News24

Eyes of the Tiger

2004-03-19 13:53

Cape Town - Tiger Woods is one of the many tour players who has had Lasik eye surgery. Has it helped their games, and can it help yours?

Patient: Tiger Woods

Occupation: Professional Golfer

Diagnosis: Severe nearsightedness. Vision is 20/15 with contacts.

Patient's complaint: Wants to play without contacts, ehich are cumbersome and bother him in windy and rainy conditions.

Objective: 20/15 vision without contacts. Ability to discard contacts.

Refrred by: Friends, other tour golfers.

Procedure: Oct.1, 1999

Patient can only see clearly about one foot in front of his face.

Patient will be able to see ball in flight without aid of contacts.

Patient should be able to read breaks better. Hole should appear larger post-Lasik.

Note: Patient is more concerned about how different weather conditions will affect his eyesight and his post-Lasik than he is about the procedure itself.

Golfers, it seems, will try anything to lower their scores. How else can you explain the recent inquiry by a struggling tour professional, one who does not even wear glasses or contact lenses, about Lasik laser eye surgery as a cure for putting woes?

"I won't embarrass the guy by saying who it was," says Dr Mark Whitten, the Rockville, Maryland-based ophthalmologist who has performed laser eye surgery on close to 60 players from the PGA, LPGA and senior tours, "but he came all the way out here just certain that there was something wrong with his vision. When I checked his eyes and realised his vision was fine, I had to tell him his problems weren't because of his eyes."

No, Lasik is not for everyone. And beneath the attention the procedure has received in the past few years lies the sometimes overlooked truth that Lasik is much more a cosmetic surgery than it is a miracle cure.

That's not to say you won't see better after Lasik. In fact, you'll probably eliminate the need for glasses or contact lenses. But there are no guarantees it will improve your golf game, and some optometrists caution it might make things worse. Just as in all surgical procedures, things can go wrong. And that includes risks of minor and major complications.

Lasik (the acronym for laser assisted in situ keratomileusis) became widely available to the public in the mid-'90s, and has rapidly grown into a $2-billion-a-year industry. It is the most popular elective surgery in the United States, with more than 2.6 million Americans having undergone the procedure in the past six years. Lasik, which typically takes 10 to 15 minutes, involves a surgeon creating a corneal flap. The flap is then peeled back and a laser is used to reshape the cornea. Once the cornea is reshaped, light rays coming into the eye will properly focus on the retina for clear vision.

It's a process so routine that some patients are getting it done during a visit to the mall, sometimes paying substantially less than the $1 800 to $2 500 per eye that some of the larger, and perhaps more reputable, centres are charging.

"I don't think you want your eyes done on coupons," says Whitten, who performed Lasik on Tiger Woods in October 1999. "I also don't believe that excellent, well-trained doctors are going to put up with being paid $20 or $25 out of the $299 (per eye) some places are charging."

Trends develop quickly on tour, and when Woods validated the procedure, Lasik became the hot ticket.

Before laser eye surgery, Woods without contact lenses could barely see past his own shadow, and Bermuda grain was easier to read than the big "E" at the top of the eye chart. "He had what I call 'counting fingers vision,'" says Whitten. "He could only count my fingers a foot from his face."

Woods' post-Lasik vision is 20/15 without corrective lenses, and he says that the hole looks bigger and his ability to read greens has improved dramatically. Coincidence or not, Woods won the first five tour events he played after having the surgery. Then he won four consecutive majors beginning with the US Open in 2000. Now 21/2 years removed from the surgery, Woods says he's still happy as ever with his vision.

"I was apprehensive, just like anyone else would be when their vision is going to be altered," says Woods, who received $2 million to endorse the TLC Laser Eye Centres, "but I was prepared, because I researched everything, and I had a lot of faith in Dr Whitten." Today the list of Lasik patients includes US Open champion Retief Goosen, Scott Hoch, Jesper Parnevik, Vijay Singh, Hal Sutton, Lee Westwood and Mike Weir; LPGA stars Juli Inkster, Se Ri Pak and Laura Davies; and senior players Tom Kite and Hale Irwin.

Each of the tour pros we talked with expressed satisfaction with their post-Lasik vision, and it?s important to note that all of them had it done for free. Even players who had complications during and after the surgery say they have no regrets.

Paul Stankowski, a two-time winner on tour, suffered what's called a "flap complication" during his Lasik surgery, when the corneal cap of his eyeball became completely detached. "No big deal," says Stankowski, "They put a contact on overnight, and that's it. Took it off and my eye was fine."

Stankowski had merely become a statistic, representing the 1-in-5 000 nationally in the US who have a flap complication from this form of laser eye surgery. Today his vision is "perfect", and he no longer needs contact lenses.

"A lot of guys on tour have had it done, and nobody I know has had a problem," Stankowski says. "Now, I wouldn't recommend it to anybody who just wants to improve their golf game, because it's not going to make them any better, but I would recommend it to anyone who is tired of wearing glasses or contacts. I don't see any better now than I did with contacts. It's just easier without them."

Enhancements after the initial surgery Canadian Ian Leggatt, a first-time winner on the PGA Tour this season, also knows a thing or two about Lasik complications. Leggatt, who had extreme nearsightedness in both eyes before having the surgery in October 2000, says it was about a week after the initial procedure before he was seeing normally again. But by Christmas, he was experiencing chronically dry eyes and blurry vision, so he went back to his surgeon.

Enhancements, which are procedures performed after the initial surgery in an attempt to achieve better visual acuity, are necessary roughly five to 10 percent of the time, depending on the severity of the prescription. Most quality surgeons perform enhancements on three to eight percent of their patients, which means they're not trying to over-correct the first time and are willing to improve things down the road. "Enhancements have nothing to do with the procedure or with anything other than the healing properties of that person," Whitten says. "The more an eye has to be corrected, the harder it is to predict healing."

