EyeWorld Asia-Pacific March 2014 Issue

41 EWAP rEfrActivE March 2014 postop was marginally superior in the LASIK group. But by 15 days postoperatively, contrast sensitivity improved in the SMILE group, in particular for higher spatial frequencies (12 and 18 cycles/degree) where the difference between the SMILE and LASIK groups was not significant (p=0.15). By 3 months postop, contrast sensitivity was better in the SMILE group than the LASIK group at all spatial frequencies (p<0.0001). Comparison of RMS (root mean square) HOAs showed a significant difference between the groups, aberrations being lower in the SMILE group than the LASIK group postoperatively at day 15 and 3 months. Higher order aberrations are associated with ghost images, halos, starbursts, and poor vision under mesopic conditions. Higher order aberrations increased from a preop mean of 0.206±0.075 µ to 0.267±0.07 µ in the SMILE group and from a preop mean (RMS) of 0.263± 0.114 µ to 0.437±0.102 µ at 3 months postop in the LASIK group. We found 0.02 µ and 0.06 µ increases in coma and spherical aberrations following SMILE, and 0.10 µ and 0.14 µ following LASIK. Thus, we concluded, both Femto LASIK and ReLEx SMILE are excellent procedures for laser correction of myopia and astigmatism. However, SMILE gives superior results and thus better quality vision than LASIK. My practice itself has witnessed a shift from predominantly Femto Lasik to predominantly ReLEx SMILE. EWAP contact information Ganesh: chairman@nethradhama.org any refractive surgery depends on several factors, the most important of course being the refractive correction. However, various other factors which play an equally important role include contrast sensitivity, higher order aberrations, and the status of the tear film. We wanted to know if there is any difference between the quality of vision experienced by patients following ReLEx SMILE and LASIK. I regularly perform Femto LASIK as well as ReLEx SMILE. In my experience, refractive outcomes and patient satisfaction, though excellent following both LASIK and ReLEx SMILE, are far superior following SMILE. Detailed evaluation of preop and postop parameters including contrast sensitivity using Functional Acuity Contrast Test (F.A.C.T) and higher order aberrations (HOA) using iTrace revealed significant differences in postoperative parameters following SMILE and LASIK. We studied data from 25 patients who underwent ReLEx SMILE and 25 patients who underwent Femto LASIK with follow ups at day 1, day 15, and 3 months. At day 1, all patients attained uncorrected visual acuity of 20/25 or better irrespective of the procedure performed; 20 patients who underwent SMILE had UCVA of 20/10, three patients had 20/15 and the remaining two patients 20/20. Two patients following LASIK attained UCVA of 20/15, 21 patients attained 20/20 and Two patients 20/25. By day 15, all patients attained UCVA of 20/20 or better and by 3months similar refractive results were maintained. Contrast sensitivity at day 1 Raindrop - from page 39 in the non-dominant eye at the average age of 51, the range of errors spanned from –0.5 to 1.5 D. To judge the outcomes, Dr. Steinert said that the criteria for an excellent outcome was to be 20/25 or better uncorrected at all three distances: near, intermediate, and distance. “It’s a higher bar than we’ve typically known for these types of corrections,” he said. Results indicate that this goal is being accomplished in most patients, and it did not make a difference, he said, in terms of where in the range of –0.5 to 1.5 those patients fell. “The Raindrop provides uninterrupted visual function and patient satisfaction across a surprisingly wide range of preoperative refractive errors,” Dr. Steinert concluded in his presentation. further studies on the rain- drop and other factors to consider “As more results come in, particularly long term, refinements in power ranges are to be expected,” Dr. Steinert said. Bilateral implantation is an exciting possibility for the future. “A large number of patients retain excellent distance vision while gaining intermediate and near at the 20/25 or better level at all three distances,” he said. “In patients who achieve those results in the first eye, an implant in the second eye seems worth considering.” He noted that pilot studies outside the United States are exploring this with caution. Patient selection for the rain- drop Dr. Steinert said the ideal patients for the Raindrop inlay would be “presbyopes who desire improved intermediate and near vision and who meet the other criteria.” If the device was available in the U.S., he would be happy to recommend it to patients. “As with any device, the list of relative and absolute contraindications needs to be respected,” Dr. Steinert said. Dry eye syndrome, often in conjunction with meibomian gland disease as well as aqueous deficiency, needs to be diagnosed and treated before refractive surgery is considered. Dr. Waring said patient selection needs to be considered when moving forward with the Raindrop and other corneal inlays. “Patient selection is still absolutely critical, and these are not devices that you would use therapeutically in any way,” he said. Patients need to have a very healthy eye, he said, comparing the patient selection to that of a multifocal IOL. The patient needs to have minimal refractive error and astigmatism unless combined with an excimer treatment, the crystalline lens needs to be clear and the macula needs to be healthy, he said. The Raindrop is already in use in Europe. Dr. Steinert said approval in the United States will probably come in the next couple of years because of the multi-year follow-up requirements of the FDA. Moving forward, Dr. Waring said it will be important to gather even more information on the Raindrop and other inlays in development. The data so far is encouraging, but it’s important to pay attention to long-term follow- up for safety and efficacy. EWAP Editors’ note: Dr. Steinert has financial interests with Revision Optics. Dr. Waring has financial interests with AcuFocus. contact information Steinert: steinert@uci.edu Waring: waringg@musc.edu