EyeWorld Asia-Pacific September 2014 Issue

14 September 2014 EWAP FEAturE said. Dr. Stonecipher agreed, as the transepithelial approach is “easy and quick. The patients don’t complain, and with the lower refractive error the outcomes are good.” The so-called “transPRK” is considered an advanced version of surface treatments (LASEK, epiLASIK, and PRK). In this technique, the epithelium is ablated by the laser without the eye coming into direct contact with any instrument. For cataract practices that have adopted the use of a femtosecond laser, Dr. Devgan said the transition to LASIK for enhancement surgery is fairly straightforward, “particularly if the practice has a femtosecond laser that does both cataract and corneal flaps.” Choosing between PRK and LASIK is based on refraction and visual rehabilitation, Dr. Stonecipher said. “That said, the laser astigmatic relaxing incision and LASIK patients heal instantly. However, the economics of these enhancements is a bit higher,” he said. “In most instances my PRK enhancements can be done using an enhancement card on my VISX laser [Abbott Medical Optics], and the outcomes are similar to those of LASIK for this patient population.” In order to properly use an excimer laser, surgeons need to be certified, Dr. Hoffman said, and need to be overseen for the first few cases. Additionally, some physicians use a trephine with alcohol to soften the epithelium, then “use a blunt blade to remove the epithelium all at once, which has a very short learning curve,” Dr. Hoffman said. For surgeons who opt to use alcohol to facilitate the process, Dr. Hoffman recommends a 30-second exposure, but 40 seconds “for younger patients.” Building confidence For those who need a hyperopic correction, Dr. Hoffman recommends PRK. “You can correct for hyperopic outcomes with LASIK, but there’s a greater chance the flap isn’t as wide as you’d like it to be. With PRK, that’s not an issue. Hyperopic corrections tend to need a 9-mm flap or larger, whereas myopic corrections only need 8.0–8.5 mm,” he said. Centration of the flap is more of an issue when the correction is hyperopic, he added. “But if the surgeon is proficient with femtosecond laser for advanced cataract surgery, all those learning curve issues are significantly diminished. For the non-corneal surgeon, however, PRK is truly a non-threatening, easier technique,” Dr. Hoffman said. EWAP Editors’ note: The physicians have no financial interests related to their comments. Contact information Devgan: devgan@gmail.com Hoffman: rshoffman@finemd.com Stonecipher: stonenc@aol.com Experts - from page 12