April 29, 2001: Fox 5 Ten O'clock News                                   

Mary Erra, the first patient to have her eyes corrected by the SRP procedure in the United States, was also interviewed by Andrea Day. She told of how her life has improved since Dr. Soloway performed this surgery on her. She no longer has to wear reading glasses and can now complete tasks that used to be difficult, such as putting on her make-up and reading a newspaper with ease.

While this surgery will not be fully approved for a couple of years, it is possible for patients to take part in the FDA clinical trials. We are now forming a waiting list to participate in the Phase II trials, which will begin shortly at the New York Eye and Ear Infirmary.

If you are interested in finding out if you are a candidate for the Surgical Reversal of Presbyopia, please call 888 NYLASIK.

In the March 29, 2001 issue of the Wall Street Journal Barrie Soloway, MD, FACS appeared in an article entitled:

Is End of Reading Glasses in Sight?

This discussed the concept of the Surgical Reversal of Presbyopia (SRP) procedure, as well as the results of the FDA monitored clinical trial in the United States.

Due to the fact that almost everyone older than 45 will need reading glasses, the author states that "the potential demand could be huge." So far in the testing "few problems have been reported." When asked how the patients that Dr. Soloway operated on for the FDA trials are doing, he stated "four of the five patients are out of reading glasses 100% of the time, and the fifth uses them only if the light is dim."

Overall there have been many successful SRP procedures completed throughout the world. Many doctors in the United States have undergone the surgery after seeing the results. Many even trusted the surgery enough to invest their own money in Presby Corp., the company that makes the implants.

In the March 26, 2001 issue of the New York Resident, Barrie Soloway, MD, FACS appeared in an article entitled Out of Sight. This article reviewed various aspects of eye health.

The first topic discussed was the need for regularly scheduled eye exams. This is important because disorders such as glaucoma and cataracts may go unnoticed until they are in the severe stages. "Most patients don't notice anything out of the ordinary until their condition is quite advanced," explains Dr. Soloway.

The article then goes on to discuss laser vision correction. It explains the importance of seeing an experienced doctor who is a cornea specialist. It also emphasizes the need for the surgeon to see the patient before and after the procedure as to prevent any oversights.

In the March 2001 issue of EyeWorld magazine, Barrie Soloway, MD, FACS, along with four other respected doctors, discussed various microkeratomes and the benefits of each.

This article was designed to educate LASIK surgeons. There are many different companies that manufacture microkeratomes and it is sometimes difficult to know which ones are the best for a given situation. Dr. Soloway and the other experts were able to explain through a running dialogue how to choose the correct microkeratome.

An article describing a study conducted by Barrie Soloway, MD FACS on the Moria One disposable microkeratome was printed in the March 1, 2001 issue of Ocular Surgery News. The purpose of this study was to find out if the microkeratome was predictable in its flap thickness and diameter.

In the past doctors have not felt comfortable using disposable microkeratomes, the instrument used to cut the flap during the LASIK procedure. These keratomes have been thought to be very unpredictable in respect to the thickness and size of the flap that they create. Moria, a company that has been at the forefront of microkeratome technology, has developed a disposable instrument that may break these rules.

Dr. Barrie Soloway treated 50 eyes with this LSK One disposable microkeratome to find out if it is reliable to use for LASIK surgery. He wanted to discover if the outcomes that were advertised by the manufacturer were in fact correct. After careful evaluation, Dr. Soloway was impressed by his findings. "We found that the flaps we achieved were very close to what was advertised by the manufacturer: 160 m. " Even more importantly, the visual outcomes of the surgery were comparable to nondisposable microkeratomes.

Not only were the clinical results excellent for this study, but Dr. Soloway and his technicians liked the ease of the use of the instrument. "with excellent flap visibility the transparent suction ring gives visual indication of active 360-degree suction," states Dr. Soloway. He further says, "(the Moria microkeratome) is better than any other manual keratome I have used."

Barrie Soloway, M.D., F.A.C.S. completed a study of 274 eyes of patients who underwent LASIK on the Alcon Summit Autonomous LADARVision Excimer Laser System. It was thought that as long as the patient's pupil did not grow larger than the area treated, they would not experience nighttime aberrations. The results of this study were printed in the February 1, 2001 issue of Ocular Surgery News.

Dr. Soloway performed LASIK on patients with a pupil size between 6mm and 8mm. These patients would have had a high risk of having night glare and halos if they had surgery on another laser system. The LADARVision small spot laser treats a wider area on the cornea than the traditional broad beam lasers.

Six months after the original procedure none of the patients complained of debilitating glare and only 1.6% reported an increase in night vision aberrations. "What we surmised through patient discussion and a questionnaire that was filled out at 1 week, 1 month and 3 months is that night vision was great or that night vision was better than before," explained Dr. Soloway.

This study proved that the main reason for poor post-LASIK night vision was in fact the diameter of the laser beam being smaller than that of the pupil. It was determined that patients with larger pupils would fair better having LASIK on the LADARVision laser because of its ability to treat a broader zone.

