The Male Health Center - Men & Vision

Vision and aging

Between their 10th and 16th birthdays, about 25 percent of Americans begin to lose the ability to focus their eyes clearly on distant objects. Nearsightedness—the inability to see a pitch coming before it's too late to swing—is probably one of the few things short of broken bones that can convince a young man to seek medical help.

Until recently, eyeglasses or contact lenses were the only remedies for what is technically called myopia. Although many nearsighted people continue to see well up close for many years, corrective lenses were a constant companion at ball games, in the car, at school, and wherever distant vision was important.

Then, in the late 1970s, surgical correction for myopia was introduced to the United States. Many years and many happy patients later, radial keratotomy continues to be a very controversial approach to correcting nearsightedness. I asked Arnold Stokol, an optometrist, what the latest info is on corrective surgery. As someone who doesn't do surgery himself, he should be an unbiased source.

In myopia, the eye is too long, or the cornea (the eye's lens) is too steep. As a result, light rays focus in front of the retina, causing distant objects to appear blurred. Radial keratotomy flattens the lens (by a series of radial incisions in the cornea), which causes light to focus closer to the retina.

Although the majority of patients report complete satisfaction with radial keratotomy, it's also worth looking at the down side.

Surgery is no guarantee of freedom from glasses. Studies show that more than a third of those who have radial keratotomy still need glasses afterward, with as many as 17 percent ending up farsighted. Furthermore, contact lenses usually can't be tolerated after surgery. And because the incisions weaken the eye, protective goggles are a must for athletes.

An alternative to radial keratotomy is a new procedure called photorefractive keratectomy. Using a computer controlled laser, the doctor changes the shape of the cornea by removing 5 to 10 percent of its thickness. Persistent haze and corneal scarring are the greatest risks to the laser method. This new approach has largely replaced radial keratotomy in Canada, and FDA approval in the U.S. is expected very soon.

As is the case with any surgical procedure, there are also rare but not insignificant risks: Infection or inflammation is possible, and a few patients end up with worse vision. Pain after surgery is common with either method.

Finally, refractive surgery isn't cheap. The procedures generally cost about $2,000 per eye, and neither Medicare nor most private insurers will cover them.

Whether you decide to wait for lasers or go ahead with radial keratotomy now, pick a doctor with experience: It's the best predictor of success.

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