VISION CORRECTION:
An eye-opening new procedure in Michigan

Patients who have been rejected for popular LASIK refractive surgery have a new option: an implantable lens that promises perfect or near-perfect vision.

On Monday, Dr. William Goldstein, a Shelby Township ophthalmologist, performed the first procedures in Michigan using the Visian Implantable Collamer Lens.

The procedure's biggest drawback is its price. Goldstein charges $3,500 for each eye -- nearly double the price of LASIK -- and others may charge more. Deemed cosmetic surgery, insurance doesn't cover it.

Six patients underwent the 20-minute, painless operation at the Henry Ford Health System's Lakeside Medical Center.

"It's amazing, I can finally see," said Rhonda Biack, 43, of Armada, who has been wearing contact lenses or glasses since she was in second grade. She could barely see past her nose.

Turned down for LASIK because her vision was so bad, Biack was told by Goldstein that the Visian lens "was coming to the States and you should qualify."

On Monday, she left happy, with perfect vision.

So did Susan Haslett, 58, of Shelby Township, who was Goldstein's second patient Monday.

"I've worn glasses for 54 years," Haslett said. "I'm very excited."

LASIK a popular surgery

Each year, some 4.5 million Americans undergo LASIK, or Laser-Assisted In-Situ Keratomileusis. One of the most common elective surgeries in the United States, it uses a tiny scalpel to lift a thin flap of tissue, followed by quick bursts of a laser to sear away part of the cornea, usually to correct nearsightedness.

As many as one in five patients who want LASIK can't have it because they are extremely nearsighted, prone to dry, red eye or have large pupils or thin corneas.

The Visian lens is implanted behind the iris, the color portion of the eye. It is approved for adults 18-45 who aren't LASIK candidates but doctors may use the lens in a so-called off-label use, a common practice, for other candidates of any age.

Because the procedure involves surgery inside the eye, it carries more risks than LASIK. One is cataract formation, which occurred less than 1% of the time, and even rarer retinal tears or detachments, which can be blinding, according to a study of some 500 patients presented to the federal Food and Drug Administration last year to obtain federal approval.

Goldstein considered the results of all six procedures on Monday "stunning. Everyone read 20-20 or better. It was so thrilling to have patients experience such dramatic changes so soon."

Patients can't write it off as a medical expense on their taxes, Goldstein's tax accountant told him Monday.

The procedure is reversible, so anyone developing a cataract can have the lens removed and a cataract lens is implantable, Goldstein said.

Like LASIK, the Visian lens can cause halos, glare and night-vision problems, but much less so, doctors say. "You maybe trade a higher initial risk with this surgery to a potential better visual result," said Dr. Jayne Weiss, an ophthalmologist at Detroit's Kresge Eye Institute who chaired an FDA ophthalmology panel.

Weighing the risks

The big question ahead is: Will implantable lenses replace LASIK?

"I'd have to say no," said Dr. David Manzo, a Royal Oak ophthalmologist. But he expects to eventually offer an implantable lens. "In the right situation, it could be very good."

Dr. John Hart, an ophthalmologist at Beaumont Hospital in Royal Oak, also expects to offer the technique. He said he and other ophthalmologists were waiting for the Visian lens to be approved because some others on the market are implanted in front of the iris, making it more prone to cataract formation.

"This isn't for everyone," he said. "The risks are definitely greater when we move inside the eye."

Contact PATRICIA ANSTETT at 313-222-5021 or anstett@freepress.com.

Copyright © 2006 Detroit Free Press Inc.