurred Following the Laser Treatment?
I Take My Regular Medications on the Day of the Laser Treatment?
The Laser Procedure Take Place?
Will I Be Able
to Drive Myself Home?
contacts - where'd they go?
It isn't every day
that a doctor gets a taste of his own medicine, but after years of
enjoying the satisfaction of giving my patients clear vision following eye
surgery and relishing in their ability to see clearly without dependence
on eyeglasses or contacts for every task, I decided to become a patient
I have worn glasses for the better part of four decades. Contacts never
worked well for me, they were difficult to insert, uncomfortable to wear
and I never saw clearly. So just like many ophthalmologists, I wore
glasses. As an eye surgeon, the dream of one day freeing myself from this
handicap is one that I shared with thousands of others.
So why choose surgery? With today's advanced technology, the surgical
reshaping of the eye's cornea with LASIK Excimer Laser procedure can bring
images into more natural focus, replacing the need for eyeglasses or
Let me tell you about my experience. I've have never enjoyed wearing
glasses, the simplest of activities like reading the alarm clock or
turning on the lightswitch was not possible without them. I spent much of
my day cleaning my glasses to ensure the clear vision that I required as
an ophthalmologist. And swimming, skiing, playing tennis, or driving was
impossible without them. But like many others, I put up with what I
considered a necessary handicap.
So, after experiencing the delight of thousands of my own patients on whom
I had performed refractive correction to provide lens-free living, several
years ago I decided it was time to have my own eyes corrected. The whole
thing took a matter of minutes, with no shots, no stitches, no bandages
and no pain! And the result is amazingly clear.
Having had my vision corrected, rather than depending upon eyeglasses and
contacts for the rest of my life, is one of the best things I've ever done
for myself. I cannot explain the excitement of awakening to clear images.
Taking a shower,
walking in the rain, and travelling has taken on a whole new dimension. It
is a sheer pleasure to play sports, swim and actually see underwater,
bike, play tennis and ski without glasses getting in the way. And best of
all, I can now work all day without constantly cleaning my glasses.
Even though my experience is similar to that of many of my own patients,
this procedure is a matter of individual life-style choice, and it may not
be for everyone. I know that if I had to do it all over again, I would do
it again in a heartbeat, and my only regret was not having had it done
Because of my intensely positive personal experience with this delicate
and wondrous procedure of vision correction, I today can share my
experience with those of so many others. I, too, am a believe,r and I know
that many other doctors, nurses, athletes, police officers, firemen,
lawyers, soldiers, technicians, housewives, models, line workers, miners,
construction workers, actresses, actors, bank tellers, students, service
personnel, flight attendants, politicians, secretaries, accountants,
transcriptionists, clerks, and the thousands of others who have delighted
in this technology are believers, too.
Ask your optometrist or ophthalmologist about the options available for
you. Clear vision is in sight...the new vision correction procedures of
laser PRK, LASIK and the Implantable Contact Lens may be the right choice
for the new you.
THE HISTORY OF REFRACTIVE
The desire to be able to see without
depending upon an optical device has been one of mankind’s goals for
centuries. The discovery of
modern day refractive surgery, the procedures which ophthalmologists
perform to permanently correct the eye’s incorrect focus, had a most
It all started in Moscow, Russia in 1973.
A thirteen-year-old boy by the name of Boris Petrov was involved in
a fight in the school yard. During
the fight, his eyeglasses were broken and pieces of the glass cut the
cornea or clear surface of his eye. The
boy was taken to the Moscow Eye Institute where he was attended to by
world famous eye surgeon Svyatoslav N. Fyodorov.
Dr. Fyodorov cleansed the eye and bandaged it tightly for several
days. When the bandages were
removed, the boy remarked to Dr. Fyodorov on how much more clearly he
could see without his glasses than he could before the injury.
Dr. Fyodorov examined the child’s eye and discovered that the
tiny cuts made by the shards of glass had reshaped the cornea and
corrected the child’s focus. Dr. Fyodorov felt that if a thirteen-year-old boy could
correct his nearsightedness with broken pieces of glass, then Dr. Fyodorov
as an experienced eye surgeon could do the same for others with delicate
instruments in a careful planned fashion.
This became the beginning of what is known as the refractive
surgical procedures to correct nearsightedness, farsightedness and
astigmatism, the early procedures of radial keratotomy.
In 1978, a small group of pioneering
ophthalmic surgeons from the United States traveled to the former USSR and
studied with Dr. Fyodorov to learn his remarkable techniques.
They brought the procedure back to this county.
A national study commenced known as the Prospective Evaluation of
Radial Keratotomy. This study
demonstrated that despite rudimentary techniques and instrumentation at
the time, doctors were able to surgically correct eyes with imperfect
focus with a safe, reproducible and effective procedure.
Since that time multiple refinements in technique and
instrumentation have occurred. Further
development of ultra-sonic measuring devices, computer assisted corneal
mapping and computerized nomograms precisely measure the cornea and tell
the surgeon how and where to place the correcting microincisions within
the accuracy of one micron, or one-one thousandth of a millimeter.
