Eyeworld

The lack of a LASIK flap still has advantages in a femtosecond LASIK era T he standard femtosecond- assisted LASIK procedure, despite all of its precision, operates upon various corneal layers. That's just the nature of LASIK. While many ophthalmologists continue to embrace all-laser LASIK in our modern era, Tony Ho, FRCS, FRCOphth, Clearvision Eye Clinic and LASIK Centre, Singapore, has completely embraced an alternative: Epi-LASIK. Innovative in the mid-2000s, Epi-LASIK was heralded as a LASIK alternative, but it never quite caught on to the extent that LASIK has. Dr. Ho's view is important because having founded the first dedicated LASIK clinic in Singapore in 2001, he has switched entirely to Epi-LASIK. If the success of LASIK can be attributed to a "wow" factor—i.e., immediate spectacle-free, crisp vision following the procedure— the success of Epi-LASIK under Dr. Ho could be chalked up to a "no regrets" factor, emphasizing safety and a nuisance-free, long-term visual experience, free from dry eyes, flap-related complications, and risk of cornea ectasias. Epi-LASIK for the modern age In a way, Epi-LASIK isn't exactly what it was once believed to be. The procedure creates an epithe- lial flap rather than a deeper LASIK flap, but that epithelial flap is now discarded in many cases, as it is at Dr. Ho's clinic. In a way, it's a suave PRK procedure. Further, while LASIK offers immediate, sustainable, crisp vision postoperatively, visual issues are noticeable in the days following Epi-LASIK. Initial hopes that Epi-LASIK would be on par with LASIK in this regard have disap- peared. At Dr. Ho's clinic, vision is crisp immediately after the procedure, while it deteriorates at postop days 2 and 3, recovering by day 4 and 5. "You have to manage patient expectations," Dr. Ho said. "The postop period [compared to LASIK] is not to their advantage." Meanwhile, managing patient expectations can be difficult, he said. Strikingly, however, other advantages have been discovered over time, especially at Dr. Ho's clinic where the procedure is performed day-in and day-out. Dr. Ho will "conservatively say the enhancement rate is less than 1/500. LASIK enhancement has occurred (as has been documented in more extreme instances at other centers) at the rate of almost 1 in 5." Dr. Ho's clinic currently does more than 1,000 Epi-LASIK eyes a year. Dr. Ho turned to his marketing manager, Yang Lin, and said, "Yang, April 2014 by Matt Young EyeWorld Contributing Writer Back to the future with Epi-LASIK IMPORTANT SAFETY INFORMATION FOR CENTURION® VISION SYSTEM CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. As part of a properly maintained surgical environment, it is recommended that a backup IOL Injector be made available in the event the AutoSert® IOL Injector Handpiece does not perform as expected. INDICATION: The CENTURION® Vision System is indicated for emulsification, separation, irrigation, and aspiration of cataracts, residual cortical material and lens epithelial cells, vitreous aspiration and cutting associated with anterior vitrectomy, bipolar coagulation, and intraocular lens injection. The AutoSert® IOL Injector Handpiece is intended to deliver qualified AcrySof® intraocular lenses into the eye following cataract removal. The AutoSert® IOL Injector Handpiece achieves the functionality of injection of intraocular lenses. The AutoSert® IOL Injector Handpiece is indicated for use with the AcrySof® lenses SN6OWF, SN6AD1, SN6AT3 through SN6AT9, as well as approved AcrySof® lenses that are specifically indicated for use with this inserter, as indicated in the approved labeling of those lenses. WARNINGS: Appropriate use of CENTURION® Vision System parameters and accessories is important for successful procedures. Use of low vacuum limits, low flow rates, low bottle heights, high power settings, extended power usage, power usage during occlusion conditions (beeping tones), failure to sufficiently aspirate viscoelastic prior to using power, excessively tight incisions, and combinations of the above actions may result in significant temperature increases at incision site and inside the eye, and lead to severe thermal eye tissue damage. Good clinical practice dictates the testing for adequate irrigation and aspiration flow prior to entering the eye. Ensure that tubings are not occluded or pinched during any phase of operation. The consumables used in conjunction with ALCON® instrument products constitute a complete surgical system. Use of consumables and handpieces other than those manufactured by Alcon may affect system performance and create potential hazards. AEs/COMPLICATIONS: Inadvertent actuation of Prime or Tune while a handpiece is in the eye can create a hazardous condition that may result in patient injury. During any ultrasonic procedure, metal particles may result from inadvertent touching of the ultrasonic tip with a second instrument. Another potential source of metal particles resulting from any ultrasonic handpiece may be the result of ultrasonic energy causing micro abrasion of the ultrasonic tip. ATTENTION: Refer to the Directions for Use and Operator's Manual for a complete listing of indications, warnings, cautions and notes. © 2014 Novartis 4/14 CNT13017JAD-A THE C ATARAC T REFRAC TIVE SUITE BY ALCON In Epi-LASIK, the excimer laser is applied only on the surface of the cornea. Strength and structure of the cornea are better preserved. Source (all): Tony Ho, FRCS, FRCOphth Stanford researchers develop smartphone adapters for eye imaging T wo new smartphone adapters for ophthalmology imaging could prove effective for taking images of both the front and back of the eye. Researchers at the Stanford University School of Medicine, who have been working on this project for several years, have developed these low-cost adapters. The adapters offer an inexpensive option to capture images in- stead of paying tens of thousands of dollars for alternate equipment, which also requires more extensive training. The adapters require very little training for users, and photos can be securely shared with other health practitioners or stored for patient records. The researchers believe that this technology will not only help increase access to eyecare services, but also aid doctors in advising patients remotely. David Myung, MD, the lead author on two papers discussing these adapters, 1 and Robert Chang, MD, assistant professor of ophthalmology, are two researchers who have worked to develop this technology. A number of other researchers assisted with testing and trials. "Think Instagram for the eye," said Dr. Chang of the adapters. Currently, the price of each type of adapter is less than $90, with a goal of lowering this price in the future. The researchers are currently working to produce the adapters, and the technology will only be available for research purposes while the researchers work with the U.S. Food and Drug Administration. 1. Myung D, Jais A, He L, Chang R. Byers Eye Institute at Stanford, Stanford University School of Medicine, Stanford, Calif. Journal MTM 3:1:2–8, 2014.

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