EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW FEATURE 38 Keratorefractive surgery August 2014 by Lauren Lipuma EyeWorld Staff Writer Calif.) have allowed for safer surgeries and more refined ablation profiles, according to Dr. Probst. These have incorporated features such as iris registration, adjustment for centroid shift, and improved eye trackers. In addition, the use of femtosec- ond lasers to create the LASIK flap has virtually eliminated serious flap complications. The IntraLase system (AMO) has essentially eliminated epithelial ingrowth and flap striae seen previously with the microker- atome, Dr. Probst said. "Those things translate into a safer procedure, but I think that the planar flap has translated into better optics, and that has resulted in incremental improvements in visual acuity after the procedure," he said. With these technological inno- vations, surgeons are able to provide more precise custom procedures and better select their refractive goals. Surgeons can also use the technologies available to refine their patient selection, becoming more conservative with some groups of patients and more liberal with others. Patients with dry eye or certain levels of hyperopia may not be treated now, said Dr. Schallhorn, or may undergo therapy to get their conditions under control before sur- gery. Conversely, patients with large pupils who were formerly excluded can now be treated. "We've gotten better at triaging who the best candidates are, and we have other modalities available to patients—viable contact lenses and phakic lenses that were not available 10 years ago," Dr. Solomon said. "So even though we had LASIK approved in the upper range, we didn't have any alternatives. Today, we have alternatives. For higher myopes, for example, we're more likely to pro- ceed with a phakic IOL. For hyper- opes, we're more likely to proceed with a refractive lens procedure." "Those subtle improvements— and they have been subtle—have gradually improved the outcomes year to year," Dr. Probst said. Benchmarks of success Today, surgeons are striving for high- er postoperative visual acuity than before—and are achieving it. In the original FDA trials, 60% of patients were in the 20/20 range. Today, the Experts discuss LASIK outcomes in the modern refractive era M ore than 15 years after the Food and Drug Administration approved LASIK, results of the refractive procedure continue to improve. According to 3 top LASIK providers, refractive surgeons have been evolv- ing their techniques in response to improved technology and are pro- viding increasingly better outcomes for patients. Lou Probst, MD, national medical director of TLC Laser Eye Centers, Chicago; Steven Schallhorn, MD, in practice in San Diego; and Kerry Solomon, MD, Carolina Eyecare Physicians, Charleston, S.C., discussed recent improvements in the refractive procedure, current outcomes, and the future of LASIK surgery. The surgeons focused on trends in the major factors that they use to measure the success of the proce- dure—postoperative visual acuity, the incidence of complications and side effects, and patient satisfaction. The physicians agreed that there are technological and human components that have contributed to increases in visual acuity and patient satisfaction and decreases in complications and side effects. Tech- nological advances in the field have made the procedure safer and more effective, with physicians learning how to better use those technologies to their advantage. The technology-human interface Custom ablations with systems such as the CustomVue (Abbott Medical Optics, AMO, Santa Ana, AT A GLANCE • The femtosecond laser has virtually eliminated serious flap complications. • Surgeons are better at refining their patient selection and providing alternative refractive procedures. • Patient satisfaction is key to growing a refractive business. LASIK results continue to improve In this study, the majority of eyes test with better than 20/20 corrected vision preoperatively, demonstrating how high the bar is set for postoperative outcomes. Three months after Custom IntraLase LASIK, more than 95% of eyes tested with an uncorrected vision better than 20/20. When the preoperative best corrected distance visual acuity (BDVA) is compared to the postoperative uncorrected distance visual acuity (UDVA), improvement is evident at all levels of vision. Source (all): Louis Probst, MD