EyeWorld India September 2018 Issue

1. Physicians would not have LASIK on their own eyes. 2. The long-term effects of LASIK are not known. 3. Contact lenses are safer than LASIK. 4. LASIK significantly in creases the risk of a patient having glare and halo. 5. The safety and efficacy of LASIK has not improved over time. 6. Dry eye is extremely common following LASIK. Dr. Donnenfeld detailed the history of LASIK, starting with the clinical trial and its approval. As experience grew, “we began to learn who the right patient was.” Dr. Donnenfeld said one of his first papers on LASIK looked at the effect on dry eye, and he learned that it does cause dry eye. Statisti- cally, dry eye returns to normal at 6 months following surgery. Dr. Donnenfeld discussed patient dissatisfaction with LASIK, noting a U.S. Food and Drug Administration (FDA) hearing ad- dressing the topic. In addition to speaking in favor of LASIK at the hearing, Dr. Donnenfeld said he learned a lot by listening to patient testimony. Notably, he learned that the most common problem that made patients unhappy was not decreased vision but the sense of abandonment from the surgeon when they didn’t get the results that they wanted. An early problem of LASIK, Dr. Donnenfeld said, was ablation decentration, which can be ad- dressed with pupil tracking and other technologies. The problem of PRK corneal haze has almost com- pletely been resolved with the use of mitomycin-C. Meanwhile, flap complications have been addressed with the advent of the femtosecond laser and better microkeratomes. Glare and halo can be remedied with blend zones, customized ablations, and optimized ablations, Dr. Donnenfeld said. Finally, he noted that the problem of ectasia is addressed with better diagnostic equipment and patient selection, as well as crosslinking. In his conclusion, Dr. Donnenfeld again referenced the “myths and misconceptions” about LASIK: Physicians have among the highest prevalence of having undergone LASIK of any occupation; LASIK has more than a 20-year track record, and long-term studies have shown refractive stability and safety; daily wear contact lenses are likely less safe than LASIK when worn for 30 years, and extended wear contact lenses are definitely less safe than LASIK when worn for 30 years; modern LASIK improves glare and halo for the majority of patients, and there are a minority of patients who will develop glare and halo that did not have symp- toms preoperatively; LASIK is the safest procedure with the greatest satisfaction of any surgery per- formed in the world today, and the safety and efficacy have improved markedly over the last 20 years and will continue to improve with technology advances; and dry eye is common after LASIK for the first 3 months, but it usually resolves after 6 months. Moving forward, the goal is contin- ued improvement of patient satis- faction and 100% of patients seeing the same or better following LASIK than prior to surgery. “We need to embrace patients who are dissatis- fied with their vision following LASIK and never allow them to feel abandoned,” Dr. Donnenfeld said. He said surgeons need to ensure patients are better informed when acquiring their consent. CSCRS symposium highlights ‘Inner Focus’ The Combined Symposium of Cataract and Refractive Societies (CSCRS) was titled “Inner Focus – Innovative IOL Technology.” Topics covered in the session included the Light Adjustable Lens (LAL, RxSight, Aliso Viejo, California), a multicomponent adjustable IOL, femtosecond laser adjustable IOLs, extended depth of focus IOLs, a pinhole small aperture IOL, and IOLs on the horizon. Fritz Hengerer, MD, PhD , Heidelberg, Germany, discussed the LAL, which he described as a three-piece silicone IOL with unique options in order to change the refraction noninvasively after surgery. After wound healing, you can do the first refraction and see what results were obtained and how far the patient is from target refraction. The adjustments are made using UV light. Patients re- ceiving this technology are clearly informed about the technology and drawbacks, Dr. Hengerer said, stressing the importance of patients wearing UV-protecting glasses after surgery while the IOL is still being adjusted. This lens has now been com- mercially available for 10 years in Europe. There are several options to optimize VA for distance, interme- diate, and near, and adjustments are noninvasive. When the lens is “locked in,” patients no longer have to wear their protective spectacles. Dr. Hengerer noted that the LAL is available for up to 3.0 D of astigmatism and for post-refractive surgery patients and presbyopia continued on page 66