As laser vision correction improves and lasers become more precise, ODs are able to better identify great candidates for LASIK. And if, during that process, ODs remember old beliefs and conventional wisdoms regarding refractive surgery, it can allow for happy patients with even better vision outcomes.
Modern laser correction
The good news is that laser vision correction has become very accurate and the enhancement rate is around 2 percent or less for quality surgeons.
A study from the Journal of Refractive Surgery has shown us that outcomes from PRK enhancement is significantly poorer than outcomes from flap lift enhancements. Only 72.5 percent of patients achieved 20/20, compared to 91.5 percent who achieved 20/20 with the flap lift three months after the enhancement.
Even more alarming, these patients started with a SE of 1.20 D. One would expect better results from the PRK group, considering the procedure is the current best practice.
The study postulated that epithelial hyperplasia was the likely cause of poor outcomes. The rubric for our clinic has shifted to where we lift all flaps from the original surgeon of myopes under the age of 50.
The risk factors for epithelial ingrowth have always been microkeratome (who don’t do any), hyperopes, and older patients.5 Following this guideline we have not had any of the disaster epithelial ingrowth patients from earlier years.
More and more, I hear patients tell me they have been told they are “too old” for LASIK. Often, the patient is 45 years old. Chronological age is not what limits success with laser vision correction as much as the clinical findings that often accompany increased age.
The first ocular age-related change that occurs is presbyopia. Laser vision correction does not correct this. For low hyperopes and high myopes, presbyopia doesn’t even confound the laser correction discussion.
1. Joe Rogan Experience podcast #1411. Available at: http://podcasts.joerogan.net/podcasts/robertdowney-jr. Accessed 1/31/20.
2. Myung D, Schallhorn S, Manche EE. Pupil size and LASIK: a review. J Refract Surg. 2013 Nov;29(11):734-41.
3. Pop M, Payette Y. Risk factors for night vision complaints after LASIK for myopia. Ophthalmology. 2004 Jan;111(1):3-10.
4. C Chan, M Lawless, G Sutton, C Hodge. Re-treatment in LASIK: To Flap Lift or Perform Surface Ablation. J Refract Surg. 2020;36(1):6-11.
5. Friehmann A, Mimouni M, Nemet AY, Sela T, Munzer G, Kaiserman I. Risk Factors or Epithelial Ingrowth Following Microkeratome-Assisted LASIK. J Refract Surg. 2018 Feb 1;34(2):100-105.