Eyeworld

18 October 2016 EW NEWS & OPINION by Maxine Lipner EyeWorld Senior Contributing Writer Back in October 1996, howev- er, when LASIK was just a glimmer, the first EyeWorld issue highlighted how to get an individual device exemption for this since there were no FDA-approved lasers for it at the time. No one had an inkling of how the LASIK procedure would ultimately take off, Dr. McDonald recalled. "I think even the innova- tors were surprised at how big laser refractive surgery became," she said. "It was the confluence of many fortuitous things." The baby boom- ers, who were ruling the purchasing roost in those days, were ripe for the technology. "The average boomer was about 40 to 45," she said, add- ing that with their children already older in many cases, they had some disposable income to spend. Also, these 40-somethings were much more adventurous, athletic, and outgoing than the WWII gener- ation, Dr. McDonald continued. In particular, women of that age were finding that their eyes were getting dry and they could no longer wear the contacts to which they had become accustomed while hiking, Dr. McDonald, EyeWorld's first medical editor, reflects on the premier issue I t was October 1996, and the news headlines were abuzz with stories of president Bill Clinton signing the Electronic Freedom of Information Act Amend- ments into law, the New York Yan- kees winning their first world series in 18 years, and the OJ Simpson civil trial starting. In the world of oph- thalmology, there was a glossy new magazine in town, called EyeWorld, set on producing keenly researched articles on the latest in the field. EyeWorld asked the medical editor at the helm during its start and forma- tive years, Marguerite McDonald, MD, to reflect on Volume 1, Issue 1 and what was captivating the oph- thalmology world at the time. Dr. McDonald, who performed the first laser vision correction pro- cedure in the world, was a natural choice to shepherd the new maga- zine. Laser refractive surgery, in the form of PRK back then, was far from the juggernaut it ultimately became. The premier EyeWorld feature high- lighted PRK, which was off to a very modest start. "It did take off a bit slowly because in those days there was significant discomfort during the first week and a slow return of vision," Dr. McDonald said, adding that highly motivated individuals were the ones opting for the proce- dure, which had a rough first week in terms of pain back then, but which even in 1996 boasted excel- lent results. Once LASIK came along, practitioners began doing both. "In Italy today, it's 70% to 80% PRK and 20% to 30% LASIK, whereas it's the reverse in the U.S. right now," Dr. McDonald said. Looking back at EyeWorld 20 years ago continued on page 20 swimming, and doing other activi- ties. "There were a bunch of factors that came together, plus excellent technolo- gy," Dr. McDonald said. "Even 20 years ago the results for laser vision correction were excellent for PRK and LASIK. The results have only gotten better and, of course, the market penetration was big." Another article physicians read in the first EyeWorld was on using LASIK and PRK for failed RK patients. While this today is no longer a preoccupation of most practitioners, there are still millions of prior RK patients out there, Dr. McDonald pointed out. However, 20 years later, an EyeWorld headline on RK would have a different slant, with most such patients now in their older years. "Most of them are approaching cataract surgery age," she said, adding that in such cases using the ORA (Alcon, Fort Worth, Texas) intraoperatively can help practitioners come up with the prop- er IOL lens power. But back in 1996 when the priority was enhancing such patients' refractive outcomes, practitioners were still seeking the best route. "LASIK after RK turned out not to work all that well because the LASIK flap in some cases started to come apart," Dr. McDonald said. "But PRK worked and it still works." LASIK flaps and the need for microkeratomes were front and

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