On Monday, January 15, 2001 Barrie Soloway, MD, FACS was featured in an article in the Daily News entitled "Brave New World." This article was about various types of exciting new medical advances. Dr. Soloway discussed two breakthrough procedures for eyes that are designed to help patients become less dependent on their glasses.

The first procedure discussed was a new form of LASIK surgery where the laser will correct eyesight at each specific point of the eye instead of the eye as a whole. This surgery will be able to correct nearsightedness, farsightedness, and astigmatism for the patient. Clinical trials for this procedure are expected to begin in February.

The next surgery discussed was scleral expansion surgery. This procedure still probably has about five years before approval, but it will be the first procedure to correct presbyopia, the condition that causes people over the age of 45 to need reading glasses.

Barrie Soloway, MD, FACS was featured in an article in the December 19, 2000 Woman's World Magazine entitled

"All new Breakthroughs For Better Vision"

This article outlined how the new LADARVision laser is more advanced than previously used technology.

This first difference that the article reviewed between the LADARVision laser and the older lasers was due to the fact that the LADARVision laser has a thinner, more precise beam. "Because LADARVision is so much thinner, it can treat a larger and more detailed area of the cornea, and create a smoother, more precise result," explained Dr. Soloway.

This new laser also has a tracking mechanism that enables it to track the eye over 4,000 times a second. If a patient's eye moves during the procedure (which it always does) the laser will follow it and create the ablation in the center of the visual axis. Many of the side effects associated with LASIK are thought to be attributed to a decentralized ablation. This laser may eliminate these types of problems.

The final attribute of this laser discussed in the article was that it is advanced enough to be used for the forthcoming CustomCornea procedure. This new surgery will take more detailed measurements of the cornea, lens, and retina, and 20/10 vision may be possible because of it.

In the October 2000 issue of Ocular Surgery News Barrie Soloway, MD, FACS wrote an article describing his experiences performing the Surgical Reversal of Presbyopia.

Dr. Soloway began learning about this procedure in 1998 when he attended a course given by Ronald Schachar, MD. Dr. Schachar developed a new theory as to why presbyopia occurs and a procedure that could correct the problem. Dr. Soloway began traveling to Mexico to conduct the procedure on patients and saw excellent results.

In March of 2000, Dr. Soloway performed the first SRP procedure in the United States for the Phase I FDA Clinical Trials. Reporters from both NBC and ABC were present to witness this event and were amazed when they saw the outcome. "When the patient sat up and read the New York Times, we could see the journalists' jaws drop", Dr. Soloway recalls. Dr. Soloway has now completed surgery on the patients for the Phase I study. He is currently traveling abroad to conduct the surgery and looks forward to Phase II, when he will be able help more patients rid themselves of the hassles of reading glasses.

On November 6, 2000 Barrie Soloway, M.D., F.A.C.S. was featured on the CBS 11 O'Clock News. As the principal investigator at the New York Eye and Ear Infirmary for the Surgical Reversal of Presbyopia, Dr. Soloway has successfully completed all patients for the Phase I FDA Clinical Trials.

This innovative new surgery "Brings people back to a younger age when they didn't have to use glasses for reading," explains Dr. Soloway. No laser is used for this surgery. Instead four implants about the size of small grain of rice are inserted into the white part of the eye. These implants are removable if the patient is not satisfied with the results.

Two of Dr. Soloway's patients were interviewed by CBS in order to see if the procedure was a success. Anthony Sabatino, a 53 year old patient who had the procedure done, was shown reading a magazine. That would have been impossible for him to do without glasses a few months ago. "I can't believe it, it's amazing," was Mr. Sabatino"s reaction to this breakthrough surgery. Bob Gallagher was interviewed next, and was just as delighted from the results of the surgery. "It is a miracle. The day after, I could read without glasses," was Mr. Gallagher's reaction.

In the September 25, 2000 issue of New York Magazine, the New York Eye and Ear Infirmary and Dr. Soloway were featured in a special section called "Managing Your Health." This article discussed the two main advances in vision correction that were made at the New York Eye and Ear Infirmary this past year.

The first item was the addition of the new LADARVision "flying-spot" laser. This excimer laser is the only tracking laser approved by the FDA. "With the ability to track the eye over 4,000 times a second, the beam can safely stay focused on the portion of the eye where the surgery is taking place despite the fact that the eye is in constant movement." This laser also has the ability to treat a larger optical zone, thereby greatly reducing the risk of glare and halos.

The next topic discussed was the FDA clinical trials for the Surgical Reversal of Presbyopia. The New York Eye and Ear Infirmary is one of only six sites in the United States involved in these trials. Dr. Soloway explains, "Nearly 90 percent of adults aged 45 and older need glasses or contact lenses for reading and close-up tasks due to presbyopia." During this procedure Dr. Soloway places four arched bands in the sclera (white part) of the patient's eye which allows them to focus on near objects again.

