Vision correction research question.

[twentytwenty]

I am trying to look at the vision correction technology from a purely problem solving point of view and have come up with the following observation.

Near and far sightedness are caused by an irregularly shaped eye-ball. Too long for nearsightedness and too short for farsightedness.

Astigmatism is caused by irregularly shaped corneas.

Modern vision correction techniques all focus around reshaping the cornea. Now that makes sense as far as correcting astigmatism goes. But for near or far sightedness it doesnt fix the actual cause of the problem, i.e. irregularly shaped eye-ball.

Trying to do a google search on any kind of surgical eye reshaping technique didnt come up with any meaningful results.

My questions are: do such techniques exist? is any research being done in that direction?

Thanks,
Paul

[John C Hagan III, MD, FACS]

Your theory and conclusion are both wrong. Use Google search and look up myopia, hyperopia, astigmatism, look at diagrams. All refractive procedures done on the outside of the eye work by making the cornea flatter to correct myopia, steeper to correct hyperopia or round out the shape of the cornea to correct astigmatism.

JCH III  MD

[twentytwenty]

I think you misunderstood my question. I am aware of corneal re-shaping. But the way I understand it, it doesnt actually correct the original problem of non-spherical eye.

The way I see it, a refractive procedure changes the shape of the cornea so that the light is focused on the retina.

But doesnt actually change the shape of the 'back' of the eye which is the cause for the refractive error in the 1st place?

For example a person with myopia has elongated eye and normally shaped cornea.

After refractive surgery the eye is still elongated but the cornea has been flattened to correct the error. So in fact the eye now has 2 refractive errors that correct each other resulting in good vision.

What I am asking is that is there any research done to correct the actual shape of the myopic eyeball to make its overall shape the same as that of a person with normal vision? Could some internal pressure be applied to the eye to bring the retina forward for example?

[John C Hagan III, MD, FACS]

Your concept is flawed. The eye is never spherical, if it was it would look like a golfball.

And the answer to your last questions is "no" and "no".

JCH III MD

[rap]

I'm surprised that there is no apparent research into reshaping the eye-ball, to correct for the myopia, etc...does anyone else have any leads on this?

Thanks

[twentytwenty]

There are a lot of very simplified diagrams out there. Most of them have a picture of a perfectly round eye-ball showing the image focusing on the retina labeled "normal vision" and then a picture of an elongated one showing the image focusing in front of the retina labeled "myopia".

It is easy to be misled.

I did some more reading and can see now that refractive error can be caused by many other factors, such as misshapen cornea, ciliary muscle spasms, misshapen lense, etc...

However when I went to my eye doctor all he gave me was a prescription to correct my vision, but didn't actually diagnose what causes the refractive error in my specific case. Are there any existing tests to determine that?

[John C Hagan III, MD, FACS]

I have never seen a diagram of the eye that is "perfectly round"  go back and look again.

The posterior chamber of the eye enclosed by the sclera is larger than the anterior segment and has a longer radius and a flatter radius of curviture. The anterior chamber is only part of a smaller circule whose radius of curviture would be the cornea. It has a shorter radius and steeper radius of curviture.
So the eye is really like a small circle sticking out of a large circle.

There are no clinical test indicated to determine why you are near sighted, far sighted or astigmatic. The important tests are to determine what type of glasses or contact you need to see good.

JCH III MD

[twentytwenty]

I've been learning a lot about eye diseases and treatments. Sadly the prevailing attitude seems to be as you mentioned to direct all research into solving the cause and not the problem. For some reason nearsigntedness, farsightedness or astigmatism are not regarded in the same league as other illnesses. And most doctors think that prescribing glasses is enough.

Unfortunately in a case of someone who is a firefighter that is not an acceptable solution.

Contacts or glasses can not be worn since they are easily knocked off or get fogged up.

Refractive surgery is not an option because of potential dry eyes or night vision problems.

Ortho-k lense wear seems to be moving in the right direction, but unfortunately it doesnt guarantee you perfrect vision between the periods of wearing them. Not to mention the fact that you are still restricted when you do wear them.

I really hope medical community changes its attitude towards refractive error treatment and puts some effort into research on how to diagnose and solve the problem at its root...

[John C Hagan III, MD, FACS]

Let me leave you with this final thought. In the last 10-15 years more money and time have been spent on correcting refractive errors than on any other type of eye problem, the surgery (lasik, lasek, PPK, corneal rings, CK, etc) have been one of the major triumps of modern surgery.

I have at least 20 fire-fighters in my practice that have had lasik and are totally happy, also any number of military and civialian pilots, police, US Marshals.

Your best bet is to look into lasik.  And your understanding of what the medical comminity has done, is doing and will be doing in the near future is totally in error.

Having said that let me thank you for your work as a firefighter. I'm writing this from Sun Valley Idaho where the town was liteerally saved by firefighters that stopped the forrest fire at the city limits.

JCH III MD

[twentytwenty]

I would like to express a final thought as well.

Finding the cause of a problem usually leads to the solution. Even if in the beginning it is just gathering of statistical data.

But how can you even begin to look for a solution if as you said no clinical tests exist to determine exactly why a person is nearsighted, far sighted or astigmatic?

That just doesnt make sense to my simple uneducated brain :)

But I totally appreciate the money and time that has been spent on correcting of refractive errors and am very thankful for it.