EyeWorld India September 2017 Issue

10 EWAP FEATURE September 2017 dures.” SMILE, Dr. Wiley pointed out, can take longer compared to LASIK in some cases to get the “wow ef- fect.” “In someone who has a small prescription, thick cornea, and doesn’t have lifestyle concerns, LASIK might get them to ‘wow’ quicker and be more straightfor- ward,” he said. There might also be patients who are worried about a flap in their cornea but who are reluctant to have PRK, due to discomfort and delayed visual recovery, Dr. Man- che said. These patients, who Dr. Slade described as those psycholog- ically worried about LASIK, might find SMILE a palatable alternative. Not replacing but expanding the market Dr. Thompson sees newer laser vision correction technologies as “additives to the menu.” With all of the options available, includ- ing traditional LASIK and PRK, Dr. Thompson said the patient consult can be lengthy, but it’s worth tak- ing the time. “We can more specifically go after what patients’ eyes are presenting to us and what their desires are, and that’s the beauty of having all of these choices,” he said. Dr. Wiley said when you have more patients who are candidates for laser vision correction, thanks to more options expanding indica- tions, the whole field benefits. “Any time you take away a potential hurdle for one patient or classification of patients, it grows the market in a way that’s expo- nential where each patient who gets refractive surgery tells five or six other patients about their Dr. Wiley performs topography-guided LASIK with the Nidek Quest excimer laser following a femtosecond laser-created flap. Source (all): William Wiley, MD experience. The more patients go- ing through that process, the larger the market gets across the board,” Dr. Wiley said. “… even within the scope [of the procedure] if you in- crease satisfaction among patients, let’s say you decrease even just a little bit of the dryness … that’s less negatives out there.” Not only have treatment tech- nologies improved, but diagnostics have improved to help physicians better match patients with the treatment that could yield the best outcome for them. Dr. Slade said a common problem is patients com- ing in not knowing what they’re a candidate for. “People will spend years decid- ing what is best for them—PRK, LASIK, SMILE. They’ll get on the internet, compare the different procedures, and try to find out which is best, but they don’t know which is best for them,” Dr. Slade said. “We encourage people to come in and get a screening evalu- ation.” From the physician side of it, Dr. Slade said you and your pa- tients are better off if you stay up to date with technology. “You need to know about SMILE and you need to be able to intelligently an- swer questions about it. … Just like how [laser vision correction] is an elective procedure, buying a new laser, learning a new technique is an elective procedure or purchase, and you get to do it whenever you want.” Dr. Wiley cautioned colleagues and industry against pitting one technique against another. “We don’t want to get into a situation of pitting one technology against the other and saying, ‘LASIK is bad and I have SMILE, my competitor down the road doesn’t.’ … I think being careful with how we apply the new technology, educate the patients, and market the procedures, we’re better off if we market refractive surgery as a whole.” EWAP References 1. Toda I, et al. Visual outcomes after LASIK using topography-guided vs. wavefront- guided customized ablation systems. J Refract Surg . 2016;32:727–32. 2. Moshirfar M, et al. Small-incision lenticule extraction. J Cataract Refract Surg. 2015;41:652–65. Editors’ note: Dr. Manche has finan- cial interests with Carl Zeiss Meditec and Johnson & Johnson Vision. Dr. Slade has financial interests with Alcon and Carl Zeiss Meditec. Dr. Thompson has financial interests with Alcon, Bausch + Lomb (Bridgewater, New Jersey), Carl Zeiss Meditec, and Johnson & Johnson Vision. Dr. Wiley has financial interests with AcuFocus (Irvine, California), Alcon, Carl Zeiss Meditec, Johnson & Johnson Vision, Revision Optics (Lake Forest, Califor- nia), and STAAR Surgical (Monrovia, California). Contact information Manche: edward.manche@stanford.edu Slade: sgs@visiontexas.co m Thompson: vance.thompson@ vancethompsonvision.com Wiley: drwiley@clevelandeyeclinic.com “ We can more specifically go after what patients’ eyes are presenting to us and what their desires are, and that’s the beauty of having all of these choices. ” –Vance Thompson, MD New technologies – from page 9