The Eyes Have It : LASIK

Roughly 70 million Americans, one out of every four, have myopia, or near-sightedness that makes them dependent on eye-glasses or contact lenses. Increasing numbers of professional singers are paying $4,000-$5,000 for a five-minute, pain-free out-patient laser procedure that can improve vision dramatically. Laser-assisted in-situ-keratomileusis, or LASIK (pronounced like basic), has proven effective in eliminating or greatly reducing the need for corrective lenses in hundreds of thousands of patients. Studies claim that after LASIK, many have 20/20 vision and 98% of individuals have at least 20/40 vision, good enough to pass a drivers license eye exam without glasses. Among those singing the praise of the new laser surgery is performer Diana Cline, who previously had radial keratotomy surgery (RK) “The RK did ok,” says the actress/singer, “but the LASIK completely corrected my nearsightedness. I would definitely recommend this procedure, especially in our line of work.”

Refractive surgery reduces the amount of nearsightedness by flattening the cornea, the clear outer cover of the eye. Unlike the older, painful, radial keratotomy (RK) procedure popular in the 1980s, LASIK and PRK (photorefractive keratectomy) use lasers, instead of scalpels to reshape the cornea. While the final visual results are similar with either PRK or LASIK, LASIK is quickly becoming the procedure of choice for patient comfort, speed of recovery, and the ability to correct moderate to extreme amounts of myopia and astigmatism. There are highly detailed explanations of the LASIK surgical procedure on hundreds of websites (search: LASIK), but, very simply, a layer of the cornea thinner than a human hair, is lifted up as an instrument called a microkeratome glides across the cornea. Then, for less than 60 seconds, ultraviolet light and high-energy pulses from a “cool” excimer laser reshape the internal cornea. The cornea flap is replaced in its original position, with no stitches required. The patient wears a protective, clear eye guard and rests for the remainder of the day. Patients resume most normal activities the following day, wearing the eye guard for one week, only when sleeping. Surgeons commonly do both eyes on the same day, but some ophthalmologists recommend scheduling separate surgeries a week or more apart to yield the best results.

There are some practical, short-term considerations for singers before and after surgery: Singers who depend on contact lenses will have to wear eyeglasses instead for a few weeks prior to the pre-op eye exam and surgery to allow the cornea to return to its natural shape. Although a singer could attend rehearsals or lessons the day following surgery, it may take a month or more for vision to completely heal and “settle.” To prevent infection, no street or stage make-up can be worn on the eyes the first full week after surgery, so singers may wish to avoid performances or important auditions. Also, for the first few weeks, some patients have trouble with dry eyes and “halos” or “starbursts” when viewing bright lights, including stage lights. Singers’ travel schedules may need to be adjusted to accommodate critical follow-up appointments at three and six months.

While the decision to have LASIK surgery is popular, even trendy, now (over 7,000 procedures are performed each week in this country), it is not the right decision for everyone. The American Academy of Ophthalmology (www.eyenet.org) cautions that there is no guarantee that you won’t be in that unfortunate 1% of patients whose vision is actually worse after LASIK, and “even if you have 20/20 vision you’ll still eventually need reading glasses.” The newly-approved LASIK procedure for farsightedness will not prevent presbyopia, a natural aging process that causes increased difficulty in focusing on small print and close objects. Surgeons frequently recommend “mono-vision” for LASIK candidates over 40 for a sort of “bi-focal” effect. The dominant eye is corrected for distance and the non-dominant eye is left somewhat myopic for close-up vision. It sounds good in theory, but Richard Paul Fink [see Met sidebar] cautions that it may not be best for singers whose “best ideal reading distance is farther away than an average person reading a book. We hold music at arm’s length or read from a stand or piano.” For best music-reading vision, he sometimes wears a low prescription soft contact lens on his mono-vision eye. Diana Cline admits, “I have trouble with small print and some music, but I know I need one more surgical enhancement, and maybe reading glasses. Small price to pay, if you ask me.”

Finances and fear are the main reasons singers hesitate to have surgical vision correction. LASIK is expensive and is rarely covered by insurance companies which consider it a cosmetic procedure. Don’t count on a professional tax write-off either, unless you can convince the IRS you’ll only use your eyes onstage! Fortunately most refractive eye centers offer payment plans as inexpensive as $100 a month, and there is no additional charge for follow-up exams or enhancements. Richard Fink admits that fear made him wait to schedule the surgery. “I’d been thinking about it for a long time. I was nervous, but the procedure was 100% painless.” Since success may greatly depend on the skill of your surgeon, avoid physicians who offer steep discounts. Make sure the surgeon has experience in LASIK procedures (performs at least five surgeries a week) and is a corneal specialist in procedures beyond refractive surgery. Singers should choose an eye surgeon as carefully, if not more carefully, than they choose a voice teacher or manager.

Baritone Richard Paul Fink had LASIK last August, just one month before he reported to the Metropolitan Opera in Samson et Dalila. He is generally very pleased with the results of the surgery. “There is some loss of focus in dim lighting situations like subways and the Met green room, but onstage I can see my colleagues, the conductor, and the monitor just fine.” Richard had worn glasses since age eight, and rigid contact lenses since high school, to correct his near-sightedness and astigmatism. Although he has never lost a contact onstage during a performance, “even when the soprano slapped me,” he has had lenses slip or pop off-center. “That can be very dangerous in movement situations that involve choreographed sword-play or intricate whip work.” Also, there is the pain and distraction when “perspiration mixed with stage make-up gets into your eye and clogs up a contact lens. I hate that!” Some myopic singers simply leave their glasses offstage or in the dressing room. “I could never do that,” says Richard, “but I know singers who do. Do you really want a mad tenor with a knife rushing at your face when you [or he] can’t SEE?!”

Baritone Richard Paul Fink has come to international attention as a dramatic baritone, singing roles with the Metropolitan Opera, Washington Opera, and the Welsh National Opera, as well as numerous other houses. Upcoming engagements include Alberich in Das Rheingold, at Dallas Opera and for Seattle Opera’s new Ring Cycle.

Cynthia Vaughn

Contributing Editor Cynthia Vaughn has had successful private voice studios in Newark, California; Hanover Park, Illinois; Middletown, New York; Arvada, Colorado; and Springboro, Ohio. She is currently a doctoral candidate and Teaching Assistant at the University of Northern Colorado.