EyeWorld Asia-Pacific December 2016 Issue

December 2016 EWAP refractive 47 ‘Real world’ outcomes better than clinical trial data, LASIK reviews show by Michelle Dalton EyeWorld Contributing Writer Figure 1. Predictability with LASIK for –11.00 to –0.50 D. There were only a handful of outliers, illustrating the increased predictability of modern day laser eye surgery. Source: Arthur Cummings, MBChB Patient surveys indicate a higher satisfaction rate with better visual out- comes than studies have shown M odern LASIK surgery has some of the highest patient satisfaction rates of any kind of surgery, and outcomes are better than what has been reported, according to some new research and expert opinion. At the 2016 ASCRS•ASOA Symposium & Congress, Kerry Solomon, MD , presented results from a systemic peer review literature search on LASIK published between 2008 and 2015. The meta-analysis showed uncorrected visual acuity (UCVA) of 20/20 or better could be achieved in 91% of eyes, and 99.5% were 20/40 or better. These results are “significantly better” than what had been reported in the U.S. Food and Drug Administration studies. Schallhorn et al. 1 assessed patient satisfaction and quality of life (QoL) outcomes 5 years post LASIK, and reported 91% were either satisfied or very satisfied with their outcomes. According to this analysis, “uncorrected vision was the strongest predictor of satisfaction … five years after surgery, satisfaction with LASIK remained high and most patients reported that QoL was improved.” 1 Further, the analysis showed that the vast majority of QoL issues could be alleviated by spectacle correction. Clinical experience Most high-volume refractive surgeons have similar findings in their own practices. “Our personal clinical experience mirrors that of the recent long-term patient-reported outcome data from Schallhorn et al. in a large series and also the updated trial study results. In most cases, our outcomes are even better than what they’ve reported,” said George Waring IV, MD , associate professor of ophthalmology, director of refractive surgery, Storm Eye Institute, and medical director, Magill Vision Center, Medical University of South Carolina, Charleston. Arthur Cummings, MBChB , consultant ophthalmologist, Wellington Eye Clinic and Beacon Hospital, Dublin, agreed. “Our results are very similar, and when speaking to colleagues, this is what the current standard appears to be, i.e., better than what the older FDA studies found and much like Dr. Solomon’s summary suggested.” Daniel Durrie, MD , professor of ophthalmology, University of Kansas Medical Center, and founder, Durrie Vision, Overland Park, Kansas, said his group’s results “are better than the ASCRS survey and Schallhorn et al., but we really concentrate on our metrics all of the time and are constantly improving them.” The key to both studies, however, is that surgeons should expect the majority of their patients to be highly satisfied and with very few retreatments, Dr. Durrie said. “Published literature should always be the minimum baseline because the reviews are retroactive,” he said. “We should be better now than we were 5 years ago.” Refractive surgeons should compare their own outcomes to these long-term studies, and “if their outcomes aren’t better, then they’re not improving.” For example, predictability and stability are excellent in today’s refractive arena, Dr. Cummings said. Figure 1 shows how predictable today’s surgery is. “Our safety data for losing two or more lines of distance visual acuity in our myopic group (baseline vision ranging from –12 D to –0.5 D) is 0.5%, and the number gaining two or more lines is 3.9% at 6 months,” he said. “We now have 88.4% remaining unchanged or gaining one line.” In the Schallhorn study, preop manifest spherical equivalent ranged from –11 D to –4.88 D. At 5 years postop, 79.3% of eyes were within 0.50 D of emmetropia, 77.7% of eyes achieved monocular uncorrected distance visual acuity (UDVA) and 90.6% of eyes achieved binocular UDVA of 20/20 or better. “I expect 95% of patients to be 20/20 or better, and I expect continued on page 48