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Chat transcript: Dr. Douglas Koch on eye health

Baylor Laser Vision Center - Douglas D. Koch, M.D.

(CNN) -- The following is an edited transcript of a chat with Dr. Douglas Koch of the Cullen Eye Institute and professor of ophthalmology at Baylor College of Medicine. Koch joined us August 23, 1999, from Houston, Texas.

Chat Moderator: Welcome to the first of our weeklong series of Health Chats on eyesight procedures and the future. Today's guest, Dr. Douglas Koch, is here to discuss an overview of eye care.

Chat Moderator: Welcome, Dr. Douglas Koch!

Dr. Koch: Hello, everyone!

Chat Moderator: Dr. Koch is joining us today from Houston, Texas.

Chat Moderator: With all these surgical options, advocates say it's only a matter of time before eyeglasses and contact lenses go the way of the manual typewriter. Do you agree?

Dr. Koch: There will probably be a need for glasses and contact lenses for many years to come. The new procedures to correct refractive errors of the eye are not perfect and certainly are not for everyone, although they are doing wonders for large numbers of people.

Question from Terrie: What's being done in the area of macular degeneration for young adults?

Dr. Koch: Fortunately, macular degeneration rarely affects young adults, and often it is genetically different than the type that affects older adults. We need more work to understand the basic mechanisms of these various types. For now, it is felt that a healthy diet, antioxidants, a multivitamin a day and foods such as leafy green vegetables might be somewhat protective. Lots more to be learned on this, however. It would be wise for young and old alike to take good care of themselves, as these diseases develop over decades.

Question from Daphne: Dr. Koch, can farsightedness be treated by surgery? How bad does farsightedness and astigmatism have to be before surgery cannot be considered?

Dr. Koch: Farsightedness can be treated with the excimer laser using LASIK or PRK. The Food and Drug Administration (FDA) has not yet approved the treatment of both farsightedness and astigmatism, but this is anticipated late this year. The amount to be treated is around 4 diopters. New treatments for higher amounts of farsightedness are under study in the United States and internationally.

Question from JAY: Is there anything that can be done so an optic nerve drusen won't narrow your field of vision?

Dr. Koch: As far as I know, there are no known preventative treatments for optic nerve drusen. These do not cause significant problems for most who have them, but in rare instances they can cause loss of field of vision.

Chat Moderator: Do you have any knowledge about how Americans treat their eyes vs. other countries? For example, do we jump on things that are new more than people in other areas of the world?

Dr. Koch: Because of our FDA, we in the USA are actually often behind those outside the USA in how soon new technologies are available to us. It seems surprising, but my international colleagues sometimes call us a Third World country when it comes to getting access to new devices.

The FDA is trying to change this. One advantage is that risky procedures might not be introduced too soon here, but it also keeps us well behind and is extremely frustrating to physicians who want to offer the newest and best to their patients.

Question from Ell: How important is pupil size in relation to low nearsightedness and astigmatism, i.e., under -4 and under -2 astigmatism?

Dr. Koch: Pupil size is important in selecting patients for LASIK primarily when the amount of nearsightedness exceeds -5 or the astigmatism exceeds around -1.5 or -2.0. The laser corrects only a certain zone in the center of the cornea. If the pupil is much larger than this zone, then one can have glare and halos, especially at night.

Question from Cathy: What first interested you in ophthalmology?

Dr. Koch: I fell in love with this field because of the importance of vision in our lives. Also, I was fascinated that we can see so much of the eye when we examine our patients. This is unique to only a few areas in medicine. Also, the eye is such a beautiful and complex structure.

Question from Ell: Do you feel that any one laser provides better results, i.e., VISX, NIDEK?

Dr. Koch: No one has done studies that truly compare the different lasers. We use both the NIDEK and the VISX and like them both. Each may have certain advantages in certain types of patients. In the future, new technology will even surpass the superb results that these lasers give us. However, the results today for the right patient treated well are superb.

Question from Cathy: What are ways we can keep our vision from getting worse?

Dr. Koch: Good question! Lots of parts to this answer: Get an eye exam every three to five years if under age 40 and fully healthy with no eye problems or family history of eye problems.

Over 40, exams are indicated every two to three years; over 60, every one to two years. Pearls to consider: Eat a healthy diet, don't smoke, wear eye protection if at risk of being struck in the eye.

Question from JAY: Are these new retinal scanning identification technologies safe?

Dr. Koch: They appear to be very safe, although we are still understanding how to use them and when or if they are helpful.

Question from mike0000: I have severe nearsightedness (-8 diopter). Am I still a candidate for correction?

Dr. Koch: For nearsightedness greater than -8 diopters, LASIK can be performed if one's pupil is small enough (less than 8 mm) and if the cornea is thick enough. If not, in the future we will have options to place lens implants in the eye, and new techniques are under study.

Question from SusanS: What are the risks involved with these procedures? Can one's vision be worse after than before?

Dr. Koch: The risk of losing vision is 1 percent or less, and the risk of losing a lot of vision is probably much less than 1 in 10,000. We must remember that this is still surgery, and we cannot give guarantees, even though the overall results are wonderful.

Question from JAY: Some of these elective eye procedures seem to be very lucrative for the doctors. Isn't there a conflict if some people are going blind while doctors make millions?

Dr. Koch: It does seem that way, I suppose. The vast majority of those who do these procedures feel that they are truly helping people. Many of us donate many hours and dollars to causes to eradicate world blindness. Shouldn't you ask the same question of anyone who makes a good living?

Chat Moderator: Any final comments for us?

Dr. Koch: Just to say that eye health depends upon each of us. A healthy lifestyle, regular exams and eye protection are critical. If considering elective eye (or any other type) surgery, be cautious; ask questions of your own family physician, seek second opinions, and ask your prospective surgeon (whom you should meet before surgery) your tough questions.

Chat Moderator: Thank you, Dr. Douglas Koch, for joining us today to give us an overview of eye care today.

Dr. Koch: Goodbye, and thanks for the great questions.

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