EyeWorld Asia-Pacific June 2020 Issue

30 EWAP JUNE 2020 REFRACTIVE Contact information Alio: jlalio@vissum.com Ang: Marcus.Ang@Singhealth.com.sg Durrie: ddurrie@durrievision.com Lin: tclin@shaw.ca This article originally appeared in the March 2020 issue of EyeWorld . It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU here with permission from the ASCRS Ophthalmic Services Corp. by Maxine Lipner EyeWorld Senior Contributing Writer Examining the latest research in corneal refractive surgery F rom using state-of-the- art PRK to customized LASIK treatment and beyond, '[G9QTNF took a look at some of the latest refractive studies. PRK myth-busting According to David TC Lin, MD, transepithelial PRK with a visual “wow” factor is possible with SmartSurfACE (Schwind eye- tech-solutions). Most patients are able to see the clock in the room immediately postop, Dr. Lin said of the incision-less procedure. Dr. Lin and co-investigators evaluated visual recovery with the SmartSurfACE approach in a retrospective case series. 1 “Traditionally with PRK, many said, ‘Patients cannot function vœÀ ̅i wÀÃÌ “œ˜Ì…՘̈ ̅iˆÀ vision improves, and there is so much pain,’” Dr. Lin said. He said these are now myths based on use of old technology. In ̅i £™™äà ܅i˜ >ÃiÀ «Àœwià were rough, it could take a month before patients reaped ̅i Li˜iwÌà œv *, ° œÜ] > “œÀi >ÕÃÈ>˜ «ÕÃi «Àœwi ˆÃ smoother and allows for good immediate vision, Dr. Lin noted. The case series included 2,093 myopic eyes. Investigators found that monocularly, 62% of patients had 20/40 acuity or better immediately after surgery. When tested binocularly immediately after surgery, 82% of patients had 20/32 acuity, and more than 95% were at 20/40, Dr. Lin reported. For pain management, Dr. Lin said he gives patients one drop of a topical nonsteroidal at the end of surgery and another LivœÀi ̅iÞ i>Ûi° i w˜`à ̅>Ì 99% of patients have minimal discomfort with this approach. Dr. Lin said the SmartSurfACE technology is a valuable addition to refractive surgery. “I think it increases the armamentarium and removes a lot of the myths about what PRK was,” Dr. Lin said. Chasing super vision Daniel Durrie, MD, recently studied a different refractive approach, topography-guided LASIK. 2 The study looked for trends in the data from the FDA clinical trial as well as data culled from the original trial sites. “The one thing that stuck out is there Ü>à > ÃÌ>̈Ã̈V>Þ È}˜ˆwV>˜Ì number of patients who had super vision of 20/10, and that ˜Õ“LiÀ Ü>à È}˜ˆwV>˜ÌÞ LiÌÌiÀ than the best corrected vision preoperatively,” Dr. Durrie said. While preoperatively 1% of eyes had 20/10 corrected distance visual acuity, at 3 months postop 7% had 20/10 or better uncorrected distance visual acuity; by 12 months it had risen to 16%. The fact that vision continued to improve after 3 months is likely linked to a period of adjustment where patients neuroadapt to changes in higher order aberrations, Dr. Durrie said. When excimer laser surgery wÀÃÌ V>“i œÕÌ] ̅i ˆ`i> œv ÃÕ«iÀ vision was overhyped, Dr. Durrie said. Though the technology has since evolved and many attain high 20/20 rates, there haven’t been a lot in the 20/10 to 20/12 range, he said. “We need to keep looking at if there is something that can make us go to the next level,” Dr. Durrie said, adding that when patients attain acuity of 20/16 or better, they have a tendency to refer more and build the market. SMILE in the mix iÜ ÀivÀ>V̈Ûi ˆ˜Àœ>`à >Ài >Ãœ being made with the more recently developed SMILE technique. In a fellow eye study, investigators led by Marcus Ang, MBBS, PhD, considered how ̅i ivwV>VÞ œv - ÃÌ>VŽi` With the customized wavefront-guided approach, the treatment addresses total eye aberrations. Source: Jorge Alio, MD, PhD