Medicine: Bright Vision of the Future

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Nonetheless, the A.A.O. has expressed fears about the "safety and efficacy" of R/K, much to the annoyance of Fyodorov, who says, "They are afraid of new technology." Bores attributes the resistance to a bias against new procedures espoused by doctors in private practice, as opposed to those "in the hallowed halls of academe." Among the A.A.O.'s concerns about R/K is the fact that results can vary widely from surgeon to surgeon. In addition, little is known about the long-term impact of R/K: patients may ultimately be high-risk candidates for cataracts or other problems. "R/K decreases the amount of nearsightedness in virtually every case," concedes Dr. George Waring of Emory University, "but the decrease is not predictable." Waring, who chairs a five-year study on 500 R/K patients for the National Eye Institute, has found that the procedure is "pretty safe" if done by a competent surgeon. But until more infomation is available, Waring, who is nearsighted, will wear contact lenses.

The eye specialists in San Francisco were also intrigued by a new surgical laser called the YAG (for its components of yttrium, aluminum and garnet). Unlike the argon laser, which has been used by eye surgeons for nearly two decades, the YAG does not produce its effect by burning. Instead, it concentrates light energy into very short, intense pulses that create tiny, 1/10-mm cuts. "It causes a very small explosion," explains French Surgeon Daniele Aron-Rosa, who, along with Swiss Surgeon Franz Fankhauser, is credited with inventing YAG surgery.

Because of its supreme accuracy and safety, the YAG can be applied where an ordinary laser cannot. In Europe, it has been used to treat more than 8,000 patients. The technique was introduced in the U.S. earlier this year, and 800 patients have been treated. While the YAG does not replace traditional cataract surgery to remove a clouded lens, it can be used as a first step to sever the membrane that encloses the lens. The YAG is also valuable in postsurgical followup. In as many as 20% of cataract patients, a second operation is needed to cut away eye membranes that become opaque after the lens has been removed. The YAG can instantly rupture these membranes in an outpatient procedure that replaces four hours of surgery.

"Patients view the YAG as a kind of miracle," says Dr. Stephen Trokel of New York City's Presbyterian Hospital, one of about a dozen U.S. medical centers equipped with the $100,000 machine. Indeed, Florence Clemens, 74, one of Trokel's postcataract patients, reports that although no anesthetic was used, "there was no pain, just the sensation of a very bright, multicolored light." Best of all, when the $900 procedure was over, Clemens could "go right home and start dinner."