Refractive Surgery

How often have you heard a post-LASIK patient say his surgery “isn’t working anymore” or it has “expired?” While the corneal tissue that was ablated is gone forever, eyes can change over time, and laser vision correction does not stop time.

Photorefractive keratectomy (PRK) was the original excimer laser procedure approved by the FDA-and is still a safe and effective treatment of refractive errors. PRK has the benefits of no-flap creation; therefore, there is no risk of flap complications.

As primary-care optometrists, we are the gatekeepers for baby boomers inquiring about cataract surgery. Today’s patients have treatment options available not only to address their lifestyle complaints but to provide them with better vision and possibly reduced dependence on glasses or contact lenses.

My interest in refractive surgery started in 1976 when my good friend and fellow University of Southern California (USC) ophthalmology resident Rick Villaseñor returned from his course in keratomileusis surgery with Jose Barraquer in Bogota, Columbia.

As your patients celebrate another birthday milestone, they are again back in your chair wondering why their reading glasses mysteriously disappear when they are out exploring life or why their arms are not as long as they used to be.

The longer the time since the last outbreak, the better

A U.S. patent was granted to Gholam A. Peyman, MD, in June 1989 for a method of modifying the corneal curvature of the eye. The surgical procedure involved cutting a flap in the cornea, pulling the flap back to expose the corneal bed, ablating the exposed surface and then replacing the flap. The current procedure of laser assisted in-situ keratomileusis (LASIK) was not FDA approved until 1999.

The femtosecond laser has brought many significant advances to eye surgery. For more than a decade, it has been used to create lamellar corneal flaps for laser in situ keratomileusis (LASIK), and more recently this laser is used to precisely perform several steps in cataract surgery.

After much anticipation and a long wait for both clinicians and patients in need, the U.S. Food and Drug Administration (FDA) approved corneal cross-linking (CXL) in mid April. This procedure is globally considered the only method of halting the progressive family of diseases called corneal ectasias, including keratoconus.

In a recent wave of drug price increases that can only be explained by pharmaceutical manufacturers’ desire for profit maximization and which doctors and patients may call price gouging, the drug price war has been brought to the doorsteps of many eyecare providers. As optometrists are increasing their practice of medical optometry, patients are now calling their doctors about prior authorizations and unaffordable drug copays.

Cataract surgery is one of the most successful surgeries performed in the United States. By 2020, it is estimated the number of people having cataract surgery will double, and by 2030 it will triple. The optometrist’s role in comanaging these patients will be of critical importance. Developing and maintaining your post-operative clinical care skills is imperative.

One of the most common questions I hear every day from patients is, “What is new in refractive surgery?” I have asked Jim Owen, OD, an expert in refractive surgery technology, to discuss the latest version of LASIK-topography-guided LASIK-with David Geffen, OD, FAAO, who participated in Alcon’s Contoura Vision clinical trials.

A referral of your patient to a cataract surgeon seems straightforward. You refer when the vision is subjectively affected by lens opacification. But thinking out of the box will enable you to help your patients in ways you may not consider.

For years, I have been an advocate of early cataract surgery in any symptomatic patients. As we all know, the progression of cataract development is an unavoidable process, so why delay the inevitable?

In a landmark paper titled “Global consensus on keratoconus and ectatic diseases” published in the April 2015 issue of Cornea, Gomes et al sought to reach a consensus of the definition, concepts, clinical management, and surgical treatments of keratoconus and the family of corneal ectatic diseases.

We now live in the age of refractive cataract surgery. As optometrists, we think daily about refractive endpoints for glasses and contact lenses. But few think about it in terms of ocular surgery.

At present we are limited with our ability to treat presbyopes. Sure, we have progressives and multifocal contact lenses; however, from a surgical standpoint, monovision corneal refractive surgery is limited, and clear lens extraction is often extreme for emmetropes.

Corneal inlays to correct refractive errors are not new-various materials have been tried for more than 50 years to correct blurred vision. The greatest barriers to success of corneal inlays have been a lack of biocompatibility with the cornea, the difficulty of placing them within the corneal stroma safely, and refractive predictably.

The Centers for Disease Control and Prevention (CDC) recently told Women’s Health magazine that the reason some swimmers get red eyes after a dip in the pool isn’t the chlorine-it’s the urine in the water.

In October of 2009 the U.S. Food and Drug Administration (FDA), National Eye Institute (NEI), and the Department of Defense (DOD) launched the LASIK Quality of Life Collaboration Project (LQOLCP) to help better understand the potential risk of severe problems that can result from LASIK.

The landscape of cataract surgery has changed rapidly-first with premium intraocular lenses (IOLs) and now additional refractive cataract options such as laser-assisted cataract surgery (LACS) and intraoperative aberrometry.

Modern ophthalmic cataract surgery now employs sophisticated techniques to improve outcomes and patient satisfaction. This includes surgical systems providing better control, lasers to perform manual techniques, and intraoperative evaluation to evaluate surgical endpoints before the patient leaves the operating room (OR).

Years ago, I realized that a cataract is anomaly of the ocular system that should be eradicated at its earliest stages. Frankly, if you were in a relationship that was not going well and was destined to keep getting worse, would you stay?

Postoperative patients with PXF pose both short- and long-term concerns due to the underlying pathological changes that occur from the fibrillar deposition with some complications arising years after the surgery.

Before recommending laser vision correction for your patient, there are a number of factors you as an eyecare practitioner must consider.