Eyeing The Laser Option

TWENTY-seven-year-old Rekha Agarwal of Delhi went through a torrid time a year back. Soon after her pregnancy, for some inexplicable reason, her eyesight deteriorated to minus 6. Not having worn spectacles before, she was wary of the transformation her personal appearance would undergo. This was when she heard of the Photo Refractive Keratectomy (PRK) procedure. Says she, a year after she had PRK done to her eyes: "I'm so happy I took the plunge. There was just this mental block that lasers might harm the eye but that's all nonsense."

While the technology behind the PRK procedure with the excimer laser has been offering this cure ever since 1986, in India the boom seems to be just starting. Till a couple of years back, there were just a handful of PRK centres around the Indian metros. Now, the promise of a lifestyle free of spectacles or contact lenses has pushed that number to over 40 and many more are in the offing. Says Dr Sanjay Chaudhary, who was one of the first to practise the procedure in Delhi at Daryaganj: "The awareness is increasing every day."

The initial catalyst to growth has been the aesthetics inherent in PRK which won instant appeal with women in the matrimonial age bracket. Says Dr R. Khanna, who has practised the procedure on 980 people since he established his private unit in Delhi's Model Town in January '96: "Over 99 per cent of my cases have been women in the age bracket of 18 to 27. They come to me mostly when the family's hunting for a groom. Lately, there's been an increase in males who've just started college." Estimates on the number of people who have resorted to PRK in India vary from 15,000 to 20,000. The technology is rather simple. The laser is used to remove a precise amount of corneal tissue in a preprogrammed manner to alter the curvature of the cornea and reduce or eliminate myopia, hyperopia, and astigmatism. The corneal tissue is vaporised with each pulse of the laser. The beam breaks the intermolecular bonds of the cornea layer, leaving a smooth underlying corneal surface. With a modified curvature, focusing problems are reduced or eliminated.

The procedure takes anything from 20 to 90 seconds depending on the degree of myopia or astigmatism. The lasered area takes three days on an average to heal. Says Dr Anil Malhotra, who heads the Sunetra Eye Centre at Delhi's Panscheel Park: "We resculpt the cornea, we don't lacerate the eye as is the common perception."

The only temporary side-effect, the doctors claim, is a little haze in the eyes for a few days. Says Chaudhary: "Vision may be blurred for the first few days. Initially, we indulge in a temporary overcorrection. As the healing proceeds, there is a slight reversal in this status and the eye achieves zero overcorrection over three to six months."

Apart from the aesthetics involved, the non-surgical correction of vision has many takers because of people wanting to get rid of the need for wearing spectacles. Says Dr Amar Agarwal of the Agarwal Eye Clinic at Chennai: "This route is catching on as it appeals to the people's basic desire of not hurting themselves. Surgery somehow connotes that it is a serious business but this treatment is seen as a soft option. This psychological impulse will push more people towards the laser option."

AT Mumbai's New Vision Laser, a subsidiary of the Indiamco group which is largely into diamonds, there are days when telephone enquiries about the procedure touch 200. Says Satish Choksi, chairman: "We ensure a follow-up on each call." The centre conducts 12-15 correctional procedures a day with the excimer laser. It even started advertising recently. Says Choksi: "Spectacle power between minus 15 and plus 5 can be resolved to perfectly normal eyesight." Business too is picking up. The centre has grown by 60 per cent in the last two years, and due to the encouraging response, a satellite centre in a Mumbai suburb and another in Rajkot have been started.

 There is already a centre in Baroda. Says Dhawal Sheth, 18, who got the treatment done: "I had my first eye done nine months back and the second after four months. I had been wearing spectacles since class three and I was so glad to get rid of them."

 There are still others, however, who feel the laser option should be the last. Asks Dr J.K. Shah, leading Mumbai eye surgeon: "Several eye surgeons who do this treatment wear glasses. Why haven't they gone in for the laser yet?" Admits Malhotra: "Even though I run a laser centre, I advise my patients that compared to anything else spectacles are the best resort." Malhotra doesn't perform the procedure on clients whose power is below minus 1.5. He calls them visually 'happy'. Neither does he take patients with a power above minus 12. Says he: "I consider them a little risky (for laser surgery)." The side effect likely to develop in about one per cent of the cases is haze. Says Khanna: "After the procedure, epitherial growth in some patients is irregular. If the mosaic of the cornea is not regular it causes a bit of opaqueness. But it will remain maximum for six months and we can rehabilitate the patient after that. The haze is not irreversible." 

For that matter, even Shah concedes that if the case selection is right—that is age above 20, stability of eye number and no eye infection—then the success rate can be as high as 99 per cent. Otherwise, says Shah, there are risks that the patient could develop glaucoma or other eye infections.

But, that, say doctors, is true of contact lenses as well. A study published by the New England Journal of Medicine reported that corneal ulcers occurred nine to 13 times more often with extended wear of lenses. With micro-organisms being able to invade the cornea from under the contact lenses, the threat of infection is always present. There is also the hassle of having to take care of the lenses every night.

Besides, many patients have contact lens intolerance because of dry eyes and for sportsmen, glasses and contacts can pose restrictions. This is also the case in various forms of employment: pilots, flight attendants, defence forces, fire fighters etc. 

At the Eye Research Foundation at Vijaya Hospital in Chennai, Dr Babu Rajendran says that seven people underwent the treatment to join the armed forces. But warns Chaudhary: "Treatment by laser to correct the previously existing spectacle number is not officially acceptable yet. This means that if detection is done by certain sophisticated instruments it will amount to a disqualification."

 The main drawback, of course, is the cost factor. Clinics all over India charge around Rs 9,500 for a single eye. That's Rs 19,000 for both. And it doesn't look like the costs are going to decrease in the near future. For one, the machines cost over Rs 1.3 crore. Then the generation of the laser beam depends upon a gas mixture of Argon fluoride and helium. Says Khanna: "A single cylinder costing Rs 1 lakh gets used up by 200 cases. Besides, the life of the laser head is said to be just two years. That means a recurring expenditure of Rs 16 lakh every 24 months. And if you have some maintenance problems an engineer has to fly down and that costs a minimum of Rs 1.5 lakh a visit. You have to keep the prices at that level not to default on your interest payments. In fact, you break even only after about 3,500 cases."

 But, even though the treatment comes with a stiff price tag, for those who consider optical lenses a burden they can do without, it's money well spent for improved looks and vision.