Eyeworld

EW REFRACTIVE 44 July 2017 of keratitis risk. Furthermore, the data for daily wear of soft contact lenses can be extrapolated to show that the lifetime risk for microbial keratitis is much lower with LASIK than contact lenses," Dr. Masters said. While Masters et al. looked at risk of infection with various types and wear schedules of contact lenses compared to infection risk with LASIK, there are many other factors to consider when evaluating a pa- tient for LASIK, Dr. Masters said. "Our group has not looked into any of the other specifics risk com- parisons, however our analysis may serve as a model to springboard such investigations and discussions," Dr. Masters said. Masters et al. wrote that future comparisons could look at vision loss, dry eye, flap complications, and more, to better understand the safety and efficacy of contact lenses compared to LASIK. "The present analysis lends fur- ther evidence to support the shifting notion that over time the risks of contact lens use and LASIK are closer than previously thought," the inves- tigators wrote. EW Reference 1. Masters J, et al. Risk for microbial keratitis: Comparative metaanalysis of contact lens wearers and post-laser in situ keratomil- eusis patients. J Cataract Refract Surg. 2017;43:67–73. Editors' note: Dr. Masters has no finan- cial interests related to this article. Contact information Masters: jordanmasters5@gmail.com by Liz Hillman EyeWorld Staff Writer to 5 years, the investigators wrote that this "showed that daily wear of soft lenses and extended wear of soft lenses led to significantly more cases of microbial keratitis per 10,000 patients than LASIK." Dr. Masters said the microbial keratitis risk with extended wear of soft contact lenses was about 17 times that of LASIK when extrapolated to 5 years. The investigators also explained in the paper that they assumed, for their analysis, LASIK carried a one-time risk for microbial keratitis after the healing period without enhance- ments or retreatments. Nonetheless, when a 10% retreatment rate was incorporated, the results changed very little. "Our results indicate that over time the risk for microbial keratitis is higher for soft contact lens use than for LASIK, especially for extended wear lenses," Masters et al. wrote. "If we think about the popula- tion of patients that we see and their current contact lens hygiene, this is a huge population that could con- ceivably benefit from LASIK in terms with LASIK than contact lenses. The difference is even greater for extend- ed wear of soft contact lenses where just 1 year of wear demonstrated significantly more cases of keratitis than LASIK. "If a patient is a candidate for corneal refractive surgery and he or she is currently wearing contact lenses, these finding can and should be added to the discussion with patients regarding the risks and ben- efits of each route," Dr. Masters said. The research published in the Journal of Cataract and Refractive Surgery, based on data obtained from a literature search between De- cember 2014 and July 2015, found microbial keratitis incidence in daily soft contact lens wear compared to post-LASIK patients at 1 year was not statistically significantly differ- ent. However, extended soft contact lens wear (which Dr. Masters noted included patients who might occa- sionally wear lenses overnight) com- pared to post-LASIK at 1 year saw three times as many cases of micro- bial keratitis. Extrapolating this out Risk is 17 times higher with extended soft contact lens use compared to LASIK patients at 5 years postop A recent study found that while microbial keratitis is rare with contact lens use or LASIK surgery, the risk over time increases for contact lens wearers, especially those in extended-wear versions, compared to LASIK. 1 "Microbial keratitis is an overall rare complication of both contact lenses and LASIK, but we all know this can be a life-altering event in a patient's life," said Jordan Masters, MD, corneal, external disease, and refractive surgery fellow, Kellogg Eye Center, University of Michigan, Ann Arbor, and previous resident at the University of Tennessee, Memphis, where this analysis was completed. "Our findings for daily wear of soft contact lenses can be extrapolated to show that the lifetime risk for microbial keratitis is much lower Study finds risk of microbial keratitis is higher for contact lens wearers compared to LASIK patients Research highlight " Our findings for daily wear of soft contact lenses can be extrapolated to show that the lifetime risk for microbial keratitis is much lower with LASIK than contact lenses. " —Jordan Masters, MD

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