Given that 88 percent of annual eye exams are conducted by optometrists, it might seem strange that merely 20 percent of LASIK cases are referred to ophthalmologists by ODs. What’s the disconnect? Kyle Sandberg, OD, FAAO; Bobby Saenz, OD, MS, FAAO; and Michael Shumski, MD, sought to answer this question by providing an overview of the spectrum of modern refractive surgery at the American Academy of Optometry 2019 meeting
Refractive treatment options
Among the treatment options for refractive surgery, laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and the more recent small incision lenticule extraction (SMILE) techniques are the most common.
Modern laser technology for used in these approaches is improving, offering more accurate results and better outcomes for patients. It is easier than ever for surgeons to create corneal flaps at the proper depth, improve refractive outcomes, and reduce side effects during procedures. For example, the blackouts experienced by some patients during flap creation can be addressed with newer laser platforms.
“With VisuMax Femtosecond Laser (Zeiss), it’s down to zero,” Dr. Shumski says.
These advances apply to PRK as well with new protocols to prevent corneal haze and better bandage contact lenses that accelerate epithelial healing.
For patients who don’t fit the criteria for more traditional refractive therapies, phakic implants such as Visian Implantable Collamer Lens (ICL, Staar Surgical) and Verisye (AMO) offer a new fresh approach.
New options on the market, such as toric ICLs, were approved to treat myopic reduction up to 20.00 D, and they are changing the way we deliver refractive care. Just like with LASIK, patients receiving phakic implants must undergo a pre-surgical evaluation to determine whether
they will be successful. But ODs using these newer implants will need to make sure they’re evaluating the right criteria.
In particular, temporary intraocular pressure (IOP) spikes are a concern for ICLs. As such, the vault measurement is crucial to monitor.
“Troubleshooting early on with IOP is really important for grading the vault,” Dr. Saenz says.