EyeWorld India September 2021 Issue

REFRACTIVE EWAP SEPTEMBER 2021 31 Contact information Hatch: kathryn_hatch@meei.harvard.edu Jarstad: allison.jarstad@gmail.com Trattler: wtrattler@gmail.com W hen choosing the best refractive surgery option, there are a variety of factors that surgeons consider, including patient age, overall goals, and expectations. Three surgeons discussed which procedures they use and some of the specifics of laser refractive surgery, phakic IOLs, and lens replacement surgery. William Trattler, MD, said that over the last decade, surgeons have come to use LASIK for a variety of patients, from high myopes to hyperopes, in a wide range of ages. Now there are other options as well, he said, noting refractive lens exchange and the option to offer phakic IOLs to patients with lower refractive errors. When potential refractive surgery patients come in for a consultation, Dr. Trattler said it’s important to be prepared with all the options. “Every patient is going to need a unique strategy to figure out how to make them happiest,” he said. “These are patients that you’ll probably see years after surgery, so you want to give them something to make them happy in the long term as well as short term.” Dr. Trattler said procedure Comparing laser refractive surgery, phakic IOLs, and lens replacement by Ellen Stodola EyeWorld Editorial Co-Director decisions may be easier for the younger patient. For those younger than 40, typically if they’re myopic and under –9 or –10 D, he’ll offer them laser vision cor-rection, which could be PRK, LASIK, or SMILE. That decision depends on surgeon preference, Dr. Trattler said, but these are all good procedures. If the patient has more than –9 or –10 D, that’s when you start thinking ICL. Laser vision correction can be used for high myopes, but its risk profile increases, he said. A newer version of the ICL is approaching FDA approval and will make the procedure easier, he added. The new version has a small hole in the lens optic that allows for aqueous flow. This eliminates the need for placement of peripheral iridectomies. International surgeons who have been using the technology have commented that this update improves the safety of the ICL, he said. When considering patients of presbyopic age, choices become more nuanced. For those patients who are hyperopic in their 20s to 30s, Dr. Trattler said they’re typically able to accommodate through their hyperopia, except when the hyperopia is severe. But once patients reach their 40s, hyperopia starts to impact vision, and patients will request refractive surgery consultations. Hyperopic patients in their This article originally appeared in the July 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Removal of epithelium during a PRK procedure with the EBK device (Epi Clear, Orca Surgical). Source: Jennifer Loh, MD