Under the laser instead of the blade

Gilda Arriola waited, seated comfortably in a light blue recliner at the Northwest Eye Surgeons clinic in Northgate, a cup-shaped patch over her left eye.

It was early on a Wednesday morning. Her eye was numbed and prepped for surgery.

Arriola, 49, suffered from a genetic disorder that created spots on her cornea. Her only option to regain sight was a cornea transplant.

But while cornea transplants aren't new, laser technology originally created to dismantle nuclear weapons is now carefully and precisely shaping donor and recipient corneas before transplant. IntraLase-Enabled Keratoplasty (IEK) was first used in LASIK surgery, but now is also being used for cornea transplants.

		MIKE KANE / P-I
	Dr. Audrey Talley-Rostov performs an IntraLase-Enabled Keratoplasty on Gilda Arriola's left eye recently at Northwest Outpatient Medical Center in Seattle.

Traditional surgery uses a surgical blade. It cuts straight, vertical edges in the cornea, which is about as thick as a credit card. The IEK laser technology slices the cornea of both the patient and the replacement so that the pieces interlock something like a jigsaw puzzle, strengthening the attachment. Healing is estimated to be nearly twice as fast.

"This is probably one of the most exciting things I've seen in corneal transplantation in years," said Dr. Audrey Talley-Rostov, an ophthalmologist with Northwest Hospital and Medical Center.

Few eye surgeons in the area are quite so sure that the procedure, which is more expensive, has proved more effective. Talley-Rostov said she is the only ophthalmologist in Seattle using the technology.

"It can take up to a year to achieve functional vision with the blade," she said. "With this, you can get glasses in three to six weeks. It's amazing."

IntraLase works with SightLife, a Seattle-based eye bank founded by the Northwest Lions Foundation, to customize the cornea for each patient.

SightLife, one of the largest eye banks in the U.S., provided more than 2,800 corneas for transplant in 2007. It provides all of the corneal tissue used in Washington, northern Idaho, Montana and Alaska.

SightLife can prepare and cut the donor tissue with laser precision using the same design Talley-Rostov uses to remove the patient's defective cornea.

But that's also a limitation. For the custom corneas to work, both sides must have the laser. Not every eye clinic or cornea donor facility can afford the $400,000 laser.

Plus, the extra $2,000 it costs for a transplant using the technology (a standard cornea transplant costs about $9,000) isn't covered by insurance. Patients must be willing and able to pay the extra cost.

"The jury is still out on if this is going to be a major improvement," said Dr. Harry Geggel, a corneal specialist and head of ophthalmology at Virginia Mason Medical Center.

He said there has been only one long-term study about patient results after the sutures were removed, which, he said, is when it's really known how effective the surgery was. The study showed that the new procedure wasn't better than the standard.

"We'll find out over the next two or three years if this is really better," he said. "If it's the same results in the same amount of time, then it's just another way of doing a cornea transplant."

Dr. Walter Rotkis, a corneal surgeon at Swedish Medical Center, said while the concept of IntraLase is intriguing, he is cautiously optimistic and patients should be cautious, too.

"Being first is never a good idea -- whatever the technology, you have to work out the kinks," Rotkis said. "The eye bank is marketing this, and I'm more old-school. You don't have that kind of press release until you have more experience under your belt."

Lisa Davis, 40, can compare the two surgeries firsthand. She had her left cornea replaced the traditional way in November 2006. In December, she became one of the earliest Seattle patients to undergo the IEK procedure when her right cornea was replaced by Talley-Rostov.

More than a decade ago, Davis was diagnosed with a condition that gave her nearly kaleidoscopic vision by distorting her normally round eyeballs into the shape of footballs.

First, she said, the December surgery took half as long as in 2006, and then recovery was much faster.

It took a year for her left eye to heal enough for glasses after the 2006 surgery, but this time after three weeks, she was wearing a contact lens in her right eye.

"It's been a huge difference to be able to see that much sooner," Davis said. "It was less painful, and I'm healing better. I wake up in the morning and see the clock. All these things you take for granted."

Arriola's transplant also was a success. She will be back in six months for the same surgery on her right eye. The day after surgery, although there was some discomfort, and sunlight hurt her eye, Arriola was looking forward to a speedy recovery.

"To be one of the first ones to go through this surgery is great," said Arriola's daughter, Cindy. "It will shorten the time she recovers. The sooner the better, we say."