EyeWorld India June 2019 Issue

FEATURE £ä EWAP JUNE 2019 by Liz Hillman Þi7œÀ` -i˜ˆœÀ -Ì>vv 7ÀˆÌiÀ AT A GLANCE • - ˆÃ ˜œÜ >««ÀœÛi` ̜ VœÀÀiVÌ Õ« ̜ Î œv >Ã̈}“>̈Ó° • č Ó>iÀ ˆ˜VˆÃˆœ˜ Èâi >˜` ˜iÜ >ÃiÀ «>À>“iÌiÀà >Ài >««ÀœÛi` >à Üi° • /…iÃi ˜iÜ >««ÀœÛ>Ã …>ÃÌi˜ «œÃ̜«iÀ>̈Ûi ۈȜ˜ ÀiVœÛiÀÞ >˜` iÝ«>˜` ̅i «>̈i˜Ì «œ«Õ>̈œ˜ ܅œ >Ài V>˜`ˆ`>Ìià vœÀ - ] >VVœÀ`ˆ˜} ̜ «…ÞÈVˆ>˜Ã° • *…ÞÈVˆ>˜Ã w˜` «œÃ̜«iÀ>̈Ûi i˜…>˜Vi“i˜Ìà À>Ài >“œ˜} ̅iˆÀ - «>̈i˜Ìð Editors’ note: Drs. Hamilton CPF &KUJNGT JCXG ƂPCPEKCN interests with Carl Zeiss Meditec. &T 5VCJN JCU PQ ƂPCPEKCN KPVGTGUVU related to his comments. œ˜Ì>VÌ ˆ˜vœÀ“>̈œ˜ Dishler: œ˜`J`ˆÃ…iÀ°Vœ“ Hamilton: `À…>“ˆÌœ˜JÓiÞi}ÀœÕ«°Vœ“ Stahl: ÃÌ>…J`ÕÀÀˆiۈȜ˜°Vœ“ L >ÃÌ Þi>À] ̅i 1°-° œœ` and Drug Administration Ƃ® >««ÀœÛi` new indications and “œ`>ˆÌˆià vœÀ Ó> ˆ˜VˆÃˆœ˜ i˜ÌˆVՏi iÝÌÀ>V̈œ˜ - ® ̅>Ì ˜œÌ œ˜Þ iÝ«>˜`i` ˆ˜`ˆV>̈œ˜Ã œv the procedure but could result in v>ÃÌiÀ ۈÃÕ> ÀiVœÛiÀÞ° ˜ "V̜LiÀ Óä£n] ÕÃÌ œÛiÀ Ó Þi>Àà ȘVi ˆÌà ˆ˜ˆÌˆ> Ƃ >««ÀœÛ>] >À <iˆÃà i`ˆÌiV i˜>] iÀ“>˜Þ® >˜˜œÕ˜Vi` ̅i Ƃ >««ÀœÛ> œv ̅i ,i Ý - «ÀœVi`ÕÀi ̜ ÌÀi>Ì Õ« ̜ Î œv “Þœ«ˆV >Ã̈}“>̈Ó° 7…ˆi this opens the procedure, which ˆ˜ÛœÛià ÕÃi œv ̅i 6ˆÃÕ >Ý vi“ÌœÃiVœ˜` >ÃiÀ >À <iˆÃà i`ˆÌiV® ̜ VÀi>Ìi > VÕÃ̜“ˆâi` lenticule that is then extracted ̅ÀœÕ}…> È`i «œVŽiÌ] ̜ “œÀi patients, Rex Hamilton, MD , ->˜Ì> œ˜ˆV> Þi i`ˆV> ÀœÕ«] ->˜Ì> œ˜ˆV>] >ˆvœÀ˜ˆ>] Ã>ˆ` 1°-° ÃÕÀ}iœ˜Ã >Ài >Ãœ ˜œÜ able to use a smaller incision size and other new parameters. “We have the smaller incision }œˆ˜} vÀœ“ ™ä `i}Àiià `œÜ˜ ̜ Èä `i}ÀiiÃ] >˜` “>ÞLi “œÃÌ ˆ“«œÀÌ>˜ÌÞ] Üi…>Ûi ̅i œÕÌÈ`i 1°-° «>À>“iÌiÀà ˆ˜ ÌiÀ“à œv ̅i spot spacing and energies. We are able to now widen the spot ë>Vˆ˜}] ܅ˆV…>œÜà vœÀ >˜ œÛiÀ> œÜiÀ i˜iÀ}Þ `i«œÃˆÌˆœ˜ when we create the lenticule, œvviÀˆ˜} > `À>“>̈V >`Û>˜Ì>}i ܈̅Ài}>À` ̜…œÜ v>ÃÌ Ì…i ۈȜ˜ ÀiVœÛiÀÃ]» À° >“ˆÌœ˜ Ã>ˆ`° Dr. Hamilton said that with these new parameters visual ÀiVœÛiÀÞ Ìœ ÓäÉÓä ˆÃ ÕÃÕ>Þ £ ̜ Ó `>ÞÃ] >à œ««œÃi` ̜ £ ̜ Ó ÜiiŽÃ ܈̅̅i œÀˆ}ˆ˜> Ƃ‡ approved parameters. º7ˆÌ…Ì…i ˜iÜ ÃiÌ̈˜}Ã]…>Ûi been able to lower the overall i˜iÀ}Þ `i«œÃˆÌˆœ˜ LÞ xǯ° 7ˆÌ…Ì…ˆÃ È}˜ˆwV>˜Ì Ài`ÕV̈œ˜ ˆ˜ i˜iÀ}Þ] `ˆÃÃiV̈œ˜ «>˜ià >Ài cleaner and smoother, and there ˆÃ iÃà œ«>µÕi LÕLLi >ÞiÀ ˆ˜ the visual axis, which hastens the ÃiÌ̏ˆ˜} œv ̅i ̈ÃÃÕi «>˜ið /…ˆÃ …>à ÌÀ>˜Ã>Ìi` `ˆÀiVÌÞ Ìœ v>ÃÌiÀ ۈȜ˜ ÀiVœÛiÀÞ ˆ˜ “Þ «>̈i˜Ìð /…i Û>ÃÌ “>œÀˆÌÞ œv “Þ «>̈i˜Ìà >Ài ˜œÜ Ãiiˆ˜} ÓäÉÓä œ˜ «œÃ̜« `>Þ £]» À° >“ˆÌœ˜ Ã>ˆ`° “That has made a big `ˆvviÀi˜Vi ˆ˜ ÌiÀ“à œv «>̈i˜Ì >VVi«Ì>˜Vi >˜` ̅i Vœ˜w`i˜Vi œv ̅i ÃÕÀ}iœ˜ ̜ Li >Li ̜ ÀiVœ““i˜` ̅i «ÀœVi`ÕÀi]» he added. ˜ >``ˆÌˆœ˜ ̜ LÀˆ˜}ˆ˜} astigmatic correction to a new «>̈i˜Ì «œ«Õ>̈œ˜ vœÀ - ] Dr. Hamilton and Jon Dishler, MD ] ˆÃ…iÀ >ÃiÀ ˜Ã̈ÌÕÌi] Àii˜Üœœ` 6ˆ>}i] œœÀ>`œ] ̅ˆ˜Ž - ˆÃ >ÌÌÀ>V̈Ûi ̜ ViÀÌ>ˆ˜ «>̈i˜Ìà L>Ãi` œ˜ v>V̜Àà that have nothing to do with ̅iˆÀ ÀivÀ>V̈Ûi iÀÀœÀ° “The best candidates seem to be the millennial generation vœÀ > Û>ÀˆiÌÞ œv Ài>ܘÃ]» À° ˆÃ…iÀ Ã>ˆ`] > viÜ œv ̅i“ Liˆ˜} iÃà `ˆÃVœ“vœÀÌ] viÜiÀ «œÃ̜« ˆÃÃÕiÃ] >˜` > v>ÃÌiÀ ÀiÌÕÀ˜ ̜ > activities. “There is crossover Q܈̅̅i Ƃ- «œ«Õ>̈œ˜R LÕÌ an additional group [seems to LiR `À>ܘ ̜ - °» Àœ“ > «…ÞÈV> ÃÌ>˜`«œˆ˜Ì] Jason Stahl, MD , Durrie 6ˆÃˆœ˜] "ÛiÀ>˜` *>ÀŽ] >˜Ã>Ã] ̅ˆ˜ŽÃ ̅>Ì Ƃ- >˜` - candidates comprise the same patient population, though he, Dr. Hamilton, and Dr. Dishler ̅ˆ˜Ž -…>à ̅i >LˆˆÌÞ Ìœ ÌÀi>̅ˆ}…iÀ “Þœ«ið “Now that we have the Èä‡`i}Àii È`i VÕÌ ˆ˜VˆÃˆœ˜] Lˆœ“iV…>˜ˆV>Þ Üi >Ài ˜œÌ altering the cornea to the level ̅>Ì Üi `œ ܈̅Ƃ- ܈̅> ÓÇä‡`i}Àii «Õà ˆ˜VˆÃˆœ˜] Ü we are able to treat higher corrections in patients who we “>Þ ˜œÌ…>Ûi Lii˜ Vœ“vœÀÌ>Li ÌÀi>̈˜} ܈̅Ƃ- ]» À° >“ˆÌœ˜ said. “Those patients used to Li Àii}>Ìi` ̜ *, ] ܅ˆV…ˆÃ > w˜i «ÀœVi`ÕÀi LÕ̅>à > œ˜} ÀiVœÛiÀÞ ˆ˜ ÌiÀ“à œv ̅i ۈȜ˜ >˜` ˆÃ ˜œÌ >˜ œ«Ìˆ“> V…œˆVi vœÀ “œÃÌ «>̈i˜Ìð» 1Ìˆ“>ÌiÞ] ˆv > «>̈i˜Ì ˆÃ >˜ œÛiÀ> V>˜`ˆ`>Ìi vœÀ >ÃiÀ ۈȜ˜ correction, choosing the right «ÀœVi`ÕÀi vœÀ ̅i“ Vœ“ià `œÜ˜ ̜ ̅i «>̈i˜Ì½Ã ˆviÃÌޏi >˜` «iÀܘ> ˜ii`Ã] À° -Ì>… Ã>ˆ`° ÀÞ iÞi Ãޓ«Ìœ“à Ài>Ìi` ̜ ÃÕÀ}iÀÞ >Ãœ Ãii“ ̜ Ài܏Ûi µÕˆVŽiÀ ܈̅- Vœ“«>Ài` ̜ Ƃ- ] À° >“ˆÌœ˜ Ã>ˆ`° i Ã>ˆ` …i Ü>À˜Ã Ƃ- «>̈i˜Ìà œv ̅i «œÌi˜Ìˆ> vœÀ `ÀÞ iÞi Ãޓ«Ìœ“à What’s next for SMILE after new approvals Patient population for SMILE expanded to include astigmatism; new parameters speed recovery The lenticule is extracted after dissection in SMILE. -œÕÀVi\ œ˜ ˆÃ…iÀ] This article originally appeared in the March 2019 issue of EyeWorld . It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU here with permission from the ASCRS Ophthalmic Services Corp.