JAN 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 49 of 70

January 2013 tional minute. That's it. These are the only procedural differences compared to standard LASIK. For Dr. Tan, this means no additional time to the LASIK procedure required. Normally when Dr. Tan doesn't perform Lasik Xtra, after putting the flap back, he waits three minutes and then finishes the procedure. "I like to wait three minutes for my flap to really stick on well so there are no flap shifts [during standard LASIK]," Dr. Tan said. "I used to wait one minute but then would occasionally get a few flap shifts. Then I waited two minutes and rarely would get flap shifts. When I wait three minutes I get no flap shifts. For the last few thousand cases I have never had a flap shift. So I wait three minutes. It seems to be a nice magic figure for me." Now instead of waiting three minutes, he performs the crosslinking component during this time. With the riboflavin component, UVA illumination component, and added machines moving about during crosslinking, the time involved is identical to Dr. Tan's standard LASIK procedure. "It doesn't increase my time for surgery at all, at least for my technique," Dr. Tan said. Drawbacks vs. drawbacks Initially, Dr. Tan said he was using a riboflavin formula that included dextran during the Lasik Xtra procedure. "When you leave dextran underneath the flap, it causes a little bit of DLK," Dr. Tan said. "With the new formulation of riboflavin without dextran—with just normal saline—there is no DLK." The DLK experienced previously was mild, grade 1 DLK, he said. While the jury is still out on the long-term effects of crosslinking, Dr. Tan is convinced that it is safer than performing PRK with mitomycin-C, another refractive surgery option for higher myopia that reduces the risk of ectasia. "If you have a choice between crosslinking and mitomycin-C, mitomycin-C is more dangerous," he said. Meanwhile, Lasik Xtra is a better option than the Visian ICL (STAAR Surgical, Monrovia, Calif.) for many cases in Singapore, he said. Dr. Tan described the typical Singaporean myope as having "long eyeballs and anterior chambers that are too shallow for the Visian ICL. If I try to [implant a Visian ICL] in Singapore, the anterior chamber is going to be too small." Referring to Lasik Xtra, Dr. Tan said, "If there is no downside, why not do it?" EW EW International 47 Editors' note: Dr. Tan has no financial interests related to this article. Contact information Tan: +65 6738 8122, jtaneyes@singnet.com.sg

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