Eyeworld

I APRIL 2020 | EYEWORLD | 75 monitor it. When it is impacting vision, go in and remove it, but he cautioned, "the problem is epithelial ingrowth in retreatment is difficult to eliminate." When epithelial ingrowth keeps occurring, Dr. Maloney said he sutures the flap tightly. Dr. Gordon mentioned glue and soft bandage contact lenses as options as well. Both said if there is a button hole in the flap or if it doesn't go away despite these efforts, flap amputation might be necessary. "The expression on [the patient's] face is 'What does that mean?' The reality is the flap doesn't do anything other than it's a platform for the epithelium to sit on that has a Bowman's membrane," Dr. Gordon said. Removing the flap transitions the patient to a PRK-like condi- tion. "You amputate the flap, let them heal, and frequently that's all you need to do. … Treat them like a PRK with mitomycin. They usual- ly heal fine. In 3–6 months, if the vision isn't where you want it, fix it with a PRK." If a primary epithelium ingrowth occurs, Drs. Price and Gordon said it's usually some- one who had undiagnosed anterior membrane dystrophy. "It's not that you missed it, it just wasn't present when you took a look at the patient," Dr. Gordon said, explaining that its signs can be transient. Dr. Price usually waits a couple of months to address ingrowth, depending on how bad it is, "because a lot of times it will resolve and get better, especially if it's out at the edge." Dr. Maloney said epithelium ingrowth occurs within the first week of surgery, but it's often not visible until later (it can be visible at 3 weeks postop but is easier to see at 5–6 weeks). Dr. Maloney addresses epithelium ingrowth as soon as he sees it because "the longer you leave it, the more likely it is to recur after surgery." Stopping recurrent erosions Recurrent erosion is often associated with underlying basement membrane dystrophy, according to Drs. Gordon and Maloney. Dr. Price said January 2020 marked 25 years that he's been performing LASIK, and he discussed with EyeWorld how far the procedure has come in that time, making surgical complications exceed- ingly rare. One of the major advances was the switch from microkeratome to laser. He also mentioned the PROWL-1 and PROWL-2 studies, which looked at patient-reported outcomes with LASIK, finding that more than 95% of patients were satisfied with their procedure. 2,3 Dr. Price and coresearchers separately published a study in 2016 that compared visual satisfaction with LASIK and con- tact lenses. 4 To assess satisfaction with patients' method of vision correction, Dr. Price said they posed the statement: "I would recommend my current method of vision correction to a close friend or family member." At 3 years after baseline the percent of people who "strongly agreed" with this statement were as follows: 88% for LASIK after contact lens wears, 77% for LASIK after glasses wearing, and 54% for those staying in contact lenses. When adding the percent who also just "agreed" with the statement the percentages were 98%, 99%, and 97%, respectively, so that overall both the contact lens and LASIK group would recommend their current form of visual correction, Dr. Price said, adding that the very satisfied percentages were signifi- cantly higher in the LASIK group com- pared to the contact lens group. LASIK was also found to reduce difficulty with night driving and other nighttime visual disturbances in the former contact lens and glasses wearing groups. Those in the LASIK group also had fewer self-report- ed eye infections, ulcers, and abrasions, compared to contact lenses wearers. continued on page 76 About the doctors Michael Gordon, MD Gordon Schanzlin New Vision Institute La Jolla, California Robert Maloney, MD Maloney-Shamie Vision Institute Los Angeles, California Francis Price Jr., MD Price Vision Group Indianapolis, Indiana

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