Barrie Soloway, M.D., F.A.C.S., Surgical Director , appeared on the front page of the Health and Fitness section of The New York Times on August 8, 2000.

The article by Abigail Zuger, entitled "Reading Glasses as Inevitable as Death and Taxes. Or Are They?" discussed the various theories behind the ever-controversial subject of why everyone eventually needs to wear reading glasses. One theory is that the lens gets harder and decreases focusing ability with age due to the fact that the proteins in the lens are never replaced. "The protein molecules in the aging lens slowly change in ways that make them bend light less...Thus, although it is more spherical, an elderly lens is less and less able to focus the light from nearby objects."

More recently Dr. Ronald Schachar formulated a theory that states "as the lens of the eye swells with age, the muscles and fibers surrounding it grow lax, and the system can no longer work effectively." Dr. Schachar has developed a procedure called the Surgical Reversal of Presbyopia. This surgery implants small curved pieces of plastic into the sclera (white part of the eye) and gives the muscles more room to flex and focus the lens.

"In March, the Food and Drug Administration approved preliminary trials of the operation at six sites in the United States, including the New York Eye and Ear Infirmary in Manhattan, where Dr. Barrie Soloway, co-medical director for vision correction, will head the studies".

While the surgery is just beginning to take place in the United States there have been several hundred cases done successfully around the world. "A few hundred patients who have volunteered for the surgery over the last decade in Mexico, Canada, and Europe...report that the surgery does indeed seem to restore their ability to see up close."

Barrie Soloway, M.D., F.A.C.S., Surgical Director was featured on the March 30, 2000 airing of Good Morning America.

In this news piece, reporter Michael Guillen profiled Dr. Soloway and the advances made in a new surgery to reverse the effects of presbyopia. The previous day Dr. Soloway had performed the first Surgical Reversal of Presbyopia procedure in the United States. This new procedure is exceptionally exciting because until now there has been no way to treat this problem. Laser surgery had been able to treat nearsightedness, farsightedness and astigmatism, but presbyopia was always a condition that puzzled doctors. "There has never been any other way to treat presbyopia. This is the first method, probably because we didn't have a good idea why people became presbyopic," Dr. Soloway explained to Michael Guillen.

The latest theory is that the lens in the eye continues to grow as we get older. Eventually it crowds out the muscles in the eye that are used to flex the lens, and the ability to focus is diminished. During this surgery the doctor places four plastic inserts in the sclera (white part of the eye) which creates a larger space for the muscles to properly function. Aubrey Herry, a patient who underwent this procedure over a year ago in Mexico stated, "Its hard to believe you can switch in an hours' time. It's a whole new world."

Just minutes after Dr. Soloway performed the surgery on his patient Mary Erra, she was shown sitting up in her hospital bed reading the fine print in the telephone book. The quickness and painlessness of the surgery even surprised Ms. Erra who could only exclaim, "Oh, this is wonderful!"

Barrie Soloway, M.D., F.A.C.S., Surgical Director and Co-Director of the New York Eye and Ear Vision Correction Center, appeared on WNBC New York in a news report given by Dr. Max Gomez on March 29, 2000. Earlier that day Dr. Soloway had performed the first Surgical Reversal of Presbyopia (SRP) procedure in the United States for the Phase I FDA investigational study.

Dr. Gomez interviewed Dr. Soloway before the surgery so that he could explain what exactly the theory is behind this amazing new procedure. "Instead of the lens getting hard (as it was previously thought) it gets too big. The lens continues to grow in the eye and as it grows it crowds the muscles around the eye and it isn't able to change its shape in order to focus in."

During the SRP procedure Dr. Soloway implants four tiny plastic segments into the sclera (white part) of the patient's eye which give the muscles more room to flex the lens. Just minutes after the surgery Mary Erra, Dr. Soloway's patient, was shown sitting up in her hospital bed reading The New York Times. "I was reading the newspaper and it was effortless," stated Ms. Erra.

Experimental surgery helps over 40 crowd read without glasses

By Carole Tanzer Miller, HealthSCOUT Reporter

(HealthSCOUT) Look out LASIK, there's a new surgical breakthrough that may soon let bleary eyed baby boomers read the fine print without squinting or groping for their glasses.

The painless, 45 minute implant operation called surgical reversal of presbyopia, or SRP will be the focus of a Food and Drug Administration monitored clinical trial beginning this month. If the trial is a success, the surgery could be available to patients in the United States as early as 2004, when the youngest boomers hit 40.

That's the age when presbyopia, which can't be cured through LASIK or laser surgery, begins forcing most people to hold things at arm's length to see them clearly. It's a sign of age and it's inevitable. By age 45, nearly nine out of 10 adults need corrective lenses for reading or closeup tasks such as sewing.

