Eyeworld

EW REFRACTIVE 78 March 2017 cations, an intact Bowman's mem- brane, reduced eye dryness (Sicca syndrome), rare epithelial ingrowth due to the small opening, and the complete absence of sound and smell," he explained. In SMILE, the refractive correc- tion is carried out in the stroma. The laser cuts the lenticule to size, which is then removed through a small opening. Refractive results had new options, but regeneration was slow, the procedure caused pain, and the risk of haze made for unhappy patients. The keratome solved these problems; however, flap complications like free cap, incom- plete flap, buttonhole, thin flap, and wrinkles overshadowed some poten- tially good outcomes. Even femto- second laser showed disadvantages such as flap complications, dry eye, ingrowth beneath the flap causing astigmatism and opacification, and other interface problems. Now, there is a new surface-protecting tech- nique for corneal refractive surgery that has both pros and cons. ReLEx [refractive lenticule extraction]– SMILE [small incision lenticule extraction] (Carl Zeiss Meditec, Jena, Germany) has the advantages of no flap and therefore no flap compli- have been shown as comparable to LASIK. 1 Studies substantiating the advantages of SMILE report the im- portance of retaining the integrity of the anterior corneal lamellae, which maintains a higher resistance to tear- ing and results in a reduced risk for keratectasia. There are no flap-relat- ed complications and less dry eye. The SMILE procedure also preserves the sensory nerve fibers and allows faster corneal nerve rehabilitation. The procedure allows better contrast sensitivity and fewer higher-order aberrations than LASIK. The advan- tage over femto LASIK is the use of a single laser as opposed to two dif- ferent ones. Femto LASIK, however, still has the edge when it comes to applicability in both myopes and hyperopes, and for easier retreat- ments, which are more challenging in SMILE. "But, be warned. In spite of these positive developments, sur- geons should remain questioning," Dr. Priglinger said. "New technol- ogies have been dropped before due to high complication rates and bad results, such as multifocal laser therapy, the cachet anterior chamber lens, various presbyopic corrections, and even corneal inlays are being reconsidered. We have to be wary of accepting new technologies and new procedures too readily. It is import- ant that patients have a safe and sure outcome. You have to be able to offer an effective and safe therapy, not a personal enhancement, but a valid therapy. The happiest patients are the ones who leave your office with their vision and visual system intact. You really have to distin- guish between curative medicine that treats a medical problem and elective medicine that improves someone's quality of life. It is a huge market and there is certainly some bias associated with refractive proce- dures, but I am happy not to have to deal with unhappy patients. None- theless, in spite of my early caution, there is a place for refractive lasers in curative medicine," Dr. Priglinger said. EW Reference 1. Reinstein DZ, et al. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. Eye and Vision. 2014;1:3. Editors' note: Dr. Priglinger has no financial interests related to his com- ments in this article. Contact information Priglinger: Siegfried.Priglinger@med. uni-muenchen.de Come Visit Us at ASCRS 2017 in Booth 1606 to learn how to best organize the Flow and Space in your practice. "We have made at least $5 for every dollar we spent on Practice Flow Solutions. Working with Practice Flow Solutions saved me from a really bad plan from the general architect. Your pre-design Assessment was very detailed and pointed out all the flow issues with the plan I had. Invaluable." Dr. Edward Meier Apex Eye Cincinnati, OH www.PracticeFlowSolutions.com F L O W A S S E S S M E N T S S P A C E A S S E S S M E N T S O F F I C E D E S I G N + ONSITE EFFICIENCY STUDIES + IDENTIF Y THE PROPER AMOUNT OF SPACE + MA XIMIZE YOUR WORKFLOW LOGJAMS IN YOUR PATIENT FLOW? NOT SURE YOUR SPACE IS SUPPORTING YOUR PRACTICE WELL? Refractive continued from page 76

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