This made radial keratotomy the most delicate microsurgical
procedure in use for many years.
Several other techniques were subsequently
developed to reshape the cornea and correct the eye's imperfect focus.
For people who are farsighted or extremely nearsighted, the
automated corneal shaper was utilized to perform lamellar keratoplasty (ALK)
to reshape the central cornea.
In 1995, the United States Food and Drug
Administration approved an investigational device known as the excimer
laser. This microscopic
laser removes incredibly small amounts of corneal tissue with an
ultraviolet laser, and instead of making radial incisions, can correct
nearsightedness, farsightedness and astigmatism.
Today, the Excimer Laser and the procedure known as LASIK are
increasingly being utilized to accurately perform one of mankind’s
longtime goals and the ophthalmologist’s finest microsurgical miracle
procedure, to correct the focus of the human eye.
The history of cataract
Cataract surgery is one of the oldest known surgical procedures.
Writings concerning the treatment of cataracts date back to the
Bible, ancient Egyptian papyruses and the writing of Hippocrates. Surprisingly, the actual procedure had changed very little
over thousands of years.
Cataracts were once believed to be a film or
growth in the eye. The
treatment for correction of this growth was to get the obstruction out of
the way. This procedure was
known as couching. The
surgeon, who could be anyone from the local medicine man to the barber
would insert a sharp object into the eye and push the clouded lens out of
the way. Many famous people
throughout history underwent this procedure including the artists
Michelangelo, Rembrandt and Renoir.
Fortunately, in the twentieth century modern
surgical techniques began to change the nature of cataract surgery.
It became a major surgical procedure requiring general anesthesia
and a hospital stay. A large
incision was placed into the eye with the patient asleep, the cataract
surgically removed from the eye, the eye stitched closed and heavily
bandaged. Patients were kept
at bed rest with their heads sandbagged into position to prevent movement
for days at a time. Then when the eye was healed, a very thick pair of
eyeglasses were fitted to allow the patient to see once again. The glasses were cumbersome and caused excessive
magnification and distortion. Still
it was better than going blind from cataracts.
This procedure was utilized until the early 1980s.
In 1949, a physician in the British Royal
College of Surgeons, Mr. Harold Ridley, was experimenting with the
correction of aphakia (the loss of the human lens from cataract surgery)
by implanting artificial lenses into animals.
As World War II broke out, he treated many fighter pilots whose
eyes were injured by shattering plastic from the windshields of their
fighter jets damaged during air combat.
He discovered that if the tiny pieces of plastic were left in the
eye, they were very well tolerated. A
medical student suggested to Dr. Ridley that he use this plastic known by
the chemical name, polymethylmethacrylate or Perspex CQ, as the material
for a human intraocular lens implant.
Thus became the beginnings of the artificial lens implant to
replace the cataractous lens removed at the time of cataract surgery.
Intraocular lens implants or IOLs gained in
popularity in this country in the late seventies and early 1980s and is
one of the most important advances in the field of modern eye surgery.
In fact, Robert Young, the actor who played Dr. Marcus Welby in the
TV series, credited the procedure with saving his career.
Recent advances in the techniques of cataract
surgery continue to make this one of the fastest evolving surgical
procedures known in medicine. Today
cataracts are removed using a process known as phacoemulsification.
A tiny hollow titanium needle is introduced through an incision of
about one millimeter and the entire cataract is liquefied and vacuumed out
through the tube in a matter of minutes.
Because the incision size is so much smaller
than conventional surgery, hospitalization, general anesthesia, sutures
and bandages have all been eliminated.
Someday we may understand why cataracts
develop and prevent them from occurring.
Until then, todays' advanced technology can make the daily modern
miracle of cataract surgery a reality of clear vision for millions the
Lessons from the Practice-The Gift of Sight
by Robert M. Kershner, MD, FACS
It was nearing the end of a long, hot dusty day in the Navajo reservation in northeastern Arizona when a young man stood shyly in the doorway of our makeshift eye clinic just as we were about to close our doors for the night. The young man explained that his great-grandmother wanted her eyes examined although she had never been to a doctor in her life. As a volunteer at the Arizona Medical Eye Unit, a project started in 1979 to provide ophthalmic examinations to the Indians of the Navajo reservation, I was aware that many Indians did not receive specialist medical care if they did not travel off the reservation.
He explained that she lived as many Navajo elderly did, with her family in a "hogan" or hut. For the past 27 years he had known her, they had cared for her, clothed her, and fed her because she was blind. He walked to his truck and returned leading an elderly woman by the arm.
For me, in 1985, a young doctor from the city, she was a magnificent sight. Dressed in the traditional long black dress of the Navajo, she was wearing elaborate pieces of turquoise and silver jewelry, collected through years of trading between various Indian groups of the region. One look in her eyes revealed that both of her pupils were as opaque as the turquoise jewelry that she wore. She had advanced cataracts. I told her great-grandson that her sight might be restored by surgery, which could be done in Tucson, several hundred miles to the south.
