FEB 2014

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

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E W MEETING REPORTER 104 treatment before moving on to steroid injections. "You could unknowingly u nmask an infectious agent," Dr. Srivastava said. Editors' note: Dr. Srivastava has no financial interests related to this presentation. 'Revolution' is occurring in keratoconus treatment A movement away from penetrating keratoplasty has been occurring in the treatment of keratoconus for years, with the approval of the Dres- den protocol by the U.S. Food and Drug Administration potentially possible in the next year to two years in the U.S., a physician said. "We've entered a new era with a r evolution in treatment predicated mainly on collagen crosslinking," said Michael B. Raizman, MD, Boston. "I think that we're shifting away from the need for keratoplasty, and I hope it can be eliminated. I think that you should also consider the use of scleral lenses for your pa- tients." He said the safety and efficacy of UV collagen crosslinking will most likely play a key role in the topic into the future, while lenses also are playing a role. Editors' note: Dr. Raizman has finan- cial interests with Avedro (Waltham, Mass.). Friday, Jan. 24, 2014 LASIK will not rebound until millennials need surgery With LASIK procedure numbers down across the country, a rebound in refractive surgery might not occur until 2020, when the next genera- tion that will be the best LASIK candidates will be the right age and have dispensable income to afford surgery. Richard L. Lindstrom, MD, Minneapolis, moderated the "Refrac- tive Surgery" symposium and pre- sented an overview on the current situation with LASIK surgery, "When will LASIK surgery rebound in the U.S. and why?" He said his practice, Minnesota Eye Consultants, did 7,700 LASIK cases in 2001. In 2013, the group p erformed about 2,800 to 3,000 cases. "Every year, it's been down. Where is the bottom number? What's going on?" he said. "The bad news is, the bottom is still a ways away." The main reason for the decline is demographics, Dr. Lindstrom said. W hen the excimer laser was first ap- proved, the age of the average Baby Boomer was 35 years old. That pa- tient was a pre-presbyopic myope, often with an established life and good job, so he or she could afford LASIK and was a good candidate for the laser procedure. "They definitely weren't like my k ids and their friends, which is the millennial [generation], and it's the millennial that's going to be our next patient," Dr. Lindstrom said. However, for right now, he said the average millennial is often in debt, looking for a job, or working in a job that is not in their field. These patients are in their 20s and are not yet ready to have refrac- tive surgery, he said. Data shows that they will want refractive surgery and that they are a big population potential for the procedure, but they are not yet prepared to have it in large numbers. Several factors could assist, he said. Crosslinking could be approved in the U.S. in the next year or two, and that could expand refractive possibilities in 10 to 15% of cases that have atypical corneas. A corneal inlay being approved could also assist in presbyopic Baby Boomer c ases, he said. But what else can a refractive surgeon do in the face of stagnate LASIK numbers? Prices can be low- ered, but reduced price vs. volume does not always correlate, Dr. Lindstrom said, so that is not the most effective solution. Aggressive marketing might assist in growing r efractive practices, but that also comes at a cost. "We used to be able to generate a LASIK eye for about $200 in mar- keting but now it's about $800 to $1,000 [an eye]," he said. He said practices might want to consider having someone younger, or who understands the unique n eeds of this new generation, to help in attracting younger patients. "Bottom line is, we've got to wait for these millennials to get a lit- tle bit older, a little bit richer, a little bit better jobs, and to get a little less happy with their contact lens. We all know as they age, they're going to burn out a little on their contact lens wear," he said. "They're coming ... and we want to be prepared." Editors' note: Dr. Lindstrom has financial interests with several compa- nies that make femtosecond lasers. Performing LASIK in complicated cases Surgeons need to practice caution in controversial LASIK cases such as those with dry eye, large pupils, and glaucoma, according to a physician. February 2014 Reporting live from the 2014 Hawaiian Eye, Kauai, Hawaii Sponsored by View it now ... EWrePlay.org Christopher J. Rapuano, MD, discusses anterior segment trauma pearls. Thursday on EWrePlay 98-105 MR Hawaii_EW February 2014-DL2_Layout 1 1/30/14 11:57 AM Page 104

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