Eyeworld

57 EW REFRACTIVE SURGERY October 2015 flap tears, dislodgement, epitheli- al ingrowth, and diffuse lamellar keratitis. Good surgical technique is the key to avoiding most flap-related issues, and with femtosecond laser Additionally, the flap and pho- toablation disrupts cornea nerves. Approximately 50% of all LASIK patients report dry eye symptoms up to 6 months after surgery, she said, although most cases improve after 6 to 12 months. The second issue she mentioned was the LASIK flap, with which there is a possibility of flap striae, flap creation, flaps are more adher- ent and stable, greatly reducing the incidence of traumatic flap dis- lodgement. Next, Dr. Chan said to watch for keratectasia, which has an estimated incidence of about 0.04 to 0.6%. The risk of this has fortunately decreased over the years because of heightened awareness of the prob- lem, careful patient selection, better flap thickness predictability with femto flap creation, and improved topography risk assessment systems. Dr. Chan recommended sur- geons be aware of degradation in visual quality. This is seen in almost all refractive surgical procedures, she said, especially in cornea-based procedures. This can mean glare and halos, decreased contrast sensitivity, or decreased quality of vision in dim lighting. It may be improved slightly by better excimer laser treatment profiles. Dr. Chan said that LASIK is her first-line refractive surgical proce- dure because of the many strengths, but she added there are certain cases when she would not choose LASIK, like in those with extremely high myopia (more than –12.0 D), or those constantly involved in high impact sports. For any refractive pro- cedure, even if you have a favorite procedure, careful patient selection remains important, Dr. Chan con- cluded. EW Editors' note: Dr. Chan has financial interests with Alcon (Fort Worth, Texas), Allergan (Dublin, Ireland), Bausch + Lomb (Bridgewater, N.J.), and Carl Zeiss Meditec (Jena, Germany). Contact information Chan: cordelia_chan@snec.com.sg An NSAID formulated to penetrate target ocular tissues PROLENSA ® POWERED FOR PENETRATION Available in a 3-mL bottle size Please see brief summary of Prescribing Information on adjacent page. References: 1. PROLENSA ® Prescribing Information, April 2013. 2. Data on file, Bausch & Lomb Incorporated. 3. Baklayan GA, Patterson HM, Song CK, Gow JA, McNamara TR. 24-hour evaluation of the ocular distribution of 14C-labeled bromfenac following topical instillation into the eyes of New Zealand White rabbits. J Ocul Pharmacol Ther. 2008;24(4):392-398. 4. BROMDAY ® Prescribing Information, October 2012. ®/™ are trademarks of Bausch & Lomb Incorporated or its affiliates. © 2015 Bausch & Lomb Incorporated. All rights reserved. Printed in USA. US/PRA/15/0015 PROLENSA ® delivers potency and corneal penetration with QD efficacy 1,2 • Advanced formulation delivers corneal penetration 1-3 • Proven efficacy at a low concentration 1,4 INDICATIONS AND USAGE PROLENSA ® (bromfenac ophthalmic solution) 0.07% is a nonsteroidal anti‑inflammatory drug (NSAID) indicated for the treatment of postoperative inflammation and reduction of ocular pain in patients who have undergone cataract surgery. IMPORTANT SAFETY INFORMATION ABOUT PROLENSA ® Warnings and Precautions • Sulfite allergic reactions • Slow or delayed healing • Potential for cross‑sensitivity • Increased bleeding of ocular tissues • Corneal effects, including keratitis • Contact lens wear Adverse Reactions The most commonly reported adverse reactions in 3%‑8% of patients were anterior chamber inflammation, foreign body sensation, eye pain, photophobia, and blurred vision.

• Cover