EyeWorld India September 2017 Issue

September 2017 EWAP FEATURE 21 segment surgeon has the skill set for some refractive procedures and would be well served by under- standing all the options that are available. PRK and LASIK are two options for procedures that surgeons may want to become well versed in. When it comes to choosing be- tween PRK and LASIK, Dr. Yeu said that PRK has less of a chance for ectasia. It’s also technically easier to perform, she said. Although PRK is a simpler procedure to master technically, Dr. Hatch thinks it’s an advantage to be able to offer both procedures to patients. “A lot of people are good candidates for LASIK, and you don’t want to restrict them to PRK,” she said. Many refractive procedures may look easy, particularly when they go well, Dr. Parkhurst said. However, they are no different from other surgical procedures when there is any risk of complica- tions. “Surgeons performing [these procedures] need to know how to avoid complications and manage complications and how to select the right procedure for the right individual,” he said. For someone starting in refractive surgery, Dr. Parkhurst said that determining good candidates for a procedure is the first step. Incorporating corneal refractive surgery into a practice To incorporate corneal refractive surgery into a practice, Dr. Yeu advised surgeons look at how other surgeons, particularly in a practice size similar to theirs, incorporate it. She said to question if there is a need in the market. Are you plan- ning to use it as a primary surgery or only to correct refractive errors after cataract surgery? “Certain marketing can be helpful, but start with internal marketing with established patients,” she said. It’s also important to educate staff and consider having a counselor. “We learn in medical school that any time we’re consulting patients for any health condition, our job is to discuss the risks, benefits, and alternatives of every option,” Dr. Parkhurst said. This is important when evaluating all options for patients. Dr. Hatch said incorporating corneal refractive surgery into a practice involves advertising that you’re doing it. “You have to make it available and make it known that you’re doing it.” This could be done through patient education materials. She also said the staff needs to support what the surgeon is doing and should be educated when talking to the patients about these procedures. Tips for LASIK or PRK after phaco Dr. Yeu recommended waiting at least 6 weeks to allow full healing of any limbal relaxing incisions or cataract wounds. Perform YAG posterior capsulotomy before per- forming corneal refractive surgery, she added. Dr. Hatch stressed the impor- LASIK procedure just after the flap is lifted, immediately preceding excimer laser ablation; in this example, the flap is centered upon the visual axis created by the VisuMax femtosecond laser, which is the same laser used to perform ReLEx SMILE. LASIK procedure at the conclusion of closing the flap Source (all): Gregory Parkhurst, MD tance of waiting until the patient is well healed from the cataract procedure. She also recommended managing dry eye issues and optimizing the ocular surface. Dr. Hatch likes to perform a YAG capsulotomy before a laser vision correction procedure. All ophthalmologists who per- form anterior segment surgery are participating in refractive surgery whether they think of it in that way or not, Dr. Parkhurst said. The first step is to start really looking at refractive outcomes in cataract surgery, he said, because you can’t improve until you measure it. EWAP Editors’ note: Dr. Parkhurst has finan- cial interests with Carl Zeiss Meditec. Drs. Hatch and Yeu have no financial interests related to their comments. Contact information Hatch: kathryn_hatch@meei.harvard.edu Parkhurst: gparkhurst@sanantonio-lasik. com Yeu: eyeulin@gmail.com