EyeWorld India September 2017 Issue

18 EWAP FEATURE September 2017 Although the need for a LASIK enhancement is not a safety issue, patients may perceive it as such, Dr. Durrie said. “The incidence of need- ing an enhancement is about 3%. Patients are reassured to know that 97% of the time, they’re done [in one procedure],” he said. Safety and contact lenses Many patients who have LASIK have used contact lenses in the past and had trouble with them or simply got tired of the daily routine. One area of interest to surgeons—and patients—is how modern LASIK fares against contact lenses in terms of safety and patient satisfaction. A study published last year and led by Marianne Price, PhD, Indianapolis, found that compared with contact lens use, LASIK improved night driving and had higher patient satis- faction levels at 1, 2, and 3 years of follow up. 4 LASIK also significantly decreased self-reported rates of eye- infections, ulcers, and abrasions and did not significantly raise the inci- dence of dry eye symptoms. Dry eye symptoms were increased, however, compared with baseline of glasses. The study included 1,800 subjects who had LASIK or contin- ued using contact lenses at 20 sites around the U.S. LASIK patients had higher levels of patient satisfaction compared with those continuing to use contact lenses and glasses. There’s an underappreciated safety aspect when you compare LASIK and contact lens use, Dr. Price thinks. “With LASIK, you have doctors paying attention to screen- ing and treatment protocols. For contact lenses, [safety] comes down to each user,” he said. Dr. Price was a co-investigator of the recently published study comparing LASIK and contact lenses with Dr. Mari- anne Price. “I have taken care of many patients who have required corneal transplants after visually devastat- ing central corneal ulcers associated with contact lenses,” Dr. Hofmeister said. “They carry greater dangers than many people realize,” espe- cially in a military environment, she added. Patient satisfaction One factor not tracked with LASIK early on was patient satisfaction. This led to some concern from the FDA, Dr. Price said. Since then, stud- ies have found consistent reports of high patient satisfaction; the study from Sandoval et al. reported an overall 98.7% satisfaction rate with LASIK, and the PROWL research found more than a 95% satisfaction rate. 1,3 The high level of satisfac- tion is for several reasons, said Dr. Solomon, who was a co-investigator Summit OmniMed laser (1990s) Source: Daniel Durrie, MD The higher-order aberration ablation treatment pattern, which was added to the standard myopic and astigmatism profile. Best corrected vision with glasses was 20/15 preop and 20/12 postop. Source: Francis Price, Jr., MD The development of larger opti- cal zones helped cut down on the amount of glare and halos that early treated patients experienced, Dr. Price said. “When we started transi- tion zones, we virtually eliminated glare and halos and problems with pupil size,” he said. Wavefront-guided and wave- front-optimized technology also helped to advance LASIK accuracy. The use of the femtosecond laser for flap creation instead of the mechanical microkeratome helped make LASIK safer, said Elizabeth Hofmeister, MD , refractive surgery advisor for Navy Ophthal- mology, San Diego. “This allows us to create flaps with much greater precision and safety than a bladed microkeratome. We can also create a ‘reverse bevel’ to create a dovetailed fit of the flap back into its bed, reducing the chance of late flap dis- locations,” she said. Studies in the U.S. Navy have shown that LASIK flaps are stable to blast injuries and G-forces, Dr. Hofmeister added. LASIK complications, side effects Glare, halos, and dry eye are all complications or side effects as- sociated with LASIK through time. Yet recent research shows these side effects, if they occur at all, are transient. “Patients can be symptomatic early on but at 3 to 6 months, the incidence of dry eye postoperatively is still fairly small,” said Kerry Solomon, MD , Carolina Eyecare, Charleston, South Carolina. “Most recent studies indicate that LASIK tends to make dry eye better.” Similarly, night vision and glare tend to get better for patients, although there is a small subset of patients who continue to experience problems with these, Dr. Solomon said. This is some- thing that the PROWL investigators reported 3 —still, even in these pa- tients, satisfaction with the proce- dure was higher than 95%, Dr. Solomon added. Even with the low risk for complications, Dr. Durrie thinks it is crucial to discuss the possibility of them with patients. However, he emphasizes that major complica- tions like vision loss, infection, or retinal issues are rare. “The inci- dence is 1 in 10,000 in the U.S. We’ve done more than 55,000 pro- cedures [at our practice] and never had a patient with major, long-term vision loss. That’s not to say eve- ryone is perfect, but I always say if you use modern equipment, keep a sterile OR, and choose patients properly, you’ll keep your risks low,” Dr. Durrie said. Looking at LASIK’s – from page 17