EyeWorld India September 2017 Issue

September 2017 16 EWAP FEATURE Looking at LASIK’s advances by Vanessa Caceres EyeWorld Contributing Writer Surgeons and industry continue to improve outcomes and boost patient satisfaction S ince its 1999 approval by the U.S. Food and Drug Administration (FDA), LASIK has been an effective vision correcting procedure, and its potential to improve vision has continued to evolve. When LASIK was first approved, 90% of patients achieved 20/40 uncor- rected visual acuity (UCVA); 50% to 60% of patients achieved 20/20, said Daniel Durrie, MD , clinical profes- sor of ophthalmology, University of Kansas Medical Center, and founder, Durrie Vision, Overland Park, Kansas. “At that point, we could say there was a high likelihood that patients would pass their driving test without glasses, but we couldn’t say they would see better than with their glasses,” he said. As technology has improved and as refractive surgeons have focused on better patient screening, the percent- age of patients achieving 20/20 is more than 90%, according to a report AT A GLANCE r 7JTVBM BDVJUZ SFTVMUT GSPN -"4*, IBWF DPOUJOVFE UP JNQSPWF B MBSHF QPSUJPO PG QBUJFOUT DBO OPX BDIJFWF WJTJPO CFUUFS UIBO UIBU GSPN UIF VTF PG HMBTTFT r 5FDIOPMPHJDBM BEWBODFT IBWF QVTIFE -"4*, UP CFDPNF TBGFS r $PNQMJDBUJPOT BOE TJEF FGGFDUT GSPN -"4*, TVDI BT ESZ FZF HMBSF BOE IBMPT BSF SBSF 5IFZ UFOE UP PDDVS JNNFEJBUFMZ QPTUPQFSBUJWFMZ BOE EFDSFBTF PWFS UJNF r 1BUJFOU TBUJTGBDUJPO IBT CFDPNF B NFBTVSF PG -"4*, RVBMJUZ PG HSPXJOH JNQPSUBODF r 0WFS UIF MPOH UFSN -"4*, JT TBGFS UIBO UIF VTF PG DPOUBDU MFOTFT from Sandoval et al. last year. 1 The Sandoval report was a review of arti- cles about LASIK and encompassed nearly 68,000 patients. A 2013 study of U.S. Navy avia- tors found that 98.3% of patients with myopia or mixed astigmatism had a UCVA of 20/20 or better. 2 The Patient-Reported Outcomes With LASIK (PROWL) studies from the FDA found that 95% of patients had 20/20 or better binocular UCVA at 3 months postoperatively. 3 There’s a greater number of patients achieving 20/15 or even 20/12 UCVA now, thanks to recent advances like topography-guided LASIK, said Francis Price, Jr., MD , founder, Price Vision Group, Indianapolis, and president of the board, Cornea Research Foundation of America. “The discussion over the last 15 years has been whether we could make people see better than with glasses. It’s taken some work, but I think that’s where we’ve arrived today,” Dr. Durrie said. LASIK technology One impetus behind LASIK advanc- es has been the evolution of technol- ogy. “It’s fun to look back. I was in the first clinical trials [for LASIK], and we had this argon fluoride laser and were trying to figure out how to use it. We were discussing if we should be opening or closing the diaphragm and where to center the procedure,” Dr. Durrie said. Tracking systems were devel- oped through time so surgeons didn’t have to worry about patients moving. Iris registration was devel- oped to handle an eye that torqued or turned. Flying and variable spot lasers were a major technological break- through because they made the procedure more flexible and helped surgeons correct more errors, Dr. Durrie said. Views from Asia-Pacific Ekktet CHANSUE, MD TRSC International LASIK Center 968 Rama 4 rd, 6th fl U Chu Liang Bldg., Bangkok 10500 Thailand Tel. no. +66838802020 echansue@gmail.com A s a dedicated corneal refractive surgeon for over 20 years, I have witnessed the development and advances that have made LASIK the household name it is today. Since my first LASIK in November 1994, all aspects of the procedure, especially the technology and instrumentation, have steadily improved to make the procedure one of the safest and most efficacious surgical procedures ever. As safe and effective as it is, an aspect that is often overlooked or even at times negatively viewed, but in my opinion is one of the most important parts of LASIK, is its ability to be enhanced for better results should the initial results not meet expectations. I believe this adjustability has played a great part in the longevity of the procedure, and should not be viewed as a sign of failure, but instead an opportunity to make an already very efficacious procedure even more so. The simplicity of it also enables us refractive surgeons to modify the results to fit the changing needs of the patients with relative ease. For example, a now-presbyopic patient who had LASIK done for distance 15 years ago can consider a 3-minute procedure to apply monovision, adding to satisfaction and creating renewed awareness and interest to refer more patients. Our internal review has shown that flap-lift LASIK enhancement procedure is highly safe and effective, even when performed 20 years after the initial procedure. Needless to say, proper technique is essential in minimizing the risk of significant interface epithelial ingrowth. While we have greatly enjoyed the safety and efficacy of LASIK over the years, more recently we have embarked on the small-incision implementation of the Law of Thickness principle described by the late Prof. Barraquer over half a decade ago. Seeing it as the natural progression of the corneal refractive surgery landscape, we started performing ReLEx SMILE in July 2010. Seven years and 15,000 cases later, it is now our procedure of choice, representing over 90 percent of our myopic astigmatism cases. We have found that while the refractive results are on par with LASIK, the side effects are even less than LASIK’s already very good record, especially in terms of dry eye and night vision problems. This is particularly significant for a high-volume dedicated refractive surgery center, since even 1% can translate into a few problem patients per month. Editors’ note: Dr. Chansue declared no relevant financial interests.