25 Years in Myopia: Surgical Advances Improve Vision

Jan. 3, 2010— -- When ophthalmologist Dr. James Salz first saw Nancy (who requested that only her first name be used), severe myopia left her completely reliant on glasses and contacts. Without them, the Los Angeles city employee and mother of two had vision so poor that she couldn't even recognize her children.

"When I woke up in the morning and they ran up to me, I couldn't tell who was who," she said. "When I was at the beach, I couldn't see where my family was. I basically was pretty paralyzed without my contacts or my glasses."

That's how things would have stayed 25 years ago.

Surgery that could eliminate the cause of nearsightedness by changing the curvature of the cornea was still a highly criticized idea in 1984, remembered Salz, who led some of the early studies and went on to be involved in every form of refractive surgery since then.

Today, refractive surgery is one of the most common of all surgical procedures, second only to cataract surgery in the United States.

This rapid revolution not only provided a cure for myopia but altered how we think about nearsightedness itself.

Seeing Deeper

In 1984, Nancy's eyes would have been considered healthy, just with refraction on the far spectrum of normal, like the range of human height from short to tall.

"At a typical exam, we'd say, 'Oh, your eyes are perfectly fine. You just need glasses," said Dr. Penny Asbell, director of the cornea service and refractive surgery at Mount Sinai School of Medicine in New York City.

Glasses and contacts remain the most common option for managing myopia. And there have been substantial improvements over the past quarter century in both, noted Salz, now of Cedars-Sinai Medical Center and the University of Southern California, both in Los Angeles.

Thinner, more attractive progressive bifocals and disposable, gas-permeable contact lenses have made visual correction easier on patients than ever, he said.

But it was only after refractive surgery offered a treatment that could actually get to the cause of the problem that "we started to realize that for many people myopia is, in fact, a disability and one they would rather not have if they had a choice," Asbell told MedPage Today.