Eyeworld

EW MEETING REPORTER 90 September 2018 EyeWorld reports from the 2018 APACRS annual meeting, July 19–21, Chiang Mai, Thailand Fritz Hengerer, MD, PhD, Heidelberg, Germany, discussed the Light Adjustable Lens (LAL, RxSight, Aliso Viejo, California), which he described as a three-piece silicone IOL with unique options in order to change the refraction noninvasively after surgery. After wound healing, you can do the first refraction and see what results were obtained and how far the patient is from target re- fraction. The adjustments are made using UV light. Patients receiving this technology are clearly informed about the technology and draw- backs, Dr. Hengerer said, stressing the importance of patients wearing UV-protecting glasses after surgery while the IOL is still being adjusted. This lens has now been com- mercially available for 10 years in Europe. There are several options to optimize VA for distance, inter- mediate, and near, and adjustments are noninvasive. When the lens is "locked in," patients no longer have to wear their protective spectacles. Dr. Hengerer noted that the LAL is available for up to 3.0 D of astigmatism and for post-refractive surgery patients and presbyopia cor- rection. He stressed that compliance is one of the keys to success. Dr. Hengerer said that there may be some limitations with the LAL. For example, small pupils or corneal scars do not allow UV light to go into the LAL. He would not use it and long-term studies have shown refractive stability and safety; daily wear contact lenses are likely less safe than LASIK when worn for 30 years, and extended wear contact lenses are definitely less safe than LASIK when worn for 30 years; mod- ern LASIK improves glare and halo for the majority of patients, and there are a minority of patients who will develop glare and halo who did not have symptoms preoperatively; LASIK is the safest procedure with the greatest satisfaction of any sur- gery performed in the world today, and the safety and efficacy have improved markedly over the last 20 years and will continue to improve with technology advances; and dry eye is common after LASIK for the first 3 months, but it usually resolves after 6 months. Moving forward, the goal is continued improvement of patient satisfaction and 100% of patients seeing the same or better following LASIK than prior to surgery. "We need to embrace patients who are dissatisfied with their vision follow- ing LASIK and never allow them to feel abandoned," Dr. Donnenfeld said. CSCRS symposium The Combined Symposium of Cata- ract and Refractive Societies (CSCRS) highlighted "Inner Focus – Innova- tive IOL Technology." this procedure persist, Dr. Donnen- feld said. He shared six myths and misconceptions of LASIK: 1. Physicians would not have LASIK on their own eyes. 2. The long-term effects of LASIK are not known. 3. Contact lenses are safer than LASIK. 4. LASIK significantly increases the risk of a patient having glare and halo. 5. The safety and efficacy of LASIK has not improved over time. 6. Dry eye is extremely common following LASIK. Dr. Donnenfeld detailed the history of LASIK, starting with the clinical trial and its approval. One of his first papers on LASIK looked at the effect on dry eye, and he learned that it does cause dry eye. Statisti- cally, dry eye returns to normal at 6 months following surgery. Dr. Donnenfeld discussed patient dissatisfaction with LASIK, noting an FDA hearing addressing the topic. In addition to speaking in favor of LASIK at the hearing, Dr. Donnenfeld said he learned a lot by listening to patient testimony. The most common problem that made patients unhappy was the sense of abandonment from the surgeon when they didn't get the results that they wanted. An early problem of LASIK was ablation decentration, which can be addressed with pupil tracking and other technologies. The problem of PRK corneal haze has almost com- pletely been resolved with the use of mitomycin-C. Meanwhile, flap complications have been addressed with the advent of the femtosecond laser and better microkeratomes. Glare and halo can be remedied with blend zones, customized abla- tions, and optimized ablations, Dr. Donnenfeld said. He noted that the problem of ectasia is addressed with better diagnostic equipment and patient selection, as well as cross- linking. In his conclusion, Dr. Donnen- feld again referenced the "myths and misconceptions" about LASIK: Physicians have among the highest prevalence of having undergone LASIK of any occupation; LASIK has more than a 20-year track record, View videos from the 2018 APACRS: EWrePlay.org Li Lim, MD, discusses the role of ocular surface disease in the management of refractive cataract surgery patients. Sponsored by

• Blank Page
• Blank Page (1)