EyeWorld India June 2020 Issue

up to femtosecond LASIK. 3 Those enrolled in the study had moderate to high myopia and underwent SMILE in one eye and LASIK in the other. Investigators found that SMILE attained comparable refractive outcomes to LASIK. With both techniques, all patients attained 20/40 uncorrected distance visual acuity at 3 months postop; 87% of those who had LASIK attained 20/20 uncorrected distance acuity followed by 84% of SMILE recipients, Dr. Ang reported. Secondary outcomes were also promising. “The patients were quite comfortable during SMILE even though SMILE takes slightly longer,” Dr. Ang said, adding, however, that they did feel a bit more uncomfortable during the lenticule extraction itself, though it wasn’t significant. Early on, patients had more subjective fluctuations in vision with SMILE. Studies like this increase the refractive choices available to carefully selected patients, Dr. Ang said. “I think what’s helping us is the increased availability of refractive techniques, which increases the surgical options in suitable patients,” Dr. Ang said. Treating highly aberrated corneas Also gaining ground is refractive treatment for abnormal corneas, according to Jorge Alio, MD, PhD. In a study, Dr. Alio and other investigators identified factors linked with a successful, customized, wavefront-guided treatment in a population with significantly aberrated corneas. 4 Calculations were done patient by patient. Treatment dealt with total eye aberrations, not just corneal ones, as studied preoperatively with the new technology of pyramidal aberrometry developed by CSO Technology, Dr. Alio said. The study was performed with the customized treatment platform of the Schwind Amaris excimer laser (Schwind eye-tech- solutions) guided by total eye pyramidal aberrometry. Investigators found 72% of eyes achieved uncorrected visual acuity of 0.2 logMAR or better postop. There was a loss of one line or more corrected distance visual acuity in 11% of eyes, Dr. Alio said. Outcomes for patients who had undergone prior refractive treatment varied depending on the type. “Patients who have been the subject of previous hyperopic treatments, decentered treatments, for instance, have a lot of coma and many times have smaller pupils,” Dr. Alio said, adding that these patients had the poorest outcomes. Meanwhile, those with a previous myopic surgery and a moderate amount of spherical aberration did well. Dr. Alio hopes practitioners come away from the study with the recognition that there is now a customized treatment for aberrated corneas. However, it is not for everyone. “Some cases are not going to be successfully treated,” he said, adding that other tools need to be developed. The study offers practical information about what can be expected today when dealing with a highly irregular cornea, he concluded. EWAP References 1. Lin DTC, et al. Immediate and short term visual recovery after SmartSurf ACE photorefractive keratectomy. J Optom . 2019;12:240–247. 2. Durrie D, et al. More eyes with 20/10 distance visual acuity at 12 months versus 3 months in a topography-guided excimer laser trial: Possible contributing factors. J Cataract Refract Surg . 2019;45:595–600. 3. Ang M, et al. Randomized clinical trial comparing femtosecond LASIK and small-incision lenticule extraction. Ophthalmology . 2019. Epub ahead of print. 4. Hanna R, et al. Factors predicting successful customized excimer laser treatment in irregular corneas. J Cataract Refract Surg . 2020;46:241–249. Editors’ note: Dr. Alio is professor and chairman of ophthalmology, University of Alicante, Alicante, Spain, and declared no relevant financial interests. Dr. Ang is associate professor of ophthalmology, Duke-National University of Singapore, Singapore, and declared relevant interests with Carl Zeiss Meditec. Dr. Durrie is clinical professor of ophthalmology, University of Kansas Medical Center, Kansas City, Kansas, and declared relevant interests with Alcon. Dr. Lin is clinical associate professor of ophthalmology, University of British Columbia, Vancouver, Canada, and declared relevant interests with Schwind eye-tech-solutions. Follow us! The Next Generation NEW Pentacam ® AXL Wave The first device to combine Scheimpflug Tomography with Axial Length + Total Wavefront + Refraction + Retroillumination The new Pentacam ® AXL Wave is a reliable partner for your refractive and cataract practice, creating the best prerequisites for surgery, based on pre-op metrics, and providing post-op measurements for reliable monitoring, in just one device! With high-end hardware and software for optimum treatment and satisfied patients, the new Pentacam ® AXL Wave makes no compromises on quality. OCULUS Asia Ltd. Hong Kong pentacam.com/axl-wave • info@oculus.hk KLB Instruments Co. Pvt. Ltd KLB REFRACTIVE