EyeWorld Asia-Pacific December 2011 Issue

December 2011 11 EW FEATURE Determining the best approach to get the patient spot on W hile all practitioners strive to hit LASIK refractions on the money, this is not always possible. Enhancements are unfortunately a fact of life in the industry. Richard L. Lindstrom, MD, adjunct professor emeritus, ophthalmology department, University of Minnesota, Minneapolis, Minn., USA, and founder, Minnesota Eye Consultants, Minneapolis, finds that the initial enhancement rate at TLC Vision, where he’s chief medical officer, is on the low side at about 2.6%. “I would say that the rate is about 5% nationwide,” Dr. Lindstrom said. Daniel S. Durrie, MD, clinical professor of ophthalmology, University of Kansas, Overland Park, Kan., USA, puts the enhancement rate in the 3-5% range with a couple of caveats. “Some people may have a higher enhancement rate or some may have a lower enhancement rate depending upon their tolerance for doing an enhancement,” Dr. Durrie said. He pointed out that he just scheduled a patient who is 20/15 (6/4.5) for an enhancement who has a little bit of residual higher-order aberration. “If you’re willing to do those it might increase your enhancement rate, maybe to the 7-8% range,” Dr. Durrie said. In addition, he pointed out that for practitioners who perform monovision or blended vision, their enhancement rates Up to the challenge: Dealing with enhancement techniques by Maxine Lipner Senior EyeWorld Contributing Editor AT A GLANCE • Early LASIK enhancements are typically done at the 3-month mark for myopes and at 6 months for hyperopes • If a retreatment is done based on outcomes from the 1-month visit, Dr. Durrie finds that there’s a 50% chance that this will be unnecessary • Thanks to self-sealing incisions, practitioners can perform retreatments relatively soon after IOL implantation—typically at the 2- to 3-month mark • Using the IntraLase to recut a flap is a boon for some and a bane of existence for others are much higher. “You have to hit both eyes exactly on the mark, so it’s more in the 15% range if you’re taking people for whom you’re trying to do monovision or blended vision,” he said. Early and late retreatments There are actually two groups of LASIK enhancement patients— early and late. Determining when to bring a patient back for an enhancement depends on in which group the case falls, Dr. Lindstrom finds. “The first enhancement is one that would occur within the first year,” he said. “That’s usually related to an under- or overcorrection.” Then there is a second group where the enhancement can be called for 5, 10, or even 15 years later, well after the eye has stabilized. “We sometimes call that a late vision adjustment or enhancement,” Dr. Lindstrom In the case of large refractive errors, physicians may consider piggybacking a lens Source: Richard S. Hoffman, MD Scraping of the epithelium for surface ablation. This technique can be used to avoid a risk of epithelial ingrowth Source: Steven C. Schallhorn, MD continued on page 12