EyeWorld Asia-Pacific December 2011 Issue

32 December 2011 EW REFRACTIVE What patients are really thinking about when it comes to LASIK options M yths can be powerful. Unfortunately, when it comes to LASIK there are some myths that have evolved over the last decade or so that are just plain confusing and may ultimately be keeping potential patients at bay. EyeWorld asked several leading practitioners to share some of the key misconceptions that they’ve recently come across. Louis E. Probst, MD, national medical director, TLC Laser Eye Centers, pegs cost as the top misconception for prospective patients. “The average price for LASIK from an industry perspective is pretty close to $2,000 per eye, and that has been shown by Market Scope,” Dr. Probst said. Cut-rate advertisements, however, give patients the impression that the rate is in the US$1,000 range. “Patients do understand that what they got from their cursory analysis isn’t the state-of-the-art LASIK that they want for their eyes,” he said. Dr. Probst commonly comes across patients who have done internet searches who worry that night glare and dry eyes after LASIK are significant concerns. Many prospective patients are not differentiating between the old technology and custom LASIK. “The reality is that since we have started using custom treatments, and that has been over 5 years now, night glare is not a significant factor and is not related to pupil size,” Dr. Probst said. He pointed to studies done by Mihai Pop, MD, and Steven Schallhorn, MD, which clearly show that pupil size is not correlated with night vision disturbances. Likewise, Dr. Probst finds that dry eye was a much worse issue with mechanical microkeratomes than with the current femtosecond laser. “Now that we are so conscious of the risk of dry eye, we use lubricating drops, like Restasis [cyclosporine, Allergan, Irvine, Calif., USA], which is extremely effective when started pre-operatively, and now that we use the femtosecond laser, which makes thinner, slightly smaller flaps than mechanical micokeratomes, the incidence of dry eye has become a small concern,” Dr. Probst said. Many fall victim to the idea that LASIK is not an effective treatment for high myopia. “I think that patients often think that if they’re anything greater than –6 that they’re essentially “blind” and there’s no way that their prescription could be treated,” Dr. Probst said. “Of course that’s not true.” Likewise, some doctors may think that it’s better not to do refractive surgery in such high myopes or to switch to an intraocular- type procedure like a phakic IOL. With consistent 100-micron femtosecond flaps, however, this is no longer the case. “We can safely do custom treatments given adequate corneal thickness up to –10, –11, or even –12 D of myopia,” Dr. Probst said. “The results are excellent.” A major myth that Robert K. Maloney, MD, clinical professor of ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, Calif., USA, encounters is the idea that LASIK is dangerous. “There’s good evidence that LASIK is safer than wearing contact lenses,” he said. “These patients come in wearing contacts that they wear every day, and every day they take a risk of getting bacterial keratitis and then they agonize over the presumed risks of LASIK.” LASIK, he stressed, is safer than contact lenses in terms of serious irreversible loss of vision. Another common myth that he comes across is the idea that LASIK can’t correct farsightedness, which has been common since the late 1990s. “I think that this myth may come from the fact that LASIK can’t cure presbyopia, and many patients confuse farsightedness with presbyopia,” Dr. Maloney said. A related myth is that LASIK can’t help reading vision. This is untrue. “There are a lot of people for whom we can help their reading vision tremendously,” Dr. Maloney said. “If they’re emmetropes, we can make one eye nearsighted, and if they’re younger hyperopes we can correct their hyperopia.” One big myth that he comes across is the idea that LASIK can’t correct astigmatism. “In the mid 90s we couldn’t correct astigmatism, but by the late 90s it was routine,” Dr. Maloney said. “But somehow that’s still out there.” Daniel S. Durrie, MD, clinical professor of ophthalmology, University of Kansas, Overland Park, Kan., USA, often comes up against this myth. “Out of ten people who come in with a misconception, nine of them will say that we can’t correct astigmatism,” Dr. Durrie said. He finds that sometimes it is the person who is selling them glasses or contact lenses who is the source of the misinformation. The irony is that he finds that these patients are particularly well suited to LASIK. “My feeling is the more astigmatism the better because astigmatism makes it hard to wear glasses and contact lenses,” he said. He frequently encounters the myth that laser surgery will lead to the use of reading glasses at an earlier age. “I can understand how they got the misconception because we do not correct presbyopia,” Dr. Durrie said. However, monovision can sometimes enable patients to forgo reading glasses for a time. “It may not keep people completely out of reading glasses as they get older, but it certainly doesn’t make them need these at an earlier age,” he said. A third myth that Dr. Durrie comes across is the idea that LASIK performed a decade before has worn off. This is generally spurred by the fact that middle-aged patients have begun running into problems with presbyopia. “I think that we have done a poor job of educating patients, even patients who have had laser surgery, about what to expect in the future and what’s going to happen to their eyes,” Dr. Durrie said. “Once I tell people that their lens has a problem but there are things that we can do about it, they’re very relieved.” Dr. Maloney frequently encounters this same myth. “A lot of people think that it’s like a face lift, you fix it and then it droops Toppling major myths about LASIK by Maxine Lipner Senior EyeWorld Contributing Editor back after 5 or 10 years,” he said. “I have to reassure them that it doesn’t wear off—vision doesn’t change obviously, but the effect doesn’t wear off, or at least that’s rare.” To help combat such myths, Dr. Durrie relies on modern media. “I think that the internet is fabulous,” he said. “With Facebook, Twitter, blogs, and websites we have great tools to get information to not only our patients but also to the public.” In his view, too much time is spent trying to educate the public on nuances in technology instead of what they really want to know, such as whether they can rid themselves of their astigmatism. He strives to address this. “We just put out a broadcast email to our patient base and the headline was, ‘Do you have astigmatism? Yes, it can be corrected,’” Dr. Durrie said. “I think that’s the type of message that we need to get out there.” EW Editors’ note: Dr. Durrie has financial interests with Abbott Medical Optics (AMO, Santa Ana, Calif., USA) and Alcon (Fort Worth, Texas, USA/ Hünenberg, Switzerland). Dr. Maloney has financial interests with AMO. Dr. Probst has financial interests with AMO and TLC Vision. Contact information Durrie: 913-491-3737, Ddurrie@Durrievision.com Maloney: 310-208-3937, rm@maloneyvision.com Probst: leprobst@gmail.com