"We joke around in the office that it's almost a Viagra issue, it's about quality of life," says ophthalmologist Dr. Barrie Soloway, who will be the principal investigator in the clinical trial at the New York Eye and Ear Infirmary, one of six hospitals taking part in the first phase of the FDA trial. "For all the hype you hear about LASIK, my feeling is this will be even bigger."

SRP offers a revolutionary alternative to glasses that turns traditional thinking about the vision problem upside down, its supporters say.

Doctors have been taught since the mid1800s that presbyopia was caused by a progressive hardening of the lens as people age. That theory made little sense to Dallas ophthalmologist Dr. Ronald A. Schachar, who had treated many elderly patients whose lenses showed no hardening. He theorizes that presbyopia occurs because the lens, like fingernails or hair, grows throughout a person's life, eventually crowding and hampering the muscles that control it.

"There is some skepticism," says Schachar, who developed SRP. "This (procedure) is the proof."

In the operation, doctors insert four tiny implants into pockets created in the sclera, or white part, of a patient's eye. The implants stretch the sclera over the muscle that pulls on the lens to adjust focus. With more room to work, Schachar says, the muscle exerts a more powerful pull, allowing the eye to focus once again at close range on small objects like words on a page.

The surgery is performed under topical or general anesthesia and will probably cost $5,000 to $6,000. The implants, made of the same material used in cataract surgery, can be removed if problems develop.

Best of all, doctors like Schachar say, the procedure is done on part of the eye rarely associated with surgical complications.

An estimated 600 patients worldwide have had SRP. Soloway has operated on several patients in Mexico, one of 26 countries where the implants are already available.

One of them was Bob Gallagher, a Manhattan real estate agent and part-time actor who had the surgery at a Puerto Vallarta clinic last winter.

"It's nothing short of a miracle," marvels Gallagher, who is in his early 50s. "I will never have to wear reading glasses again for 25 to 30 years."

Before SRP, he couldn't see anything up close without reading glasses, from the lines on his scripts during acting auditions to the tiny print in the classified realestate listings he uses in his everyday work. A day after surgery, Gallagher was astonished to find himself with 20/10 vision, able to read the bottom line on an eye chart at 6 inches without glasses.

Eye drops relieved the only postoperative problem he experienced a temporary reduction in tear flow that made him feel as though he were viewing the world through smudged eyeglasses. In Gallagher's view, it was a minor inconvenience that disappeared within a few months.

"For me to be able to pick up anything I want and be able to read it, I didn't think anything about it," he says.

Doctors don't know why it works

Besides dry eyes, patients also may experience temporary redness, tearing or sensitivity to light after SRP, Soloway says.

Eye specialists hope the FDA trial will answer lingering questions about SRP and Schachar's theory. One prominent ophthalmologist says it's not clear how the implants work to reverse the effects of presbyopia.

Dr. Richard W. Yee, professor of ophthalmology at the University of Texas Health Science Center at Houston, used an early version of the implants in a groundbreaking study in the mid1990s. In that study, nine patients each received implants in one eye. Each patient emerged with improved ability to see at close range not just in one eye, but in both. Yee still doesn't understand why.

"There's no question that this (procedure) is restoring the ability to see up close for whatever the reason," he says. "We don't know the longterm benefits. Assuming that it continues to be good and stable and safe, it will give older people an opportunity to use their own eyes up close. Whether as good as at age 20, I'm not sure."

The 1,435 patients taking part in the clinical trial will get the implants only in their dominant eye that's the one they favor, for instance, when they peer through a rifle scope. They must be at least 50 years of age and have otherwise healthy eyes with no damage to the sclera.

Most of all, Soloway says, they must be "motivated."

"This is surgery, with knives and sewing and what have you," he says. "It's painless, but it's not done with lasers.

Remember: presbyopia is an unavoidable consequence of aging. A 10 year old can see a small object 2 inches from his eyes, while a 30 year old would have to hold it 6 inches away. By age 45, he would have to hold it 12 to 16 inches away.

By Tate Gunnerson

salon.com

Kirk decided to have both eyes done at once. Like most LASIK patients, he wore his street clothes and a surgical cap for the procedure and sat back while the surgeon put drops in his eyes to numb any discomfort. He was told to look at the red light, but as the surgeon began, he wondered when they were going to discuss his questions and concerns in more detail. The surgery did not hurt, but afterward Kirk noticed that his vision was blurrier. It's a common side effect of LASIK, but one that clears up quickly for the majority of patients. Kirk also began to see fourpointed stars around bright objects at night, get headaches and sometimes feel nausea after trying to focus too hard. (A recent study found that only 3.5 percent of patients experienced severe halos and 1.7 percent severe glare.)

"People think 20/20 is a measure of vision but it's not," says Kirk. "It can only tell you if you can read something across the room on a highly contrasted chart." He believes that the use of this chart, which does not take factor in glare, starbursts and hazing, account for many of the favorable statistics about LASIK. Two months after his initial procedure, Kirk had another, more painful surgery in an attempt to correct his problems. Between 5 and 10 percent of LASIK patients require another surgery or retreatment to touch up the first one due to over or undercorrection. In the vast majority of patients, the second surgery does the trick. But Kirk experienced more bad luck and that didn't work either. He is disputing the cost of the surgery with his doctor. No procedure exists to adequately fix Kirk's eyes.