In Leggatt's case, healing was the biggest problem. After missing nine cuts in his first 12 events of 2001, he was sure he wasn't seeing as well as he had with contact lenses. By October, a year after his initial surgery, Leggatt's vision was blurry again, so in November he went in for a second enhancement that solved everything. "Obviously, I wish everything had turned out fine the first time, and that I wouldn't have needed the enhancements, but I'm seeing awesome today," says Leggatt. "It's not like I was ever going blind or anything."

According to Market Scope, the leading source of information on the refractive surgical market, there were 1.3 million Lasik procedures in the US in 2001, and there are about 1 200 laser centres across the nation. Because no one agrees on what exactly constitutes a complication, it's difficult to estimate the number of surgeries that don't go as planned. Although Lasik is marketed as a quick and painless way to improve your vision, websites like www.surgicaleyes.org and www.lasikdisaster.com include horror stories.

Richard Robinson, an attorney from Buffalo, New York, who handles malpractice, says Lasik lawsuits are on the rise. Robinson represented a client who won a $1.25 million judgment in 2000 after suffering a laceration extending through the cornea, iris and lens of the right eye during the procedure.

In Kentucky, a 38-year-old woman received $1.7 million after laser surgery left her legally blind in her left eye.

"If you turn on the radio or look in the newspaper, you'd think Lasik is the greatest thing since sliced bread," says Dr Don Teig, director of the Institute for Sports Vision in Ridgefield, Connecticut, and the vision consultant for the New York Yankees and New York Knicks sports teams.

In Teig's opinion, nine out of 10 people probably enjoy crisper vision with contact lenses than they will after Lasik surgery.

"Lasik sounds like a brilliant thing," says three-time major champion Ernie Els, who wears contact lenses and hasn't had the surgery. "But sometimes it might be better not to change the way you see things. People sometimes try to make things too perfect."

John Strege contributed to this report.

What everyone should know about Lasik

While Lasik laser eye surgery has improved vision and quality of life for most patients, including Tiger Woods and many other tour players, it's vital to note that the procedure is not a risk-free operation and might not be the best solution for your eyes. Dr Richard Leung, who practices in San Diego and performed Lasik surgery on 1987 US Open champion Scott Simpson, explains what to consider before having the procedure.

Is laser eye surgery for me?

Your eye doctor can help you determine whether you're a candidate for Lasik, but you should not have the procedure if:

You're not at least 18 years old.

Your prescription is changing.

You have unusually steep or thin corneas.

You have large pupils.

You're pregnant or nursing.

You're a slow healer.

Will it hurt?

There is very little discomfort during the procedure, because the cornea and eye are anesthetised by drops. Some patients experience increased dryness or scratchiness after surgery.

What are the risks?

Doctors have learned that about one in five patients experiences temporary side effects during the first few months after the surgery. In rare cases, some side effects can be permanent. Dr Leung finds that his patients understand the risks of Lasik surgery best when he breaks them down into the following three categories:

Side effects that may be temporary, such as glare, halos, light sensitivity, double vision, dry eyes and fluctuating vision.

Intraoperative complications, such as tears to the cornea.

Complications related to achieving the intended result, such as over-correction, under-correction or decreased near vision.

South Africa leads the way

South Africa is regarded as a world frontrunner in the field of Lasik laser eye surgery, being one of the first countries to conduct the procedure - as far back as 1994. Since its inception here it has grown to the stage where today there are 18 centres in our major cities where the procedure is performed.

The Optiklin Eye Clinic in Benoni is where Dr Danie Maritz became one of the first specialists to introduce Lasik surgery to South Africa.

"The results have been excellent," he says. "Taking into account the percentage (of South Africans) relative to the size of the population, we are probably on a par with the Americans. You also need to take into account that the Americans have a much more affluent society than us."

"Lasik eye surgery is functional surgery," explains ophthalmic surgeon Dr Frik Potgieter. "Just as you would use a crutch to assist you in walking if you had one leg shorter than the other, it works the same with vision: If you are able to make the leg longer by surgery, thereby enabling the person to walk normally, in the same sense we remove the 'crutch' of glasses or contact lenses by making people see normally."

Why then does everyone with eyesight problems not just have the surgery done? There are a few reasons, all to do with the core problem - money. Most medical aids still regard the surgery as cosmetic and, as a result, do not cover the costs unless patients and doctors can prove otherwise.

The average all-inclusive cost for the treatment of two eyes is approximately R10 000, although this can vary from centre to centre, depending on whether doctors are contracted out and whether they offer discounts for immediate payment. However, it is still cheaper to have the procedure done in South Africa than in the US. According to Dr Maritz, "quite a few foreigners come here for the surgery. But most of them have the procedure done while they are on holiday or business. They don't come exclusively for the surgery."

However, Dr Maritz believes that having the lasik surgery can save patients money in the long run. "The procedure is relatively expensive, but it would cost you the same as a new pair aof glasses every year for three years, and/or contact lenses over a three-year period."

Tiger's Op

Comment from a South African eye surgeon regarding Tiger Woods.

"I believe that although Tiger had Lasik performed, it was not the correct method of correction for him, since I believe he had a pre-operative refractive error of around -13 diopters. Nowadays, we only laser patients up to -8 or maximum -10 diopters, since there is much better technology available for the extreme cases compared to Lasik. I also believe that he (Woods) initially went to an eminent surgeon in the States, who refused to laser him, and then went to the doctor who performed the surgery."