Eyeworld

EW FEATURE 44 Rebirth of laser vision correction • June 2017 AT A GLANCE • Physicians say new laser vision correction technologies have expanded patient candidacy for corneal refractive surgery. • Three relatively recent advances include topography-guided ablations, iDesign wavefront technology, and small incision lenticule extraction (SMILE). • With these options, physicians see the opportunity to select the procedure that best meets a patient's condition. by Liz Hillman EyeWorld Staff Writer eyes," Dr. Wiley said, adding that it has also started bringing in patients who might have had earlier refrac- tive surgery and who experienced mild side effects or had irregularities in their eye to begin with. "We saw the ability to attract new patients with topography-guided [technol- ogy] but also maybe some patients who weren't quite as excited with their original treatment years ago; it may be a therapeutic option to help them." A topographic approach to laser vision correction—which takes a highly detailed map of the entire cornea—Dr. Thompson said, re- vealed that there were more patients than previously realized who had elevations and depressions within country, and phakic IOLs, I've seen a lot of refractive surgery advance- ments," Dr. Thompson continued, adding that he currently performs all of these corneal refractive proce- dures. Topography-guided ablations In his practice, Dr. Wiley credits topography-guided PRK and LASIK— first FDA approved for Contoura Vision (Alcon, Fort Worth, Texas) and later the Customized Aspheric Treatment Zone (CATz, Nidek, Fre- mont, California) technology—with bringing in patients who might have been on the sidelines of laser vision correction. "We saw a bump in our proce- dure volume with that for virgin procedures would be wavefront, but topography-customized in this group jumped to nearly 20%. LASIK, now more than 25 years old, has come a long way, said Stephen Slade, MD, Slade & Baker Vision Center, Houston. "LASIK is now modern LASIK— eye trackers, fast ablations, femtosec- ond laser keratomes, sophisticated aspheric ablations. It's not at all the same procedure, and the results are wonderful," Dr. Slade said. "Wave- front-optimized LASIK … is 94–95% 20/20. Topographically based abla- tions … are in the same range." While wavefront ablations, first approved by the U.S. Food and Drug Administration (FDA) in the early 2000s, measure aberrations or irreg- ularities in the total eye and then fix them on the cornea, topographically based ablations, approved in 2013, make the cornea itself more regular. Thus, the latter procedure may be more suited for older patients po- tentially facing cataract surgery with multifocal IOLs in the next decade where a more regular cornea would be preferred, Dr. Slade said. More recent advances in laser vision correction include the iDesign Advanced WaveScan Studio System (Johnson & Johnson Vision, Santa Ana, California)—FDA approved in May 2015—and SMILE—FDA approved in September 2016 for the VisuMax laser (Carl Zeiss Meditec). "I think the increase in the volume of refractive surgery that we're experiencing is because patient satisfaction levels are at an all-time high," said Vance Thompson, MD, Vance Thompson Vision, Sioux Falls, South Dakota. "I think it's because of the big companies out there con- tinuing to do research and develop- ment to bring us technologies that fit various indications, which leads to high patient satisfaction. When patients are telling other people and their doctors about their joy after refractive surgery, that's what drives the market. I think we work for the people and if we make them happy, [this] is what leads to a growth in refractive surgery. "As far as new technologies, I think they're playing a great role in increasing patient confidence, less- ening the fear factor, and increasing patient satisfaction postoperatively. Having been an investigator in the PRK, LASIK, and SMILE trials in this New technologies are bringing patients in off the sidelines and expanding the possibility of laser vision correction to those who might not have been candidates before, physicians say D riven by new technologies, techniques, better patient selection, and thus better outcomes, some practices have seen a resurgence in corneal refractive surgery, especially on the laser vision correction front, said William Wiley, MD, medi- cal director, Cleveland Eye Clinic, Cleveland. According to the 2016 ASCRS Clinical Survey, the average annual laser vision correction volume was 301 cases—relatively consistent with previous ASCRS Clinical Surveys. But respondents, on average, projected that in 3 years their annual laser vision correction volume would increase by nearly 80%, up to an av- erage of 535 cases annually. Among U.S. respondents, on average, 86% said wavefront technology covered the majority of their current corneal refractive procedures, compared to 48% among international respon- dents. Conversely, international respondents were more likely to perform standard ablations, small incision lenticule extraction (SMILE, Carl Zeiss Meditec, Jena, Germany), and topography-guided procedures. In the next 3 years, 73% of U.S. respondents said they thought the majority of their corneal refractive New technologies in corneal refractive surgery poised to spur growth Dr. Wiley performs the femtosecond laser portion of SMILE with the VisuMax laser. This image shows the initial portion of the posterior "refractive cut," which is the most posterior laser cut in SMILE. This is created in a circular pattern starting at the periphery and moving central.

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