EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78719
February 2012 EWInternational 77 instability, 3) real aqueous tear defi- ciency due to nerve damage, 4) and neuropathic pain (phantom pain). Dr. Tuisku has found that most patients improve with respect to the first three categories of dry eye 6-12 months after LASIK. "But neuropathic pain is more complex," Dr. Tuisku said. Regeneration of nerves can take 5 years, and the nerves regenerate differently than before, leading to what Dr. Tuisku calls "aberrant nerve fibers." "As nerve fibers grow back into the flap, they branch out," Dr. Reinstein said. "There tend to be more nerve endings than origi- nally—double or triple nerve end- ings. Now a breeze of wind across the eye will feel like three times the amount of breeze, causing a sensa- tion that the eyes are very dry." Patients cannot differentiate these sensations from normal dry eye symptoms, Dr. Tuisku said. "Doctors don't see any find- ings," he said. "The cornea looks clear and there are no signs of dry eye and still these patients com- plain, maybe 1 year after LASIK sur- gery." Asked whether he thinks SMILE could provide a solution to this problem, Dr. Tuisku replied favor- ably, but stopped short of vouching for the procedure. "SMILE is totally different from LASIK," he said. "We spare more nerves. We make a small incision. In LASIK, when we do the flap and there's a hinge, we cut 90% of the nerves. Some comparative, prospec- tive studies comparing femtosecond laser LASIK and SMILE should be done." Clinically, Dr. Shah already has seen SMILE benefits over LASIK in terms of dry eye. "I have personally treated sev- eral patients on whom I would not have done LASIK, because of dry eye, with SMILE, and they are ex- tremely happy and grateful," Dr. Shah said. Of course, there are drawbacks with any procedure, and SMILE is not immune to these. The procedure is not available for hyperopia, Dr. Shah noted. "There is also no cus- tomization possibility at the mo- ment. The treatments are already OFFICE SEEM CONGESTED? TIME WITHOUT A PATIENT TO SEE? PLANNING NEW PRACTICE SPACE? HAS THE SOLUTIONS TO YOUR PROBLEMS. BOOTH 819 ASCRS 2012 "Practice Flow Solutions was the best investment I made in building our new office." Dr. Susan Everhart - Everhart Eye Associates Practice Flow Solutions is a niche design firm uniquely focusing on helping medical practice efficiencies by identifying and solving problems in patient, staff and doctor flow. Larry Brooks, AIA and Tim Griffin, AIA, the founders of Practice Flow Solutions, have over 40+ years of experience designing and advising medical practices. www.PracticeFlowSolutions.com optimized for spherical aberrations though." EW Editors' note: Drs. Reinstein and Shah have financial interests with Carl Zeiss Meditec. Dr. Tuisku has no financial interests related to this article. Contact information Reinstein: +44 020 7224 1005, dzr@londonvisionclinic.com Shah: +91 265 3058 603, rupal@newvisionindia.com Tuisku: ilpo.tuisku@helsinki.fi + IDENTIFY THE PROPER AMOUNT OF SPACE F LOW A S S E S SMEN T S S P A C E A SS ESSME N T S O FFICE DE S I GN + ONSITE EFFICIENCY STUDIES + MAXIMIZE YOUR WORKFLOW