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The eyes have it

Ted AlvarezVail, CO Colorado
Dawn Beacon/Vail Daily
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A mountain biker races down the first open singletrack.Whipping around curves and past boulders, the biker is exhilarated – she’s been waiting all mud season for this. And then, unexpectedly, a fleck of dirt flies into her eye and in the ensuing crash, she loses her contacts; or perhaps she does an end-over-end crash and smashes her glasses. All that matters now is that she’s out in the wild, blind as Stevie Wonder.For the visually impaired, heading outdoors can be a annoying at best and even dangerous at worst. Rain or any sort of precipitation or moisture can render glasses ineffective, and even the toughest specs can get bashed in the demanding rigors of the backcountry. Contacts help, but any extended time outdoors (camping, etc.) means a greater chance for dirt, bacteria or other assorted creepie-crawlies to make their way into your eyes.”We get people looking for outdoor solutions every day,” says Vail Vision lab manager Mathew Sherwood. “I’m the one who does a lot of the sport-specific consultations, and at this point in the season I get 20 questions a day about golf or kayaking.”Lasers, manThe most well-known solution for eye impairment beyond contacts or glasses is LASIK, or laser-assisted in sit keratomileusis. The treatment involves lifting back a corneal flap and using an excimer laser to remodel the corneal shape. The procedure is permanent.”We have people who come in every week who want to be able to ski, rock climb or water ski without the hassle of contacts or prescription goggles,” says Katie Homan, patient coordinator for the 20/20 Institute in Denver. The 20/20 Institute handles all optical procedures for the Colorado Avalanche, “We hear things all the time like ‘now I can actually see my golf ball land. 98 percent of people rank it in the top five events of their life, up there with childbirth and weddings – it’s that life-changing.”Locally, Vail Vision has seen plenty of athletes ready to take the plunge into LASIK.”Two to four (people) a month come interested in LASIK,” says Dr. Dan Giovagnoli of Vail Vision. “We have dealt with competitive skiers and mountain bikers, without a doubt.”

Some professional sports players have even used LASIK to go beyond perfect vision: Tiger Woods, for instance, had advanced LASIK surgery that brought his eyesight to a superhuman 20/15.”It’s not something we can necessarily do intentionally,” says Homan. “20/20 is the measure. We can determine your individual situation and that determines what we can do. Sometimes, they can go above.”Though LASIK operations typically get referred to Denver clinics, local outfits like Vail Vision handle the pre- and post-op preparations.”LASIK is the big dog in terms of corrective surgeries – 99 out of 100 people (looking for surgical solutions) ask about LASIK,” says Sherwood. “There are very few drawbacks – there’s a very low complication rate, and that number is getting smaller all the time. But not everyone’s cornea can handle that, so it’s very important to discover whether you are a proper candidate first.”After Sherwood asks preliminary questions, Giovagnoli or another optometrist typically performs a full examination to determine several important factors in a patient’s candidacy for LASIK surgery.”If your prescription is unstable or changes too often, or if your prescription is too high or too low, you might be disqualified as a good candidate,” says Giovagnoli. “You want your eyes to stabilize out so that there hasn’t been a change in prescription for 12 to 24 months. Often, this hasn’t happened in folks under 26. And there are some corneas that are too thin to safely do the procedure – maybe 5-10 percent can’t have it done, and I’m one of them.”Though satisfaction rates remain high and complication rates are getting lower, the idea of optical surgery can freak out even enthusiastic LASIK candidates. If the procedure isn’t scary, the coast can be: LASIK surgery can cost thousands of dollars per eye, and it’s rarely covered by insurance. LASIK fees at he 20/20 Institute start at $995 per eye.”Obviously it’s a big commitment financially, and it’s a scary procedure,” says Giovagnoli. “You’re always going to be quite nervous, or at least I would be. One of the biggest annoyances has been glare issues at night. But newer lasers do much better work, and you hardly hear people complaining about it anymore.”Other options

If laser beams near your eyes still makes you squeamish, there are a few new and emerging technologies on the horizon that provide LASIK-like results without the permanency.Intrastromal corneal rings are small acrylic rings implanted in the eye to correct vision, like permanent contacts. Unlike LASIK, the rings can be removed if there are complications or replaced with new rings if the amount of correction needed changes.”I know the FDA was in preliminary trials, and I would be interested in it because it’s reversible and doesn’t interfere with the part of the eye you look through,” says Sherwood.Homan insists that intracorneal stromal rings might not provide the same benefits as LASIK surgery.”It’s not as beneficial as traditional LASIK, especially if they’re looking to increase distance power,” Homan says. “Intracorneal rings are better suited for near and far correction for people between the ages of 55 and 65.”Another new procedure involves orthokeratology, wherein users wear a rigid contact lens only at night. The pressure of the eyelid on the hard contact reshapes the cornea, so when the contacts re removed in the morning, the wearer maintains corrected vision for 24 hours or more.”I have not had anybody that’s done that here, but there are a few practitioners in Denver,” says Giovagnoli. “It’s not easy – you have to wear a hard contact lens in the evening and it’s a little uncomfortable. But it works well for low powers.”Good ol’ glassesEven as new technologies develop in eye care, the same technologies are being used to advance old-fashioned glasses and contacts, which, when in doubt, still might be the safest methods for vision correction.



“For people who are really active campers or hunters and spend many nights outdoors, they have new contacts that breathe so well they are safe to sleep in for extended periods of time,” Giovagnoli says. “Some of them are FDA-approved to be slept in for a month, so you could easily camp for a week without having to take them out. That’s something we’re doing more of.”If a patient’s eyes are too dry to handle contacts and they’re not good candidates for LASIK, custom glasses are becoming increasingly advanced and less like the frog-goggles of yesteryear.”Now for glasses there’s lots of different options – they have wraparound prescription sunglasses and even ski goggles dialed in beautifully,” Giovagnoli says.Sherwood specializes in custom-building prescription eyepieces, and he says even the most demanding designs can be made prescription and tough enough for the outdoors.”In a town like Vail, people are going to throw money at you to make the impossible happen,” Sherwood says. “I once prescription-built a pair of Oakley’s that were in the one-big-lens, shield style. The customer insisted on having that frame, so we had to have two lenses come together with the slightest of seams, and it was pretty ridiculous.””Even my guys at Oakley were stunned.”Arts & Entertainment writer Ted Alvarez can be reached at 748-2939 or talvarez@vaildaily.com.Vail Daily, Vail, Colorado


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