EyeWorld Asia-Pacific September 2017 Issue

September 2017 3 EWAP EDITORIAL ERRATUM EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Hiroko BISSEN-MIYAJIMA, Japan Hungwon TCHAH, Korea ASIA-PACIFIC CHINA EDITION Regional Managing Editor YAO Ke Deputy Regional Editors HE Shouzhi ZHAO Jialiang Assistant Editors SHENTU Xing-chao ZHOU Qi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN Deputy Regional Editor Abhay VASAVADA ASIA-PACIFIC KOREA EDITION Regional Managing Editor Hungwon TCHAH Deputy Regional Editor Chul Young CHOI John CHANG, Hong Kong Johan HUTAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Ronald YEOH, Singapore S. NATARAJAN, India Sri GANESH, India YAO Ke, China Y.C. LEE, Malaysia LASIK advances I n the September issue of EyeWorld Asia-Pacific, we revisit laser vision correction. LASIK volumes have declined in recent years but recent surveys suggest an upward trend in the last 12 months. This probably relates to improving economic circumstances, particularly in the U.S., but also a renewed focus on new technology. Although the LASIK procedure is essentially unchanged, diagnostic equipment has been refined and topography-guided laser treatments are an alternative to wavefront- guided ablations. Although the former has been available for some time and has proved useful in treating irregular corneas, there does appear to be merit in utilizing this approach in regular LASIK treatments. Intrastromal femtosecond laser correction of refractive errors or SMILE is now considered an attractive alternative to LASIK. The outcomes with this approach appear to be more predictable with higher myopic corrections than LASIK and the procedure is thought to better preserve corneal strength by limiting the breach of Bowman’s membrane to a few millimeters rather than the 8.5-mm diameter flap required by LASIK. Nevertheless, there have been cases reported of ectasia with SMILE and caution suggests that the normal precautions that we have observed with LASIK are still relevant. There does appear to be better preservation of corneal sensation and perhaps fewer dry issues by avoiding flap creation. In addition, the requirement for a single laser instead of both a femto and excimer platform is attractive. Although avoiding the need for a flap suggests a safer procedure, complications during lenticule extraction can occur. Complications, however, like any procedure, diminish with experience. Surface ablation remains relevant as this procedure remains the least likely to be associated with ectasia. Indeed, the combination of crosslinking and surface ablation has proved to be useful for early keratoconus. Transepithelial PRK where the epithelial removal and treatment are performed in a single non-touch treatment is an attractive option. In my experience, epithelial healing time and visual recovery is quicker than regular PRK or LASEK and the use of low-dose mitomycin has proved to be safe after many years of widespread clinical use. Although the instant “wow” factor associated with LASIK and SMILE is missing, by 4 to 6 weeks the predictability and unaided acuity has matched that of LASIK in recent publications. Looking to the future, the prospect of a synthetic on-lay that could be applied to the cornea and sustain an intact epithelium remains an intriguing concept as this would be a truly reversible refractive procedure. The concept remains attractive with continued research, but whether this will prove to be a viable alternative to laser correction in the future has yet to be determined. Lens-based procedures have increasingly replaced laser correction in the treatment of hyperopia in the presbyopic age group but I believe laser-based keratorefractive procedures will remain the mainstay in the correction of myopia in younger patients. It is almost 30 years since I performed my first laser correction (PRK) in 1991 and it is amazing to see how keratorefractive surgery has become increasingly sophisticated. The early microkeratomes have been replaced by femtosecond creation of flaps and lenticular removal and the topographic and wavefront-guided treatments are now commonplace. We are very fortunate to have experienced the birth of this subspecialty which has developed into one of the most common ophthalmic procedures performed today. The renewed interest in laser correction reflects the many advances in this field and ensures that laser correction will remain an integral part of ophthalmic practice in the 21st century. I am certain that you will find this issue and the description of recent advances of great interest and relevant to your practice. EWAP Graham Barrett Chief Medical Editorial EyeWorld Asia-Pacific In “MIGS: Understanding the options” ( EyeWorld Asia-Pacific June 2017, Vol. 13, No. 2, pp. 58, 60, 63), the caption for the photo on p. 58 should read as follows: “The iStent is placed in the angle intraoperatively as an adjunct to cataract surgery.” The photo was provided by Jason Bacharach, MD. We apologize for any inconvenience caused by this error.