Eyeworld

What patients are really thinking about when it comes to LASIK options M ythology can be a powerful thing. Unfor- tunately, when it comes to LASIK there are some myths that have evolved over the last decade or so that are just plain confusing and may ultimately be keeping potential patients at bay. EyeWorld asked sev- eral leading practitioners to share some of the key misconceptions that they've recently come across. Louis E. Probst, M.D., national medical director, TLC Laser Eye Cen- ters, pegs cost as the top misconcep- tion for prospective patients. "The average price for LASIK from an in- dustry perspective is pretty close to $2,000 per eye, and that has been shown by Market Scope," Dr. Probst said. Cut-rate advertisements, how- ever, give patients the impression that the rate is in the $1,000 range. "Patients do understand that what they got from their cursory analysis isn't the state-of-the-art LASIK that they want for their eyes," he said. He commonly comes across patients who have done internet searches who worry that night glare and dry eyes after LASIK are signifi- cant concerns. Many perspective patients are not differentiating be- tween the old technology and cus- tom LASIK. "The reality is that since we have started using custom treat- ments, and that has been over 5 years now, night glare is not a signif- icant factor and is not related to pupil size," Dr. Probst said. He pointed to studies done by Mihai Pop, M.D., and Steven Schallhorn, M.D., which clearly show that pupil size is not correlated with night vi- sion disturbances. Likewise, Dr. Probst finds that dry eye was a much worse issue with mechanical microkeratomes than with the current femtosecond laser. "Now that we are so conscious of the risk of dry eye, we use lubricating drops, like Restasis (cy- closporine, Allergan, Irvine, Calif.), which is extremely effective when started pre-operatively, and now that we use the femtosecond laser, which makes thinner, slightly smaller flaps than mechanical micokeratomes, the incidence of dry eye has become a small concern," Dr. Probst said. Many fall victim to the idea that LASIK is not an effective treatment for high myopia. "I think that pa- tients often think that if they're any- thing greater than –6 that they're essentially "blind" and there's no way that their prescription could be treated," Dr. Probst said. "Of course that's not true." Likewise, some doctors may think that it's better not to do refrac- tive surgery in such high myopes or to switch to an intraocular-type pro- cedure like a phakic IOL. With con- sistent 100-micron femtosecond flaps, however, this is no longer the case. "We can safely do custom treat- ments given adequate corneal thick- ness up to –10, –11, or even –12 D of myopia," Dr. Probst said. "The re- sults are excellent." A major myth that Robert K. Maloney, M.D., clinical professor of ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, encounters is the idea that LASIK is dangerous. "There's good evidence that LASIK is safer than wearing contact lenses," he said. "These patients come in wearing contacts that they wear every day, and every day they take a risk of getting bacterial keratitis and then they agonize over the pre- sumed risks of LASIK." LASIK, he stressed, is safer than contact lenses in terms of serious irreversible loss of vision. Another common myth that he comes across is the idea that LASIK can't correct farsightedness, which has been common since the late 1990s. "I think that this myth may come from the fact that LASIK can't cure presbyopia, and many patients confuse farsightedness with presby- opia," Dr. Maloney said. EW REFRACTIVE SURGERY February 2011 51 by Maxine Lipner Senior EyeWorld Contributing Editor Toppling major myths about LASIK CALL FOR NOMINATIONS! 2012 ASCRS Ophthalmology Hall of Fame T he ASCRS Ophthalmology Hall of Fame was created by ASCRS to honor ophthalmol- ogy's pioneers. In the past 11 years, 45 outstanding oph- thalmologists have been chosen for in- duction by their peers. Who will enter the Hall of Fame in 2012? You decide. Please complete the form at http://hof.ascrs.org/app (or scan the QR code to the left to access the web- page) to nominate your candidate for the class of 2012. The criteria for induction are 25 or more years of scholarly achievement and at least one solid, defining contri- bution to ophthalmology in clinical practice, research, education, inven- tion, or humanitarian work. September 2011 continued on page 52

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