Medical Breakthroughs: Correcting Eye Surgery

BACKGROUND: Up to 500,000 people in the United States undergo refractive surgery each year to correct poor vision. Refractive laser surgery, which includes LASIK and PRK, are not done without risk.

Conventional laser surgery typically treats the central portion of the eye. If it's done off-center, or if it heals asymmetrically, the patients can suffer impaired vision. Though it's rare, complications from these corrective surgeries can be debilitating. These complications can include glare, halos, double vision, night vision problems, starring, and other vision loss.

Though intraoperative complications with refractive surgery are rare, at less than 1 percent, ophthalmologist Edward Manche, M.D., from Stanford University in California said, "Post-operative complications, even in well-performed surgery, can be as high as 5 or 10 percent."

The most common problem is uneven reshaping of the eye.

NOW THERE'S HELP: Dr. Manche says there have not been many options for people who have problems following corrective eye surgery. Now he's using a procedure called Custom-CAP to offer help to patients. Custom-CAP stands for Custom Contoured Ablation Pattern treatment. The procedure links three separate devices: a corneal topography machine, a conventional laser and ablation planning software.

The topography machine makes a color map of the eye and finds exactly where treatment is needed. It calculates the exact specifications for the laser. The software then simulates the results from the surgery on a computer. Then, the surgeon is able to use the data to precisely control size, depth and location of the laser application. By doing this, surgeons are able to correctly reshape the cornea.

"It allows us to program the laser to treat a specific portion of the cornea and effectively re-center the treatment that has been de-centered. One of the things that is nice about it, is that we can run a simulation on the mapping machine before the surgery to help predict what the treatment will look like following the surgery," Dr. Manche said.

WHERE IS IT? Custom-CAP received FDA approval last December under a special "Humanitarian Use Device" exemption. Under this exemption, doctors are allowed to treat patients who have a condition that affects less than 4,000 people in the United States each year.

Dr. Manche says he is currently the only doctor in the United States performing the surgery but he says, "There will soon be 25 to 50 centers doing this across the U.S."

FINALLY, RELIEF: Dr. Manche says the use of Custom-CAP will make a big difference in many of these patients' lives. He says: "It's very satisfying to finally be able to tell these patients, 'Yes, we have something we can treat you with.' Then it's an enormous relief to the patient because they've really been left adrift. To finally be able to offer them a treatment is really indescribable."


Leslie Lyssenko
Stanford Hospital and Clinics
900 Blake Wilbur Drive
Room W3002
Palo Alto, CA 94304
(650) 498-7020

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