EyeWorld India September 2017 Issue

September 2017 8 EWAP FEATURE New technologies in corneal refractive surgery poised to spur growth by Liz Hillman EyeWorld Staff Writer AT A GLANCE r 1IZTJDJBOT TBZ OFX MBTFS WJTJPO DPSSFDUJPO UFDIOPMPHJFT IBWF FYQBOEFE QBUJFOU DBOEJEBDZ GPS DPSOFBM SFGSBDUJWF TVSHFSZ r 5ISFF SFMBUJWFMZ SFDFOU BEWBODFT JODMVEF UPQPHSBQIZ HVJEFE BCMBUJPOT J%FTJHO XBWFGSPOU UFDIOPMPHZ BOE TNBMM JODJTJPO MFOUJDVMF FYUSBDUJPO 4.*-& r 8JUI UIFTF PQUJPOT QIZTJDJBOT TFF UIF PQQPSUVOJUZ UP TFMFDU UIF QSPDFEVSF UIBU CFTU NFFUT B QBUJFOU T DPOEJUJPO New technologies are bringing patients in off the sidelines and expanding the possibility of laser vision correction to those who might not have been candidates before, physicians say “ D riven by new tech- nologies, techniques, better patient selection, and thus better outcomes, some practices have seen a resurgence in corneal refractive surgery, especially on the laser vision correction front, said William Wiley, MD , medi- cal director, Cleveland Eye Clinic, Cleveland. According to the 2016 ASCRS Clinical Survey, the average annual laser vision correction volume was 301 cases—relatively consist- ent with previous ASCRS Clini- cal Surveys. But respondents, on average, projected that in 3 years their annual laser vision correction volume would increase by nearly 80%, up to an average of 535 cases annually. Among U.S. respondents, on average, 86% said wavefront technology covered the majority of their current corneal refrac- tive procedures, compared to 48% among international respondents. Conversely, international respond- ents were more likely to perform standard ablations, small incision lenticule extraction (SMILE, Carl Zeiss Meditec, Jena, Germany), and topography-guided procedures. In the next 3 years, 73% of U.S. respondents said they thought the majority of their corneal refractive procedures would be wavefront, but topography-customized in this group jumped to nearly 20%. LASIK, now more than 25 years old, has come a long way, said Ste- phen Slade, MD , Slade & Baker Vision Center, Houston. “LASIK is now modern LASIK— eye trackers, fast ablations, fem- tosecond laser keratomes, sophis- ticated aspheric ablations. It’s not at all the same procedure, and the results are wonderful,” Dr. Slade said. “Wavefront-optimized LASIK … is 94–95% 20/20. Topographi- cally based ablations … are in the same range.” While wavefront ablations, first approved by the U.S. Food and Drug Administration (FDA) in the early 2000s, measure aberrations or irregularities in the total eye and then fix them on the cornea, topography-based ablations, ap- proved in 2013, make the cornea itself more regular. Thus, the latter procedure may be more suited for older patients potentially facing cataract surgery with multifocal IOLs in the next decade where a more regular cornea would be pre- ferred, Dr. Slade said. More recent advances in laser vision correction include the iDe- sign Advanced WaveScan Studio System (Johnson & Johnson Vision, Santa Ana, California)—FDA ap- proved in May 2015—and SMILE— FDA approved in September 2016 for the VisuMax laser (Carl Zeiss Meditec). “I think the increase in the vol- ume of refractive surgery that we’re experiencing is because patient satisfaction levels are at an all-time high,” said Vance Thompson, MD , Vance Thompson Vision, Sioux Falls, South Dakota. “I think it’s because of the big companies out there continuing to do re- search and development to bring us technologies that fit various indications, which leads to high patient satisfaction. When patients are telling other people and their doctors about their joy after refrac- tive surgery, that’s what drives the market. I think we work for the people and if we make them happy, [this] is what leads to a growth in refractive surgery. “As far as new technologies, I think they’re playing a great role in increasing patient confi- dence, lessening the fear factor, and increasing patient satisfaction postoperatively. Having been an investigator in the PRK, LASIK, and SMILE trials in this country, and phakic IOLs, I’ve seen a lot of re- fractive surgery advancements,” Dr. Thompson continued, adding that he currently performs all of these corneal refractive procedures. Topography-guided ablations In his practice, Dr. Wiley cred- its topography-guided PRK and LASIK—first FDA approved for Con- toura Vision (Alcon, Fort Worth, Texas) and later the Customized Aspheric Treatment Zone (CATz, Nidek, Fremont, California) technol- ogy—with bringing in patients who might have been on the sidelines of laser vision correction. “We saw a bump in our proce- dure volume with that for virgin eyes,” Dr. Wiley said, adding that it has also started bringing in pa- tients who might have had earlier refractive surgery and who expe- rienced mild side effects or had irregularities in their eye to begin with. “We saw the ability to attract new patients with topography- guided [technology] but also maybe some patients who weren’t quite as excited with their original treat- ment years ago; it may be a thera- peutic option to help them.” Dr. Thompson said that a topo- graphic approach to laser vision correction—which takes a highly detailed map of the entire cor- nea—revealed that there were more patients than previously realized who had elevations and depressions within their corneas that were not being addressed. “Being able to do these abla- tions and deliver more energy to the elevations and less energy to