"They're playing a game of high volume where the occasional casualty doesn't impress upon them all that heavily because they don't have to deal with it," says Ron Link, the executive director of Surgical Eyes, an organization dedicated to helping people who have suffered as a result of eye surgery. "If it works out, that's great. If it doesn't, it's hell." In Kirk's case, his doctor didn't take the shape of his cornea into consideration when he performed the surgery. Now, when his pupils enlarge at night, they expand beyond the part of his eye that was fixed by the surgery. Light comes in and is distorted by the portion of the eye that hasn't been treated. Now Kirk sees double images at night, and it's hard for him to focus. Although Kirk was given the impression that LASIK is a custom surgery, he has since learned that doctors use a "regression analysis technique" or a profile based on past patients to perform the surgery. "They take numbers based on the prescription, thickness of cornea and curvature and plug it into a formula."

Kirk's case is by no means unique. For many dissatisfied people, the main problem with LASIK is that nobody told them about all the potential side effects. This may have more to do with lack of training than any malicious intent. Assil, who has performed more than 4,000 procedures, suggests that many doctors do not have the knowledge to screen for potential problems and recommends that surgeons be trained in a full oneyear fellowship instead of relying on weekend certification courses given by the makers of the LASIK equipment. LASIK is not right for everybody. People with diabetes and glaucoma may experience longer healing times, and people who are severely nearsighted or farsighted may find that the surgery will not result in the same miraculous results.

Kirk claims that his doctor never advised him that his surgery carried any great risk. Indeed, many people complain that they're not told about certain side effects or even misled outright. Although in the past it was difficult to check the claims of doctors, Assil says that may be changing. "The Internet is becoming a powerful policing tool," says Assil. "If they're noteworthy at all, their name will start popping up." Patients should get all guarantees in writing, ask about their doctor's malpractice record and make sure that the laser the doctor will be using has been approved by the FDA, says Assil.

Dr. Barrie Soloway, the director of the Laser Vision Center of Excellence at the New York Eye & Ear Infirmary, suggests that people ask to see the doctor perform the procedure. If the doctor says that he operates every other Wednesday from 3 to 5 p.m., they should be avoided. "Do more research about it and about your doctor than you would about a television you're going to buy."

Phil and Polly Meagher researched LASIK and flew to Montreal for the procedure six months ago. They were pleased that in Canada, the procedure only cost $2,000 per eye, significantly less than was being advertised in their area. They felt comfortable with their surgeon, who had an excellent track record and was willing to guarantee his results. Although neither had any severe problems with LASIK, their differing expectations have affected their attitudes about it. Phil's vision is better than Polly's, but he isn't as happy with his results as she is. "I would not be a good poster boy for the procedure," says Phil. "I miss the nice crisp vision with glasses. I could spot a fly a block away." Although Phil appreciates the convenience of not having to deal with glasses, his vision fluctuates at different times of the day, although his ophthalmologist is surprised since his vision is 20/20 in one eye and 20/30 in the other. Polly, on the other hand, is elated with the results of the surgery. Before she had the procedure, Polly was legally blind without corrective lenses. "What other people could see at 800 feet, I had to be at 20 feet to see," says Polly. Polly's doctor advised her that because of her thin cornea, she was not the best candidate for LASIK surgery. He said he could only correct her from 20/800 to 20/60, but that was good enough for her. Although she still needs corrective lenses since her operation, she has been able to get rid of her Coke bottle glasses. Polly is representative of most LASIK patients. "The great majority of patents are satisfied," says Assil.

Future advancements may make the already safe procedure much safer. Newer lasers such as the LADARVision laser are making it possible to correct severely nearsighted and farsighted people who weren't eligible before, and efforts are being taken to customize the procedure for individual patients. In addition, a new phakic intraocular lens implanted in the eye eliminates the need to cut the cornea, and can be reversed by removing the lenses. All the success stories in the world, however, don't change the fact that Kirk's life has been changed for the worse. Before the surgery, he and his wife enjoyed going to movies, but now in order to see the screen, he has to put strong eye drops in his eyes that cause him pain and dryness the next day. "The industry still doesn't have a Plan B," says Kirk. "They might say they can take care of it with drugs, but they're still in the development phases of techniques that might fix me." Kirk still has to wear glasses, and he never has scuba dived with his wife.

When I searched the Web for information about the surgery, I came across hundreds of success stories and tons of hype, but I kept pausing to stare at the car crashes. I don't want to risk my eyesight, and I don't want to have to find a lawyer, no matter how small the risk. Although every doctor I talked with reminded me that it's possible to get an infection from contact lenses, the bottom line is that contact lenses aren't surgery. I can take my contacts out. For now, I'll buy an extra pair of glasses and give my eyes another chance to go into a total remission.

