Eyeworld

EW REFRACTIVE SURGERY February 2011 53 L ASIK, an already safe, effective, and accurate method of correcting myopia, hyperopia, and astigmatism, has recently gotten better thanks to an increase in customized laser vision correction using wavefront- guided ablation. Stephen S. Lane, M.D., clinical professor of ophthalmology, University of Minnesota, Min- neapolis, has been working with wavefront-guided ablation in combination with femtosecond flap technology for about 2 years, using the treatment on around 1,500 patients. "The results have been superb," said Dr. Lane. "While good results are achievable today with a number of laser plat- forms, the advantages of an integrated system of femtosec- ond flap formation with customized laser procedures gives us an advantage when compared to the other technologies avail- able. Our results with hyperopia are certainly better, as are our results with higher degrees of myopia." The goal of wavefront-guided ablation is to reduce the amount of higher-order aberrations introduced to the eye upon treatment. When comparing standard LASIK to a wave- front treatment, the standard treatment will create a greater amount of higher-order aberrations than the wavefront treat- ment, according to Elizabeth A. Davis, M.D., adjunct clinical assistant professor, University of Minnesota—Twin Cities, Minneapolis. "It turns out that with wavefront treatments, you reduce induction of both total root mean square (RMS), as well as in- dividual lower-order RMS and higher-order RMS," Dr. Davis said. In addition to achieving better results, wavefront treat- ment doesn't add much surgical time to the LASIK procedure, and the recovery period for the patient is similar to the stan- dard procedure. "It's a very efficient way of doing LASIK," Dr. Lane said. "It can also be done with two people in the room—one acting as a scrub technician and the other as the person who runs the laser. I think it's a more comfortable experience for the patient overall. There's a certain amount of discomfort that goes along with the placement of the suction ring of a manual microker- atome." Wavefront-guided ablation isn't perfect. In 2-4% of pa- tients, the treatment won't be possible. "There are occasional situations, such as if the patient has had prior surgery, if the patient has had a cornea transplant, or if the patient has a corneal scar, where you can't acquire a wavefront measurement. In very rare instances, the pa- tient's pupil is too small to capture an image," explained Dr. Davis. It's also more expensive than the stan- dard treatment. One way to recuperate that is by increasing the charge to patients. Drs. Lane and Davis agree that while the treat- ment may cost more, the increased visual acuity is worthwhile. "Many imaginative pricing schemes have been developed so that, overall, the price between the two isn't greatly signifi- cant," Dr. Lane said. "Certainly people who do not have a high volume will have a more difficult time justifying the cost, but many of those doctors are already in laser centers with multiple users where the prices can be spread across different users." Moreover, both doctors acknowledge some inconveniences with an opaque bub- ble layer (OBL), which can at times be fairly dense, preventing the surgeon from obtain- ing iris registration. Any issues with OBL can be overcome with experience, however. Surgeons can wait for the OBL to diminish, or there are ways around it, such as massag- SUHRS LQWUDRS SRVWRS )5((6$03/(6 ENHANCE POST-OP RESULTS ENHANCE POST-OP RESULTS ZLWK2&X62)7 /LG6FUXE 3/86 OCuSOFT ® Lid Scrub ™ PLUS with Topical Betadine Topical Betadine alone OCuSOFT ® Lid Scrub ™ PLUS with Topical Betadine Topical Betadine alone OCuSOFT ® Lid Scrub OCuSOFT Lid Scrub ® ™ ™ PLUS PLUS ™ opical Betadine with T with Topical Betadine opical Betadine alone Topical Betadine alone OCuSOFT ® Lid Scrub OCuSOFT Lid Scrub ® ™ opical Betadine with T with Topical Betadine opical Betadine alone Topical Betadine alone opical Betadine opical Betadine alone ™ PLUS PLUS ™ opical Betadine opical Betadine alone opical Betadine alone Topical Betadine alone opical Betadine alone by Faith A. Hayden EyeWorld Staff Writer Surgeons say wavefront-guided ablation provides superior LASIK results Wavefront-guided surgery with iris registration technology provides better LASIK results, according to surgeons Source: Capt. (Ret.) Steven C. Schallhorn, M.D. continued on page 54 February 2011

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