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The eyes have it

The eyes have it
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First Published: Tue, Feb 20 2007. 12 33 AM IST
Updated: Tue, Feb 20 2007. 12 33 AM IST
Actors, models, those who aspire for a career in the armed forces, railways or police corps and professional sportsmen…until recently these have been the usual suspects for corrective eye surgery.
Ophthalmologists across the country now report that more and more young professionals from very diverse backgrounds—maintenance engineers, software programmers, bankers, Art of Living instructors, painters and even singers, are today opting for a Laser Assisted In Situ Keratomileus (Lasik) procedure so that they can rid themselves of their glasses. The aim: to boost their careers or enhance lifestyles. In some cases, it’s a simple cost–benefit analysis vis-á-vis glasses or contact lenses that turns out to be the deciding factor! And no, it is not the glamour set or the well-heeled that are crowding the Lasik clinics but the working middle class. “To be frank, the upper class and the rich and famous are quite comfortable with glasses and contact lenses—it’s the middle income group that is opting more for the procedures,” says cornea specialist Dr Umang Mathur, who is also associate medical director, at Dr Shroff’s Charity Eye Hospital (SCEH) at Daryanganj in Delhi.
“I have had singers and Art of Living instructors opting for the procedure as they say they need to make better eye contact with their audience,” says Vadodara-based Dr Rupal Shah, who has a thriving practice in Ahmedabad and Mumbai as well.
Among those who have recently walked into Shah’s New Vision Laser Centre are maintenance engineers from Reliance who have been nudged by their employers to undergo Lasik as it reduces risks on the shop floors, bankers, software professionals and pilots who don’t want to contemplate retirement just yet. “About 10% of those who come into our clinics do so for career enhancement,” says Rupal’s husband Samir Shah, who is director at the Centre.
“Recently, I have had photo journalists coming in for the procedure,” says Dr Mahipal Sachdev, chairman and medical director, Centre for Sight, Delhi. “The perception that it is a cosmetic surgery is slowly but surely changing,” says Dr Sanjay Dhawan, senior eye surgeon at Max Eye Care centre in Delhi, who points out that a number of men—midlevel executives with big disposable incomes—are increasingly opting for the procedure. SCEH’s Dr Mathur confirms that 40% of the cases he takes on in the 30-40 age group are men.
A typical case is Mandeep, who works for one of India’s biggest software firms, who underwent the procedure as he felt ridding himself of his glasses would help in some of his afterwork interests—driving and swimming. The fact that his company picked up the tab was an added incentive. “Many banks and manufacturing firms in Gujarat are reimbursing part, if not the whole cost of the procedure,” says Shah.
It’s about 10 years since the Lasik procedure was officially approved in the US. In India, the technology has been available for the last seven or eight years but it’s really in the last one year that there’s been a quantum jump in volumes. Samir Shah says there is a 40% surge in volumes (they do about 2,500 surgeries a year in Vadodara, 1,500 in Mumbai and 1,800 in Ahmedabad). In Mumbai, he says, he has seen four new centres come up near their clinic in the last year. In Delhi, which has 25-30 centres and the highest density of machines, SCEH reports a 20% surge over last year. It’s not as though prices have come down—rather they have gone up by about Rs2,000 or so—but still volumes are going up.
If hospitals and eye clinics are pushing the procedure aggressively—at investments of around Rs3 crore, the expensive laser machines cannot afford to be idle—the huge technological leaps in the procedure, which is now safe and easy, has also helped fence-sitters take the plunge. From the early days of photorefractive keratectomy (PRK) where some amount of the scraping off of corneal tissue was involved, to the latest Allegretto Wave PerfectPulse (built by Wavelight) or Zyoptix Aspheric (built by Bausch & Lomb), which even fix complaints like halos, glares and night vision, there has been rapid progress in the field.
Basically, earlier the laser technique used to flatten out the cornea but now eye tissue is reshaped in a smooth, consistent manner, keeping the curvature intact as far as possible, as this provides the very best results. The flaps used are also getting more thin.
