Eyeworld

EW FEATURE 52 Rebirth of laser vision correction • June 2017 found more than a 95% satisfaction rate. 1,3 The high level of satisfac- tion is for several reasons, said Dr. Solomon, who was a co-investigator in the Sandoval study. "We're doing a better job at patient selection, we have better technology to assist with the screening process, and we have better technology to create flaps and better lasers to perform abla- tions," he said. "There's been a lot of research and development devoted to LASIK." The use of validated ques- tionnaires like the one developed through PROWL can help refractive surgeons continue to monitor for outcomes and visual quality, sur- geons said. Future of LASIK Just as a great deal of research has led to LASIK advances in the first decades of the procedure, more advances will continue. More sophisticated diagnostic technol- ogy that spurs continuous quality improvement will likely refine the procedure, as will the addition of topography, Dr. Durrie thinks. Even though LASIK fell on hard times during the recession, Dr. Durrie regularly has parents—many of whom had LASIK—now bringing their older children to his practice and asking when they can have LASIK. This and the large number of people who can't seem to stick to contact lenses point toward an untapped market, he said. The addition of new refractive procedures like small incision lent- icule extraction (SMILE, Carl Zeiss Meditec, Jena, Germany) shows a re- newed interest in LASIK procedures, Dr. Durrie said. "SMILE may be comparable someday but not now. For now, we can get out the story about how safe LASIK is," Dr. Price said. "I think we'll see more and more people have LASIK. If LASIK is done correctly, it's extremely safe and predictable." EW References 1. Sandoval HP, et al. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016;42:1224–1234. 2. Tanzer DJ, et al. Laser in situ keratomileusis in United States Naval Aviators. J Cataract Refract Surg. 2013;39:1047–1058. 3. Eydelman M, et al. Symptoms and satis- faction of patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis studies. JAMA Ophthalmol. 2017;135:13–22. 4. Price MO, et al. Three-year longitudinal survey comparing visual satisfaction with LASIK and contact lenses. Ophthalmology. 2016;123:1659–1666. Editors' note: Dr. Durrie has finan- cial interests with Johnson & Johnson Vision (Santa Ana, California) and Alcon (Fort Worth, Texas). Dr. Solomon has financial interests with Alcon. Drs. Hofmeister and Price have no financial interests related to their comments. The views and opinions expressed by Dr. Hofmeister are her own and do not necessarily reflect the official position of the U.S. Navy, Department of Defense or Federal Government. Contact information Durrie: ddurrie@durrievision.com Hofmeister: elizabeth.m.hofmeister.mil@mail.mil Price: fprice@pricevisiongroup.net Solomon: Kerry.solomon@carolinaeyecare.com decreased self-reported rates of eye infections, ulcers, and abrasions and did not significantly raise the inci- dence of dry eye symptoms. Dry eye symptoms were increased, however, compared with baseline of glasses. The study included 1,800 subjects who had LASIK or contin- ued using contact lenses at 20 sites around the U.S. LASIK patients had higher levels of patient satisfaction compared with those continuing to use contact lenses and glasses. There's an underappreciated safety aspect when you compare LASIK and contact lens use, Dr. Price thinks. "With LASIK, you have doc- tors paying attention to screening and treatment protocols. For contact lenses, [safety] comes down to each user," he said. Dr. Price was a co-in- vestigator of the recently published study comparing LASIK and contact lenses with Dr. Marianne Price. "I have taken care of many patients who have required corneal transplants after visually devastat- ing central corneal ulcers associated with contact lenses," Dr. Hofmeister said. "They carry greater dangers than many people realize," especial- ly in a military environment, she added. Patient satisfaction One factor not tracked with LASIK early on was patient satisfaction. This led to some concern from the FDA, Dr. Price said. Since then, stud- ies have found consistent reports of high patient satisfaction; the study from Sandoval et al. reported an overall 98.7% satisfaction rate with LASIK, and the PROWL research Looking continued from page 51 Summit OmniMed laser (1990s) Source: Daniel Durrie, MD AT A GLANCE • Attending a training course and finding a mentor are two good ways for comprehensive ophthalmologists to learn new refractive procedures. • In addition to learning a new procedure, knowing how to choose the right patient is extremely important. • Learning refractive procedures will allow surgeons to help their patients who may need further correction following cataract surgery. by Ellen Stodola EyeWorld Senior Staff Writer Physicians discuss expanding the practice of the comprehensive ophthalmologist to include more procedures I n this changing ophthalmic en- vironment, with new technol- ogies and innovations, many ophthalmologists are beginning to incorporate a wide variety of procedures into their practice scope. How to start performing refractive surgery Comprehensive ophthalmologists are doing more than just cataract surgery and are learning refractive and corneal refractive procedures, including PRK and LASIK. Elizabeth Yeu, MD, Virginia Eye Consul- tants, Norfolk, Virginia; Kathryn Hatch, MD, Massachusetts Eye and Ear, Waltham, Massachusetts; and Gregory Parkhurst, MD, Parkhurst NuVision, San Antonio, Texas, com- mented on why it could be valuable for ophthalmologists to offer more procedure options, tips for learning to perform these refractive surgeries, and how to incorporate them into practice. Why perform corneal refractive surgery? With the increasing popularity of refractive cataract surgery, patient expectations run high, Dr. Hatch said. Sometimes even with surgi- cal planning and newly available continued on page 54

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