Eyeworld

BOOST YOUR REFRACTIVE AND CATARACT SURGERY PRACTICE 4 | SUPPLEMENT TO EYEWORLD | DECEMBER 2021 can be a bit of a challenge, but Carl Zeiss Meditec has a new reporting and no- mogram calculation tool that can help: Visulyze 1.0. The program allows the user to input refractive data, analyze the data, create graphs and nomograms based on user, device, etc., and export nomograms and create treatment plans for patients. A look at functional vision Diving deeper into SMILE data, Dr. Rivers, a retired colonel from the U.S. Army, described research that evaluated SMILE in the U.S. military from a "func- tional perspective." The military tends to look at not only clinical evaluations but functional vision, he said, describing the single-center, prospective study of the procedure on active duty service members who self-selected SMILE as their refrac- tive procedure. Testing, which included visual acuity, higher order aberrometry, visual perfor- mance, patient-reported outcomes, and marksmanship performance (a subgroup), was performed preoperatively and at 1 and 3 months postop. At 3 months postop, 96% of eyes achieved 20/20 or better vision; 99% were 20/25 or better. According to Dr. Rivers, there were no over or under corrections in this group, and 97% achieved a refraction within 0.5 D of target. There was an increase in higher order aberrations in terms of contrast sensitivity, he said, especially at 1 month postop, but loss of contrast sensitivity was reduced at 3 months postop. On the patient questionnaire, Dr. Rivers said 10% of patients reported job impairment due to contact lens or glasses use preop; 20% said they had impair- ments that were not job related. "After SMILE, all those went to zero," Dr. Rivers said. The biggest thing Dr. Rivers said he was excited about from the data was in marksmanship. Seven participants increased their shooting score postop, and six scored at an expert level postop compared to only one scoring at this level preop. "You can see the big increase in peo- ple scoring 'expert' [postop]," Dr. Rivers noted, which "speaks for itself." This study showcases that "SMILE does facilitate functional vision," Dr. Rivers said, "and like the other proce- dures, they provide service members with great independence from glasses, and they are able to do their job." SMILE has lower enhancement rates Postop enhancements due to off-target outcomes or unmet patient expectations are costly. Not only do they cost the phy- sician and the practice time and money, but they also impact patient perception about the procedure. Dr. Wiley referenced research by Daniel Durrie, MD, that estimated the cost of an enhancement pushing up to $15,000. How? "You expect every patient who gets refractive surgery to tell three or four other patients to come in," Dr. Wiley said. "That feeds that pipeline, and your refractive surgery department depends on that. So any enhancement that you have is going to cost you money. It's not just the cost of the enhancement itself, but it's that loss of referrals or loss of confidence, so it's expensive." Dr. Wiley called SMILE a "great tool to avoid enhancements." Data shows lower enhancement rate with SMILE The best treatment for enhancements, Dr. Wiley quipped, is to avoid them complete- ly. He reported seeing fewer enhance- ments with SMILE in his practice. He also said the rate of enhancement seems stable regardless of prescribed treatment. Historical enhancement rates for all procedures from 2002–2020 was 5%. One published study reported an average continued from page 3 Stats from the "Small incision lenticule extraction (SMILE) in the U.S. military: A functional perspective" study: 96% of patients were 20/20 or better 97% of patients were within 0.5 D of BCVA 7 participants increased their shooting score postop 6 scored expert level postop vs. only 1 preop Marksmanship capabilities increased after the SMILE procedure. Source: Bruce Rivers, MD 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% QUALIFICATION CATEGORY Qualified Marksman Sharpshooter Expert NO. (%) OF PARTICIPANTS Preop Postop 1 3 4 10 1 6 1 0

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