EyeWorld India September 2018 Issue

EWAP REFRACTIVE 41 September 2018 in the first few hours.” A simple change such as keeping patients an extra hour in clinic will allow practitioners to detect and im- mediately treat 10% of all striae cases, he noted. In addition, the study ad- dressed the idea that striae might induce some cylinder. However, this was not necessarily what investigators detected, Dr. Waller- stein observed. “We found that on average striae caused a mild hyperopic shift and that the majority—77%—don’t induce any astigmatism,” he said, adding that there is variability based on where the striae are located. Those locat- ed closer to the central visual axis might induce cylinder, whereas if they’re off-axis they might induce some higher order aberrations that contribute to decreased visual quality. Investigators also learned that while striae can cause patients to lose between one and three lines of vision, treatment can usually correct this. The efficacy index improves by 25%, heightening the accuracy to close to the non-striae eye and allowing the safety index to return to that of the non-striae eye. However, there still may be a slight difference. “We found that 12% of those striae-treated eyes had one line or more of difference between uncorrected distance vision and corrected distance vision,” Dr. Wallerstein said, add- ing that 13% fewer striae-treated eyes attained 20/20 uncorrected distance visual acuity. Also, the striae-treated eyes had a little more cylinder magni- tude than the controls, Dr. Waller- stein pointed out. As a result, striae eyes were twice as likely to need an enhancement with an excimer laser than the non-striae eyes. “Surgeons now know that about 6% of striae-treated eyes will need a retreatment, compared to only 3% of non-striae eyes,” Dr. Wallerstein said. One study finding on flap thickness ran counter to reports in the older literature, which had indicated that thinner flaps had higher rates of striae, Dr. Waller- stein reported. “Our findings did not support that,” he said. In addition, investigators think that if the eyelid is taped shut for a period immediately after surgery, it may confer a protective effect against striae. “That’s not nec- essarily a conclusion, but it’s a suggestion in that this is what our results showed,” he said. Dr. Wallerstein also advised practitioners not to wait around once they’ve found clinically significant striae. “Once you’ve determined that this is potentially clinically significant you should treat it early,” he said. This is the first study that looked at the outcomes of a surgically treated LASIK complication in a multi surgeon standardized proto- col, Dr. Wallerstein pointed out. “What we have is a LASIK compli- cation, then we treated it, looked at the outcomes, and compared the outcomes to a control,” he said. “That’s the first time that’s happened when the protocol and the practices were controlled and standardized.” Also important is the fact that this drew from a large electronic medical record database, he said, adding that going forward, such data mining will provide valuable information that will allow for the continued improvement of patient outcomes. EWAP Reference 1. Wallerstein A, et al. Clinically significant laser in situ keratomileusis flap striae. J Cataract Refract Surg. 2017;43:1523–1533. Editors’ note: Dr. Wallerstein has no financial interests related to his com- ments. Contact information Wallerstein: awallerstein@lasikmd.com Appasamy Associates Page: 13 www.appasamy.com Diamatrix Ltd. Page: 27 www.diamatrix.com Feather Safety Razor Co., Ltd Page: 45 www.feather.co.jp Haag-Streit AG Page: 17 www.haag-streit.com Indonesian Society of Cataract & Refractive Surgery Page: 37 www.inacrs.org Oculus Optikgeräte Page: 33 www.oculus.de Ziemer Page: 72 www.ziemergroup.com ASCRS Page : 5, 71 www.ascrs.org APACRS Page : 2, 36 www.apacrs.org EyeWorld Page : 7, 8, 39 www.eyeworld.org Index to Advertisers