EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/357599
39 EW FEATURE August 2014 Pole Position. HigH Performance system: HigHest Performance tHrougH soPHisticated tecHnology. new! www.geuder.de Visit us at tHe escrs / euretina 11 – 17 sePtember, bootH no. H15 numbers have improved: 60% are 20/15 or better and 90% to 95% are 20/20, according to Dr. Solomon. "Today almost everyone is on the money or awfully close," he said. "The fact that we're achieving vi- sion better than [20/20] could speak to the quality of the ablations and the quality of the surgery. The eye has the potential to see better than 20/20, it's just a question of wheth- er or not we can optimize patients' visual systems," he said. "Back in the early days of refractive surgery, we were happy if patients could see 20/20, and we considered that to be a victory," Dr. Probst said. "In the whole modern refractive era—and I think this will translate to cataract surgery too— what we find is that 20/20 is not a very ambitious benchmark for a postoperative outcome. "I think in our society, the laser vision correction 'deal' is that you have no problems, that you've paid your money, and that you're going to have better vision than you've ever had before. What we want to do is have people seeing better than they were before—that should be our benchmark. With the current technology, we can do that in the vast majority of people," he said. The physicians agreed that patient satisfaction is the final measure. The "bottom line," according to Dr. Schallhorn, is what the patients think about their LASIK results. It is critical to maximize visual acuity and minimize side effects and complications to have a successful refractive business. Side effects such as dry eye and poor night vision due to glare or halos are correlated to the postopera- tive residual refractive error, he said, so focusing on achieving the best possible uncorrected visual acuity is key to reducing these effects. One suggestion that Dr. Probst made for increasing patient satisfac- tion is to demonstrate to patients how their vision has improved post- operatively. "To hear the numbers and to hear that you're seeing better than 20/20, you walk out of the clinic feeling like you've got a superpower of some sort. This is a way that we can use our advanced outcomes to increase our patient satisfaction," he said. Future of refractive surgery Drs. Probst, Solomon, and Schallhorn agreed that outcomes will continue to improve and that refractive surgeons will see new technologies become available in the coming years. In Europe, eye trackers are more advanced than in the U.S., Dr. Probst said, and can account for eye rotation. "There are improvements in aberrometers and the iDesign unit [Abbott Medical Optics]," he said. "That should allow a higher resolu- tion wavefront map, which could be translated into better procedures. Femtosecond lasers continue to become faster and more precise, and that will result in smoother beds and faster procedures, which will be less traumatic on the eye." "I think we're going to see our procedures get more refined, less in- vasive, and more accurate," said Dr. Solomon. New refractive procedures are on the horizon, he added, such as all femto-based intrastromal abla- tions like the SMILE procedure (Carl Zeiss Meditec, Jena, Germany). The refractive landscape will continue to change as new procedures emerge and existing ones evolve. "I see a progressive march toward better outcomes with the surgery," Dr. Schallhorn said. "I think medicine in general, and certainly these procedures, move in one direction—to improve the outcomes; we've certainly seen that over the last 10 years or so, and we'll continue to see that." EW Editors' note: Dr. Probst has no financial interests related to his comments. Dr. Schallhorn has financial interests with AMO and Carl Zeiss Meditec. Dr. Solomon has financial interests with Bausch + Lomb (Bridgewater, N.J.), AMO, and Alcon (Fort Worth, Texas). Contact information Probst: 708-562-4682 Schallhorn: scschallhorn@yahoo.com Solomon: kerry.solomon@carolinaeyecare.com