A preoperative physical examination showed this 103 year old woman to be in remarkably good health. With local anesthesia and with her great-grandson interpreting my instructions for her, a cataract was removed and an intraocular lens implanted.
The next morning, as the bandage was carefully removed, she looked at me and spoke a few pleasant-sounding words in Navajo. Her great-grandson translated that she "liked my beard." Hearing his voice, she turned to her great-grandson and smiled. She knew who he was from the sound of his voice, but she had never before seen his face.
That evening, on my drive home, I took the long way through the foothills surrounding the city. As the sunlight reflected its colors on the mountains, I imagined seeing it all for the first time.
So what's all this talk about laser vision correction?
There have been so many advances in surgery that corrects vision...it is
all very confusing. What is this new surgery called LASIK? How is it
different from PRK and RK?
Vision correction procedures comprise the most exciting advance in the
rapidly changing field of ophthalmology and microsurgery of the eye. From
the earliest procedures to correct nearsightedness and astigmatism, radial
keratotomy, developed by Dr. Svyatoslav N. Fyodorov from Moscow, Russia in
the early 1970s, to the most recent advancements in laser reshaping of the
eye, LASIK, we have come a long way from the dependence upon eyeglasses
and contacts to clear vision without lenses!
The eye works by bringing light through the outside window of the eye -
the cornea - through the pupil and the lens, until it focuses on the
retina. If the curvature of the cornea is steeper than normal, or if the
eye is slightly elongated, light is improperly focused and nearsightedness
or myopia occurs. In this case, only objects up close are in focus and
everything else is blurred. An irregularity to the corneal curvature is
known as astigmatism, which is one other distortion of vision.
Radial keratotomy, previously the most commonly performed
and best known of the refractive procedures, flattens the surface of the
cornea, the clear part of the eye through which we see, with microscopic
incisions around the center of vision. Thousands have undergone this
procedure, which has quick recovery and corrects both nearsightedness and
In 1976, researchers at IBM developed a laser technology
known as excimer for use in industrial applications to create computer
microchips. This particular type of laser can produce very precise etching
of material with almost negligible effects outside the area which is
targeted. In June of 1983, Stephen L. Trokel, M.D. of New York worked with
physicists at the IBM Research Center in Yorktown Heights, New York, and
demonstrated that excimer laser radiation could be utilized to reshape
corneal tissue without damaging it. This is the basis of the patent which
Dr. Trokel received in 1983. Since that time, several other ophthalmic
surgeons have applied the excimer laser clinically to correct astigmatism
and nearsightedness (myopia), and farsightedness (hyperopia). In the
United States two companies - Summit Technology of Waltham, Massachusetts
and VISX of Santa Clara, California - successfully collected data from
surgeons utilizing this technology to be awarded approval by the United
States Food and Drug Administration for use in the correction of human
vision in 1995 and 1996.
Early work with the computer-controlled laser showed that precise
microscopic amounts of corneal tissue could be removed, thus flattening it
and potentially bringing the eye into more normal focus. This procedure is
known as photorefractive keratectomy or PRK. Despite promising initial
results, acceptance by the general public was slow. In an effort to
improve the precision and speed up the healing following the laser
procedure, pioneering refractive surgeons applied different techniques to
the application of the laser. LASIK is one such technique. The name LASIK
is short for laser in-situ keratomileusis. Like photorefractive
keratectomy with the excimer laser, LASIK reshapes the cornea. Using an
automated instrument known as a microkeratome, the refractive surgeon
creates a flap on the surface of the cornea. This flap remains attached on
one side and, as it is folded over, the excimer laser is applied to
reshape this newly exposed layer of cornea. Once the surface of the cornea
has been reduced by the exact amount determined by the computer, the
surgeon returns the flap of surface cornea to its original position and
the procedure is completed. Usually the excimer laser procedure takes less
than one minute to perform. Following the procedure, the eye has been
reshaped by the appropriate amount and images can now come into more
Many surgeons feel that LASIK offers advantages over PRK and RK by leaving
the surface tissue of the cornea undisturbed. Recovery is quicker and any
discomfort is reduced.
The likelihood of a successful outcome following modern laser surgery is
excellent. As with all surgical procedures however, there are certain
risks. Unsatisfactory results with the laser are uncommon, though there is
a small likelihood that the microkeratome cannot create a proper flap and
the procedure has to be delayed.
To learn more about the vision correction procedures or to find out if you
are a candidate, consult an ophthalmologist or optometrist, who has
experience with these new techniques. The promise of natural vision, once
a dream, today can become a reality.
(FAQs) are excerpted from the book "Lessons from the Practice-The
Gift of Sight" written by Robert M. Kershner, M.D., F.A.C.S.
2000. All Rights Reserved.
Not to be copied by any means, mechanical or electronic without the
written permission of the author.