Small incision to improve sight

A more permanent solution for vision: implanting lenses

December 27, 2010

It's all in the eyeball.

That's where Dr. John Berdahl does his best work. He's part of a team of Sioux Falls surgeons who use a growing assortment of procedures to help patients regain the sharp vision they once enjoyed.

He works with Dr. Vance Thompson and other specialists at Vance Thompson Vision, a clinic under Sanford Health. Most of their work, 80 percent or more, is laser surgery to reshape the cornea. But now a growing share is implanting contact lenses, a more complex process catching on as another option in vision care.

"These lenses have been around four or five years. Most people don't know about them," Berdahl said.

The health industry sees both laser and implant procedures as elective. Insurance programs generally don't cover them, Berdahl said.

The Thompson clinic does one or two procedures a week, about 100 a year, Berdahl said. The Lasik laser procedure costs $2,500 per eye in an outpatient setting at the clinic with an eyedrop for a local pain killer. The other procedures can cost up to $4,500 per eye in an operating room with anesthesia.

The process moves eye work one step closer to the brain.

While glasses sit a half-inch from the eyeballs and traditional contact lenses sit on the surface of the eye, these procedures cut into the flesh. The Lasik uses a cold laser stream to reshape the cornea, the outer surface of the eye. Now comes the implant procedure, requiring a cut into the eye to insert a tiny lens in front of the iris.

Thompson, a pioneer in this treatment, testified before federal officials in 2004 on the value of this method. The newer implant process requires a cut farther back in the eyeball and dropping the contact behind the iris.

The end result in each case is to help the eye convey light to the retina at the back wall of the eye socket, allowing light to send accurate images by way of the optic nerve to the brain.

"The whole reason we're doing this is to focus the the light in the right place so vision is clear," Berdahl said.

The process has its skeptics and its converts.

No regrets about 30-second procedure

Kim Otten, a Sioux Falls architect, was in his early 40s when he reluctantly agreed to let Thompson do surgery.

Otten had worn glasses since age 12 and never moved to contacts.

"I didn't like the idea of poking myself in the eye every morning," he said.

The thought of someone cutting into his eyes made him all the more squeamish until a change in health coverage made him think it over.

"Our insurance company was covering the procedure, but it was not going to be a continuing benefit. I decided to go ahead and have it done and got it in under the wire. I never pursued it until they said the opportunity was going away."

Otten, now 52, has no regrets. He had one follow-up with Thompson a few weeks after the surgery, but he hasn't needed help in the years since. To him, the event was like a brief trip to the dentist with the cutting shorter still.

"It took about 30 seconds," Otten said.

Natural eye tension holds lens in place

Amber Brennan, 26, an ophthalmic assistant to Berdahl, wasn't a candidate for reshaping the cornea, so she had the lens implants in November. Her new lenses are behind the cornea and in front of the iris.

The lenses are oblong, about 13 millimeters, with tiny holes on each end. The natural tissue grows through the holes to hook the artificial lenses in place. She also has microsutures of nylon to seal the incision.

"It's more comfortable than when I had contact lenses in my eyes," she said.

Dr. Alison Tendler, another surgeon at the clinic, had the procedure with lenses inserted behind the iris. The natural tension in the eye holds her lenses in place.

Another process goes deeper still. It removes the natural lens behind the iris to insert an artificial lens in its place. The process is similar to cataract surgery to remove a cloudy lens.

Berdahl said the procedure doesn't replace routine eye care, but called it "a permanent fix until you develop cataracts later in life."

"In 10 years, I'll need reading glasses," said Tendler, who's 35. "But this is a bonus. Everybody will have to deal with the issue of an aging eye."

Reach reporter Jon Walker at 331-2206 or 800-530-6397.