Can you get it done too?
Are you one those fence-sitters who are itching to get rid of your glasses but plagued by doubts because it involves surgery? Here are some facts that could help you decide one way or the other.
This is the most basic question. Well, a round of the eye clinics and talking to a host of patients who have had it done is reassuring on that count. The procedure itself is harmless. But, of course, you have to place yourself in the right hands. Make sure you get it done at a centre where the machines are new, where disposable heads are used, and the doctor’s credentials are impeccable. The quest for cheap packages can backfire with disastrous results.
Abroad, especially in the US, there are issues of optometrists doing the procedure as opposed to trained eye surgeons, as anything to do with dispensing glasses or contact lenses is seen as an optometrist’s beat. But in India, it is still very much a surgeon’s preserve.
This varies from centre to centre, but on an average, the standard Lasik costs Rs18,000 to Rs20,000 while customized (or Zyoptix) Lasik costs Rs32,000-36,000 for both eyes. That’s the cost of six years of contact lens use!
Not surprisingly a huge number of NRIs and foreigners are making a beeline for India to get the procedure done (rates in the US are equivalent of Rs2 lakh and on lower generation machines compared with India.)
The procedure is not covered by any insurance company, although several have begun picking up the tab and there are promotional offers through strategic tie-ups between, say a Bausch & Lomb and a corporate, that occasionally hit the market.
Which procedure?
Given the cost differential between standard and customized Lasik, which one do you go for? Here, there is some difference of opinion. Dr Mathur feels that the standard one works in most cases as well as the latest procedure, though there are others who insist that if you can afford it, it is better to go for the newer technology as niggling problems like glares, etc. could be better taken care of.
Interestingly, the armed forces insist that its corps go for the old PRK technique. That’s because in the newer versions, there’s a flap put over the cornea, which in a high impact collision could fall off. On that same principle, Dr Mathur suggests that those involved in physical contact sports, should opt for PRK. Though the PRK takes more time to heal, “in the long run, it might be safer for those in contact sports,” says Dr Mathur.
Interestingly, the Shahs charge the same amount for both procedures. “Some companies charge a commission on each use of the machine, which is why many Delhi centres have a cost differential, but on our Karl Zeiss machines, there is no commission, hence we go with the procedure we feel is more suitable for the patient and charge the same amount,” explains Shah.
Is it permanent?
This is often tricky ground. Because, while the effects of Lasik itself are permanent, the eye is constantly changing. As of now, the procedure can treat either short sight or long sight but not both together. Hence, if you are in your late 30s and want to get rid of your myopic vision problem, chances are that by 40 you will still get reading glasses. (See story on Presbyopia)
There could also be other changes in the eye—maybe due to hormonal imbalances—that could cause problems. However, doctors say there are enhancement procedures that can easily address the issue.
But before all this comes the big question: are you eligible at all for the procedure? If you are above 18, and have had stable vision for a couple of years, with no glaucoma, keratoconus or cataract, then you can consider it. But doctors will still screen your corneal thickness. Only those with corneal thickness above 500 microns are eligible for the procedure and there’s a 20 to 30% rejection rate at the good clinics.
However, many of the rejected candidates simply go elsewhere, to less conservative doctors who are willing to leave behind lesser tissue. (The rule is that at least 250 microns have to be left behind and the conservative doctors will take on those cases with 750 micron thickness as they want to leave behind more tissue).
And finally comes the question that you must ask yourself—why do you need the surgery—is it out of mere vanity (in which case you should think again because any surgical procedure has obvious risks such as infection); or do you feel it will improve your lifestyle, or aid you in your work. Dr Dhawan encourages those with afterwork interests like sports and swimming to go for it. “Take the case of someone who has to use crutches permanently—if surgery can offer him a chance to walk normally again, he won’t need to think twice,” he says.
Write to us at businessoflife@livemint.com
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First Published: Tue, Feb 20 2007. 12 33 AM IST
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