EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78708
June 2012 International techniques and technology February 2011 EW FEATURE 45 seems to be able to pick up the changes with a parameter that we can actually measure. The area of research is still young." Dr. Reinstein said a 2010 study by Daniel Kampik, M.D., clinical research associate, and colleagues at University College London, Institute of Ophthalmology, showed that CXL does not change the LASIK ablation rate. "It does change nomograms, so this is a consideration if one wants to combine the two procedures," he said. Risks and benefits Avoiding ectasia is the primary ben- efit of combining CXL and LASIK, but a more predictable effect of LASIK has "yet to be proven," ac- cording to R. Doyle Stulting, M.D., Woolfson Eye Institute, Atlanta, and professor of ophthalmology, Emory University, Atlanta. "Indications for the combina- tion might include eyes at risk for ectasia, but some argue that PRK [photorefractive keratectomy] is a better procedure for those individu- als," Dr. Stulting said. He added that he doesn't see a benefit to promot- ing routine CXL at the time of LASIK because of the downsides, including cost, risk of infection, additional surgical time, and risk of endothelial cell damage. "Many would argue it is not a good idea for eyes at risk for ectasia because they would be better served by CXL and PRK," Dr. Stulting said. "They might also argue that it is not a good idea for eyes not at risk for ectasia." Even the ectasia benefit remains to be seen, said retired Navy Capt. Steve C. Schallhorn, M.D., former director, Cornea Service & Refractive Surgery, Naval Medical Center, San Diego; and professor of ophthalmol- ogy, University of California, San Francisco. "Because we do not know if CXL combined with primary LASIK will prevent ectasia, there is no way to assess the risk/benefit ratio," Dr. Schallhorn said. "No one has estab- lished evidence-based indications for the combination." Dr. Schallhorn said he has yet to see clinical studies that combine pri- mary LASIK with CXL. "The issue is ectasia prevention, and ectasia can manifest years after LASIK," Dr. Schallhorn said. "Any studies would require long-term follow-up and need to be combined with a control population who un- derwent LASIK without CXL. This would be a difficult and expensive study to conduct." Dr. Schallhorn doesn't believe it's a good idea to use CXL in pri- mary LASIK procedures, especially if the patient is an otherwise excellent candidate for LASIK. "In fact, promoting CXL with primary LASIK for all patients could do the community and the market great harm because essentially the message would be that LASIK with- out CXL is unsafe, which of course is not true." Challenges would be additional surgical time and exposure to addi- tional products (risk of infections), possible endothelial cell damage, and possible side effects of kerato- cyte death, Dr. Stulting said. If the procedure isn't performed correctly, Dr. Tomita noted, compli- cations could include severe DLK or increasing striae. "When performed as instructed, the post-operative outcomes at 1 continued on page 46 The VISUAL Clinical Trials for Uveitis Clinical Trial Recruitment for Patients Diagnosed with Non-Infectious Intermediate, Posterior, or Pan-Uveitis Seeking Adult Patients for Clinical Trial Enrollment Right now, our US investigators are seeking patient referrals. Your patients may qualify if they: s !RE P G TREATING OTHERIMMUN E MEDIATEDDISEASE S PP s s AT LEAS T YE RSA OLD s(AVEBEENDIAGNOS ED OR PA N UVEITIS !RETAKINGPREDNISON E s IN -EET OTHER INCLUSION AND EXCLUSION CRITERIA BOTH EYES Seeking New Investigators 7E 6)35!, For more information on referring a patient or becoming an investigator, visit www.visualclinicaltrials.com or call 1-800-931-6190. ARE LOOKING FOR 53 OPHTHALMOLOGISTS TO BECOME INVESTIGATORSFORTHE #LINICAL 4RIALS WITH NO N INFECTIOUSINTERMEDIAT E POSTERIO R (AVE"EST#ORRECTED6ISUAL!CUIT Y "# OR EQUIVALENTCORTICOSTEROI #66 ! OF A MI N D IMUM O F LETTERS Scan the code for more information © 2012 Clinical Trial Marketing Communications