I Can See Clearly Now

Broadway actress Rachel DeBenedet went from being acutely nearsighted to having stellar 20/15 vision in less than a minute. Hello, technology.

By Lisa Klugman

One day, last autumn, Rachel DeBenedet, 33, walked Manhattan's crowded, polluted streets like she had done many times before. This time, however, she was crying for joy. "I could see," she remembers. "It was one of the most incredible feelings I have ever had in my entire life. I can't even describe the feeling. It was just like a feeling of immense power. I could see." Overwhelmed and teary among blas?ew Yorkers, Rachel stopped at the nearest pay phone to call the man responsible for her newly perfected vision: Barrie Soloway, MD, the director of the New York Eye & Ear Infirmary's Vision Correction Center, and the pioneer of corrective laser surgery for eyesight. "I left a rambling, emotional message on their office answering machine," Rachel recalls. "I just had to thank him right then and there. Thank you, thank you, thank you..."

Dr. Soloway is used to this kind of gratitude. He's performed more than 5,000 vision correction laser procedures in the past four years.

"Everyone has been extremely pleased with the results." says Dr. Soloway. "Except one guy was somewhat unhappy. He complained when he could see slightly better in one eye that was 20/15 than the other which was 20/20."

No Pain, Lotsa Gain

So here's the deal: First, Dr. Soloway decides if you're a good "candidate" or not. (The eyelaser field has its own vocabulary. The patients are "candidates," the surgery is a "procedure," and if another procedure is required, it's not called another procedure, its called an "enhancement." Got it?) Whether you're nearsighted, farsighted, you're probably a good candidate, as long as your expectations aren't bizarrely off the map. Like weight loss, giving up your glasses isn't a miracle cure for everything that's wrong in your life. "Some people have crazy desires," Dr. Soloway laughs. "Some folks ask if I can make them see through people's clothes! Dr. S. sends those nut jobs out the door to get on with their nutty lives. (Thank goodness the seeingthroughclothes surgery is still way off in the future!) Also, to be a candidate, your vision can't be exceptionally bad (we're talking thick, cokebottle glasses) and if your pupils are way larger than average, a special laser that works with a "larger optical zone" such as the Autonomous LADARVision should be used.

After you've received your "good candidate" thumbsup, you schedule your procedure, hop aboard the doctor's table, and stand by for the procedure, which includes a twinge of discomfort as you're given a drop of antipain juice. The doctor then steps in for a total of about twenty minutes, with the actual laser work taking a whopping 20 seconds. (Rachel's eyes took 35 seconds, as her vision was fairly bad.) During those 20 or so seconds, the surgeon changes the shape of the cornea, which enables a person to see objects that are further away, or closer, as the case may be.

People are then told to forget about wearing any eye makeup for a good two weeks. They also shouldn't rub their eyes for a while, and they're told to go home and take a nap. When they wake up, their vision should be either perfect, or well on its way to stellar. Most experienced and well-known city docs like Dr. Soloway charge $5,500 for the whole shebang, which includes "enhancements," if that's necessary, but there are less expensive (albeit less experienced) doctors out there.

Rachel Today

Although Rachel had been wearing glasses since she was 9, and contacts since she started modeling at 13, she now takes the whole eyesight thing for granted. "Sometimes I try to remember what that incredible feeling was like, of walking down the street that first day after my operation," Rachel says. "But I don't usually think about it. I spent more than 20 years reaching for my glasses or contacts every morning, and now I wake up and never even think about it."

"A Clear-Eyed View"

The article by Elizabeth Krieger,beginning on page 70, discusses the various vision correction surgeries, and quotes Dr. Soloway on the success rate of LASIK.

'Dr. Barrie Soloway says more than three-quarters of his patients end up with 20/20 vision...But every operation can have a margin of error, and with LASIK the trickiest part is creating the flap. '" If it's not quite right?too ragged, for instance, and the surgeon goes ahead and does the lasering, the eye won't heel properly,"' says Soloway.

Dr. Barrie Soloway, Surgical Director of Vista Alliance Eye Care Associates and Director of the Autonomous LADARVision Center of Excellence at the New York Eye & Ear Infirmary's Vision Correction Center, appeared on the nationally syndicated radio program, "Living Without Limits" through the month of November 1999 to discuss the latest advances in laser eye surgery, in particular, the Autonomous LADARVision laser system -- currently the newest system available in New York.

Vallerie Magory, Dr. Soloway's patient, who recently underwent LASIK with the Autonomous laser, also appeared on the radio program to discuss her pre-, during-, and post-operative experience with listeners. As she told it, for all of her life, Vallerie had to suffer through wearing glasses -- she used to have a high level of astigmatism, everything was blurry. Contact lenses were difficult to wear for Vallerie, and so she could survive only with her glasses. It was her son who gave her encouragement. First receiving LASIK from Dr. Soloway, Vallerie then decided, after watching her son 's vision restored to 20/20, that she would get the surgery.

