EyeWorld India December 2018 Issue

EWAP REFRACTIVE 59 December 2018 User feedback on SMILE, PRK, and LASIK by Michelle Stephenson EyeWorld Contributing Writer Three surgeons share ex- periences with these ways of correcting refractive error S MILE, PRK, and LASIK are FDA-approved methods to correct refractive error. Eye- World asked three surgeons from around the world how and when they are performing these proce- dures. Stephen Slade, MD , Hou- ston, and Arthur Cummings, MMed(Ophth) , Dublin, Ireland, perform all three procedures. “I was an investigator for the SMILE studies, so I have been performing SMILE for several years,” Dr. Slade said. “Additionally, I perform LASIK and PRK.” He noted that he performs LASIK more often than the other two procedures. “SMILE is not FDA approved to treat astigma- tism, so many patients with astig- matism are still being treated with LASIK,” Dr. Slade explained. He thinks there is a significant advantage to being able to offer all three. “You don’t have to offer everything, but we’ve found it’s a real advantage to be able to offer SMILE. We do have people who come in asking for SMILE. We’re not marketing it, we’re not adver- tising it, but people find out about it,” he said. Dr. Cummings primarily performs LASIK and PRK, but has also done some SMILE procedures. “LASIK provides the best visual results in my hands with the least downtime,” he said. Damien Gatinel, MD, PhD , Paris, France, performs only PRK and LASIK. “I perform LASIK most often because it has the broadest range of indications and provides the fastest recovery with minimal discomfort. PRK is indicated when LASIK is not suitable, such as for patients with thin or irregular corneas,” he said. Fastest recovery According to Dr. Slade, in the FDA trial for SMILE, which treated one eye with SMILE and the fellow eye with LASIK, LASIK provided eyes better vision at day 1, but the SMILE eyes were a little more comfortable at day 1. “PRK came in third place on both vision and comfort,” he said. Dr. Cummings agreed, noting that LASIK has the fastest visual recovery, followed by SMILE, with PRK bringing up the rear. Most expertise Dr. Slade noted that there is a learning curve with SMILE. “We all know how to do LASIK at this point. SMILE is a new technique, and it has a little bit of a learning curve, but it’s not bad,” he said. Dr. Cummings said that the procedure that requires the most expertise depends on which plat- form you use and how you cus- tomize the procedures. “In purely technical terms for the operation- al aspects of the surgery, PRK is simplest, then LASIK, and finally SMILE is the most challenging,” he said. Dr. Gatinel agreed. “PRK is the easiest technique to perform, and the transepithelial option makes it virtually surgeon-independent. SMILE is the most demanding technique because it requires a manual dissection of two interfac- es and an intact lenticule extrac- tion,” he said. Correction of –2 D, –6 D, and hyperopia The surgeons were asked their preference for a patient who has a thick enough cornea to undergo all three procedures and requires a correction of –2 D. Dr. Slade recommended LASIK for this patient. “I would do LASIK. We’ll do SMILE down to –3 or so, but typically do LASIK,” he said. His preferred enhancement method for LASIK is to lift the flap and perform LASIK. For SMILE, it’s PRK on top of the SMILE. “We haven’t had to do many SMILE enhancements because it’s pretty accurate,” he said. Dr. Cummings said that LASIK provides the fastest recovery and the best results for a correction of –2 D and –6 D. For correcting hyperopia, he also recommends LASIK. “I use IOLs if the patient continued on page 60