8 EyeWorld Asia-Pacific | September 2024 In China, however, Prof. Yao Ke from APACRS argued (with evidence from studies) that, while remaining a safe and effective technique, FLACS has the ability to reduce phaco power and involves the risk of posterior capsule rupture. Furthermore, Prof. Yao argued against the claim made by Dr. Reus that in one of his studies, he found an endothelial cell loss rate of 7.85% after FLACS compared to 19.96% after phaco. SMILE vs. LASIK Even though LASIK has come a long way in the 22 years since it obtained US FDA approval, it still possesses shortcomings with its procedure, William F. Wiley, MD (USA) from ASCRS explained. Problems with dry eye, long-term enhancement options, biomechanics, and flap safety are a few to name. “This is where SMILE has stepped in,” Dr. Wiley said. 6 years after its US FDA approval, the data on SMILE showed that 95% of patients achieved 20/20 vision after 1 month while 98% of patients achieved 20/20 after half a year. “SMILE eliminates the ‘what-ifs’ in refractive surgery,” Dr. Wiley said. From not achieving attempted outcomes, to mitigating risk for dry eye, among other considerations like biomechanical strength issues and need for enhancement, Dr. Wiley professed a slew of different ‘what-ifs’ for contemplation. “Not everyone achieves the refractive target in the long-term,” Dr. Wiley explained. “With LASIK, it is relatively easy to enhance the eyes in the first year or two. But after 4-5 years, you have a higher risk of epithelial ingrowth.” With the additional benefit of the minimally-invasive nature of SMILE allowing patients to quickly return to regular activities, there are good reasons why SMILE is the fastest-growing corneal refractive procedure. “I’m always an advocate for saying all refractive procedures are great, so it is really difficult to argue for one,” ESCRS representative Thomas Kohnen, MD, PhD, FEBO (Germany) said. But there are clear advantages, with LASIK procedures including faster rehabilitation time, high safety outcomes, and good astigmatism correction, he said. In fact, Dr. Kohnen shared that a lack of cyclotorsion control and centration during SMILE has been shown to contribute to axis alignment inaccuracy, which negatively affects astigmatism correction outcomes. Even patient satisfaction is quite high with LASIK. A 2016 LASIK update review article analyzing 97 articles reported that 1.2% of patients were dissatisfied with their LASIK procedure. “Tell me one procedure in medicine that can give a 99% satisfaction rate,” Dr. Kohnen challenged. William F. Wiley Thomas Kohnen FEATURE Highlights from the 36th APACRS - 24th CSCRS Joint Meeting Chengdu, 2024 Yao Ke
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