72 | EYEWORLD | DECEMBER 2020
R
EFRACTIVE
Contact
Chang:
dchang@empireeyeandlaser.com
Faktorovich:
ella@pacificvision.org
Nehls: nehls@wisc.edu
Waring:
georgewaringiv@gmail.com
issue himself, Dr. Chang said he will usually pull
the patient's mask down so that their nose is
exposed at the time of the surgery. You can tape
the mask down to the middle of their face or
you can pull it down past their nose, but aware-
ness and identifying the potential problem is the
key, he said.
Dr. Nehls said she did have a case where
fogging occurred. She had not previously seen
it but in retrospect realized what it was. This
patient ended up with a flap that was too thin,
she said.
As a result, Dr. Nehls said changes were
made at her surgical center. This patient in
particular had been wearing a very large N-95
mask, and he had insisted on wearing his own
mask. Now, the surgery center has a rule that
patients must wear masks from the surgery
center, Dr. Nehls said, and they tape the nose
and across the cheek. She hasn't experienced
this complication since the surgery center made
the change.
Dr. Nehls said she had an "ah ha" moment
when this alert was distributed by the clinical
committee. She said she may go back and treat
that patient, possibly recutting the flap.
to the nuisance of glasses fogging associated
with mask wearing.
With all of these factors at play, Dr. Waring
said he's seen an uptick in volume. He added
the more people who undergo vision correction,
the more advocates you have for it as well.
ASCRS Refractive Surgery
Clinical Committee alert
In July, the ASCRS Refractive Surgery Clinical
Committee released an alert about the increased
risk of femtosecond laser flap creation compli-
cations while patients wear masks. It noted that
there is the possibility of fogging open femtosec-
ond laser applanation cones if patients wear a
mask during the procedure.
Dr. Waring noted that patients wearing
masks in the clinic and OR is new, so it was
good to be able to identify and address these is-
sues. This problem with the use of femtosecond
lasers and masks is one that is remedied mostly
with a piece of tape over the bridge of the nose,
he added.
Dr. Chang also commented on the alert
from the ASCRS Refractive Surgery Clinical
Committee. Though he said he hasn't seen this
continued from page 70
Intraoperative photo of an end of surgery LASIK flap floated back into perfect position
Source: Sarah Nehls, MD
