Eyeworld

51 EW FEATURE June 2017 • Rebirth of laser vision correction AT A GLANCE • Visual acuity results from LASIK have continued to improve; a large portion of patients can now achieve vision better than that from the use of glasses. • Technological advances have pushed LASIK to become safer. • Complications and side effects from LASIK such as dry eye, glare, and halos are rare. They tend to occur immediately postoperatively and decrease over time. • Patient satisfaction has become a measure of LASIK quality of growing importance. • Over the long term, LASIK is safer than the use of contact lenses. by Vanessa Caceres EyeWorld Contributing Writer them with patients. However, he emphasizes that major complica- tions like vision loss, infection, or retinal issues are rare. "The inci- dence is 1 in 10,000 in the U.S. We've done more than 55,000 pro- cedures [at our practice] and never had a patient with major, long-term vision loss. That's not to say every- one is perfect, but I always say if you use modern equipment, keep a sterile OR, and choose patients properly, you'll keep your risks low," Dr. Durrie said. Although the need for a LASIK enhancement is not a safety issue, patients may perceive it as such, Dr. Durrie said. "The incidence of needing an enhancement is about 3%. Patients are reassured to know that 97% of the time, they're done [in one procedure]," he said. Safety and contact lenses Many patients who have LASIK have used contact lenses in the past and had trouble with them or simply got tired of the daily routine. One area of interest to surgeons—and patients—is how modern LASIK fares against contact lenses in terms of safety and patient satisfaction. A study published last year and led by Marianne Price, PhD, Indianapolis, found that compared with contact lens use, LASIK improved night driving and had higher patient satis- faction levels at 1, 2, and 3 years of follow up. 4 LASIK also significantly Surgeons and industry continue to improve outcomes and boost patient satisfaction S ince its 1999 approval by the U.S. Food and Drug Administration (FDA), LASIK has been an effec- tive vision correcting pro- cedure, and its potential to improve vision has continued to evolve. When LASIK was first approved, 90% of patients achieved 20/40 uncorrected visual acuity (UCVA); 50% to 60% of patients achieved 20/20, said Daniel Durrie, MD, clinical professor of ophthalmology, University of Kansas Medical Center, and founder, Durrie Vision, Over- land Park, Kansas. "At that point, we could say there was a high likeli- hood that patients would pass their driving test without glasses, but we couldn't say they would see better than with their glasses," he said. As technology has improved and as refractive surgeons have focused on better patient screening, the percentage of patients achieving 20/20 is more than 90%, according to a report from Sandoval et al. last year. 1 The Sandoval report was a review of articles about LASIK and encompassed nearly 68,000 patients. A 2013 study of U.S. Navy avi- ators found that 98.3% of patients Looking at LASIK's advances continued on page 52 The higher order aberration ablation treatment pattern, which was added to the standard myopic and astigmatism profile. Best corrected vision with glasses was 20/15 preop and 20/12 postop. Source: Francis Price Jr., MD with myopia or mixed astigmatism had a UCVA of 20/20 or better. 2 The Patient-Reported Outcomes With LASIK (PROWL) studies from the FDA found that 95% of patients had 20/20 or better binocular UCVA at 3 months postoperatively. 3 There's a greater number of pa- tients achieving 20/15 or even 20/12 UCVA now, thanks to recent advanc- es like topography-guided LASIK, said Francis Price Jr., MD, founder, Price Vision Group, Indianapolis, and president of the board, Cornea Research Foundation of America. "The discussion over the last 15 years has been whether we could make people see better than with glasses. It's taken some work, but I think that's where we've arrived today," Dr. Durrie said. LASIK technology One impetus behind LASIK advances has been the evolution of technol- ogy. "It's fun to look back. I was in the first clinical trials [for LASIK], and we had this argon fluoride laser and were trying to figure out how to use it. We were discussing if we should be opening or closing the diaphragm and where to center the procedure," Dr. Durrie said. Tracking systems were devel- oped through time so surgeons didn't have to worry about patients moving. Iris registration was devel- oped to handle an eye that torqued or turned. Flying and variable spot lasers were a major technological break- through because they made the procedure more flexible and helped surgeons correct more errors, Dr. Durrie said. The development of larger op- tical zones helped cut down on the amount of glare and halos that early treated patients experienced, Dr. Price said. "When we started transi- tion zones, we virtually eliminated glare and halos and problems with pupil size," he said. Wavefront-guided and wave- front-optimized technology also helped to advance LASIK accuracy. The use of the femtosecond laser for flap creation instead of the mechanical microkeratome helped make LASIK safer, said Elizabeth Hofmeister, MD, refractive surgery advisor for Navy Ophthalmology, San Diego. "This allows us to create flaps with much greater precision and safety than a bladed microker- atome. We can also create a 'reverse bevel' to create a dovetailed fit of the flap back into its bed, reducing the chance of late flap dislocations," she said. Studies in the U.S. Navy have shown that LASIK flaps are stable to blast injuries and G-forces, Dr. Hofmeister added. LASIK complications, side effects Glare, halos, and dry eye are all complications or side effects asso- ciated with LASIK through time. Yet recent research shows these side effects, if they occur at all, are transient. "Patients can be symptomatic early on but at 3 to 6 months, the incidence of dry eye postoperative- ly is still fairly small," said Kerry Solomon, MD, Carolina Eyecare, Charleston, South Carolina. "Most recent studies indicate that LASIK tends to make dry eye better." Similarly, night vision and glare tend to get better for patients, although there is a small subset of patients who continue to experience problems with these, Dr. Solomon said. This is something that the PROWL investigators reported 3 — still, even in these patients, satisfac- tion with the procedure was higher than 95%, Dr. Solomon added. Even with the low risk for com- plications, Dr. Durrie thinks it is crucial to discuss the possibility of

• Blank Page
• Blank Page (1)