The Autonomous LADARVision laser is able to track one's eye movements 4,000 times per second -- it is the only laser eye system that has been created with the same equipment that is used at NASA. Because of this, Vallerie felt safe knowing that her eye could move and that the movement would not affect the outcome of her surgery. Today, Vallerie is seeing with 20/20 vision and is completely glasses-free.

On October 14, 1999 Barrie Soloway, M.D., F.A.C.S. performed a live surgery that was aired on Good Day New York. Correspondent Cheryl Washington interviewed Dr. Soloway and his patient Vallerie Magory throughout the procedure.

Vallerie Magory had worn glasses all her life because of severe astigmatism. Her pupils had been too large for the previously used lasers, so she was waiting for Dr. Soloway to receive the new state of the art Summit/Autonomous LADARVision tracking laser. This laser has the ability to treat a larger area on the surface of the cornea, so risk of night glare and halos is drastically reduced. It also has the ability to track the eye over 4,000 times a second, so if your eye should move involuntarily during the surgery the laser will follow it.

Looking very calm, Ms. Magory lay on the table while Dr. Soloway explained each step of the surgery as it was happening. Veronica Ruelas, O.D. also helped to explain some of the details of the surgery to Cheryl Washington while the procedure took place. In just a couple of minutes the surgery was completed and Vallerie Magory was on her way to eliminating her need for glasses.

A Clear-Eyed View

Surgery to Improve Vision is all the Rage. But are There Hidden Risks?

By Elizabeth Krieger

Michael Maxim's nervous voice floats up from beneath several layers of sterile plastic. "Yeah, I feel a little pressure now," he says quietly. His right eye is under the scalpel of Richard Abbott, co-director of cornea and refractive surgery at the University of California at San Francisco's Beckman Vision Center. Through a minuscule incision, Abbott digs two tiny tunnels around the outer edges of Maxim's cornea and inserts two slivers of plastic called Intacs. On a television monitor above the table, the 33-year-old engineer's bulging, anesthetized eye appears terrified and vulnerable.

Just 30 minutes later, Maxim feels well enough to join a friend for a plate of chow mein in the hospital cafeteria. As he leaves the hospital, his bandaged eye is still sensitive to light and pressure, he says, but stray eyelashes have given him more trouble.

By the next morning, his vision in the treated eye was 20/40 and improving. "For the record," he said of the procedure, "going to the dentist is worse." Two months later, Maxim had the Intacs removed.

Having your eyes done used to mean surgically lifting droopy lids, but no longer. In hopes of escaping the tyranny of spectacles and contact lenses, nearly half a million Americans have offered up their orbs for a more invasive form of vision correction: surgery.

Intacs are the newest form of surgical vision correction -- approved for general use just last spring --and the only procedure that's reversible if results aren't up to snuff. Even more popular is Laser In Situ Keratomuleusis, or LASIK, a stream-lined version of a surgical technique that's been around for a dozen years.

The allure of either operation is easy to understand: no more midnight fumbling for glasses when the phone rings or frantic scrambles for a lost contact on a busy sidewalk. "Throw away your glasses," one splashy ad gushes.

But can you? Should you? While many problems that dogged earlier techniques have indeed been ironed out, the Federal Trade Commission has called the fevered pitch of many ads misleading. Even the Council for Refractive Surgery Quality Assurance -- a consortium of experts who perform the techniques -- says that only about half of all patients end up with 20/20 vision six months out. Harsher critics worry that amid the excitement, the risks of side effects are being underplayed. Before you let your own eyes go under the knife or laser, here are a few things to consider.

How Blind Are You?

The acuity of your vision depends largely on the shape of your cornea, a transparent cap that covers the iris and pupil. As light enters the eye, the cornea helps focus the incoming image. If your cornea's too steeply curved, you're nearsighted --- distant objects look blurry. Too flat and you're farsighted, unable to sharply focus on people or objects close at hand. If you have astigmatism, your cornea is steep and flat by turns. In theory, at least, refractive surgery can eliminate all three flaws by slightly changing the cornea's shape. But take note: If you've suddenly found yourself struggling to read the phone book or thread a needle, chances are the lens of your eyes have started to stiffen, as happens in most adults by age 45. None of the surgical techniques introduced thus far can eliminate the need for reading glasses.

What Are the Risks?

In 1978, American doctors began to use a technique called Radial Keratonomy (RK), which is essentially a series of incisions made around the iris to flatten the cornea. That eased myopia, but the deep cuts were painful as they healed into scars that often clouded vision. In 1987, Photorefractive Keratectomy (PRK) produced better results by using a laser to more lightly sculpt the cornea, but haziness and discomfort often persisted.

