HEALTHY EYES: REFRACTIVE EYE SURGERY IN UNITED STATES
The new surgical procedure for curing nearsightedness involving tiny multiple incisions on the cornea which was developed by Soviet Dr. S.N. Fyodorov did not win acceptance in the United States with the speed of vodka. Early in 1976, Dr. Leo D. Bores visited Dr. Fyodorov to study the surgeon's lens implant technique and was amazed at the results he was getting for the correction of myopia.
Dr. Bores describes what he witnessed this way: "My initial reaction was one of disbelief. A reaction that I'm sure everyone experiences when first exposed to this procedure. After all - it seemed rather a bizarre solution to the "eyeglass problem." In addition, I was familiar with Sato's work. It hadn't worked for Sato, why should it work for Fyodorov? Could this be another Russian reinvention?"
But Drs. Bores and Fyodorov became fast friends. They spoke together "heart to heart" (in Russian that's "dusha-dusha"). "Therefore, when he explained this procedure to me," Dr. Bores continued, "I was disposed to believe him, despite my misgivings. I was allowed to examine the patients without interference. They all had vision ranging from 20/15 to 20/30 unaided [after undergoing RK (radial keratotomy)]. My examination of records showed that pre-operatively they all had 20/100 vision or less unaided. And if the records were correct, there was no question that their corneas had become flatter as a consequence of the surgery."
Dr. Bores then examined the next group of patients before they underwent RK. He observed the surgeries. His examination of them postoperatively indicated undoubtedly that their corneas had become flatter. Next, Dr. Fyodorov suggested that Dr. Bores try his hand at accomplishing the correction for patients. The following day they did six cases together. One eye of each patient was corrected. A week later the other eye was done for the same six people.
"In each case, flattening occurred and the myopia vanished," said Dr. Bores. Furthermore the patients that I had examined the previous week had returned and were examined again. They were still flat. Needless to say, I was impressed; I was also scared because if this operation really worked, it should be introduced into the United States. The potential of this procedure was enormous."
Because of fear of colleague criticism of RK saying it was too risky, too variable, too unpredictable, and wouldn't last, Dr. Bores held off its performance in this country. Dr. Fyodorov visited Detroit, in the fall of 1976 to give a lecture at the Kresge Eye Institute on the topic of RK. The physician response was polite but indifferent.
Dr. Bores later returned to Moscow with a retinue of other American eye surgeons, in May 1977. He again examined the patients upon which he had operated the year before. They were all still seeing well without visual aids. He also examined the records of some of the earlier cases performed at the Moscow Scientific Research Laboratory of Experimental Eye Surgery. There were no regressions, no infections, no dystrophic changes. "Now," said Fyodorov, "You will do?"
Bores didn't "do" because of continuing anxiety about peer review. The influences of American medical schools and the hospital residency system of medical teaching tend to remove physicians' personal creativity. It represses the physician's inclination to accept any innovation without great resistance. Most doctors usually follow the state medical society's party line which scoffs at something new unless it undergoes "double-blind testing" or randomized studies. Innovation gets discouraged.
But when Fyodorov showed Bores, in the spring of 1978, records of the patients upon which the American had performed surgery two years before, the Russian couldn't be denied. Bores' Russian patients' excellent and sustained results coupled with the proof of good effects of four years of follow-ups on almost two hundred others did it. "I had to get off dead center," declared Leo Bores, M.D.
In November 1978, on a 34-year-old American woman, Dr. Bores performed the first radial keratotomy in the United States. Two weeks later he corrected the woman's other eye. In January 1979, he presented the patient at Grand Rounds of his hospital and showed a film of the technique that had been produced while he had been performing the surgery. Dr. Bores also laid before his colleagues all of the existing Russian data about RK. Their response? ZERO! The one question asked by his colleagues was, "Isn't this the Sato procedure?"
Deciding to do his own thing, Bores set aside his anxiety about colleague criticism and performed RK on any patients whom he believed would benefit from the procedure and who asked for it. He constructed a protocol for other ophthalmologists to follow and set up the framework for a national study. In a copyrighted course that he created, Bores taught the operation to other eye surgeons. For example, William D. Myers, M.D. of Southfield, Michigan, Assistant Clinical Professor of Ophthalmology, Michigan State University, Lansing, learned from Bores and, in turn, taught RK to Ronald A. Schachar, M.D., Ph.D., Director of the Texoma Eye Institute of Denison, Texas, and his brother Les Schachar,
M.D., Director, Eye Clinic at nearby Gainesville, Texas The four have performed some 3000 radial keratotomies to correct nearsighted eyes.
*53/127/5*
GENERAL HEALTH
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