The solution was LASIK, developed around 1990. LASIK skips scraping the top of the cornea in favor of sculpting beneath its surface; it's known as "flap and zap" in surgery circles. The doctor first numbs the eye, then carefully slices across the cornea a flap the thinness of an onion skin and holds it out of the way. Next, with the eye looking like a peeled grape, the laser goes to work shaving off less sensitive cells underneath. After about a minute, the flap's replaced, and the procedure's over. The flap re-adheres to the eye much as plastic wrap does to Jell-O. Recovery time's quicker than with PRK, and there's little pain; most people return to work in a day or two.

LASIK'S success rate is impressive, too -- at least for some surgeons. Barrie Soloway, co-medical director of the New York Eye & Ear Infirmary's Vision Correction Center, says three-quarters of his patients end up with 20/20 vision; another 20 percent get at least 20/40. While initially just for nearsighted patients, LASIK can now help those who are mildly to moderately farsighted or who have astigmatism as well.

But every operation has a margin of error, and with LASIK, the trickiest part is creating the flap. "If it's not quite right -- too ragged, for instance -- and the surgeon goes ahead and does the lasering, the eye won't heal properly," Soloway says. "There may be scarring." To reduce the chance of a mishap, he says, choose a highly experienced surgeon from a reputable center who has enough humility to know when to call off the procedure. (It can be attempted again once the eye heals.)

Unfortunately, certain side effects aren't predictable and can never be undone. If the calibration of the laser is off -- which experts say can happen in the hands of even the most skilled doctors -- you could go into the operating room nearsighted and end up a bit farsighted, or vice versa. From one to five percent of patients struggle with chronic glare after LASIK, or see halos around bright lights. Such complications, especially noticeable at night or while driving, can be a nuisance for some people and a nightmare for others, says Walter Stark, a professor of ophthalmology at Johns Hopkins Medical Center's Wilmer Eye Institute who's seen some of the worst complications from botched jobs.

You shouldn't consider LASIK if you have diabetes or any other medical condition that threatens eyesight, or if your lens prescription has appreciably changed in the previous five years. The stronger your lens prescription, the higher the risk of side effects; there's simply more work to be done in the eye. It also helps to have a fat wallet: LASIK runs about $2,500 an eye, and insurance companies rarely cover the cost.

Joy Graziano, 60, of Overland Park, Kansas, was happy to pay that price, even though her distance vision after LASIK is less sharp than with contacts. "Before, if you were standing in front of me and I didn't have my lenses in, I couldn't tell who you were," Graziano says. "Now I can."

If you're not quite so blind, Intacs may be a better choice. (So far, Intacs are an option only for the mildly nearsighted, though other groups are likely to be included eventually). The crescents of plastic placed around the edges of the cornea subtly and precisely change its shape. Because the center of the cornea is avoided, any scarring is usually out of the line of sight. Tests suggest the results are on par with similarly priced LASIK, but with fewer side effects.

Intacs aren't perfect, however. They, too, can cause glare and starburst halos around lights, particularly at night; in early tests about 4 percent of patients had the inserts removed because of these other side effects. Maxim had his taken out after being dogged by unrelenting double vision and light sensitivity.

Though disappointed the Intacs failed him, Maxim doesn't regret having tried the procedure. "I asked if I could keep them," he says. "I'll put them in my good-ideas-that-didn't-work box." He still feels he's a walking advertisement for their strongest selling point: reversibility. His uncorrected eyesight is now about what it was before. With contacts, he has 20/20 vision.

What Are Your Goals?

In the end, how satisfied you're likely to be with either Intacs, or LASIK depends mostly on how poor your vision is beforehand and how bothersome your find contacts or glasses. If even a mild improvement in vision would make you happy, you're less likely to be put off by the risks or common side effects.

"I prefer patients who tell me, "I want to be able to go to the beach and see my towel,' not perfectionists who say, "I don't want to ever wear glasses or contacts again," says Soloway. "I can't guarantee that, and anyone who does is lying." Remember: Even at their most effective, Intacs and LASIK just buy a little lens-free time. Surgery or not, nearly everyone eventually needs glasses to read.

"Should You Get Your Eyes Lasered?"

The article, beginning on page 195, follows Dr. Soloway and his patients during and after their vision correction procedures. Writer Mary Murray discusses the various laser and non-laser options for those with nearsightedness, farsightedness, astigmatism and presbyopia (poor reading vision).

"Saturday mornings in Dr. Barrie Soloway's ophthalmology clinic have the feel of an old-time revival meeting. Maybe not when you first walk into the bright, white, marble-floored waiting room. There, patients who have had laser eye surgery the day before, sit quietly in rows of chairs against the walls, with little clear-plastic shields awkwardly taped over their eyes. But follow them into the exam rooms where Soloway removes the shields, and you hear exclamations straight from a faith healer's tent: 'It's a miracle!' Or, 'You've changed my life!' Or, just plain, 'I can see!'....'"Bad vision no longer has to be a disability,"' says Dr. Soloway. '"It can be fixed permanently."'

Murray also wrote about the new lase