1
|
Three-year outcomes of mixed astigmatism correction with single-step transepithelial photorefractive keratectomy with a large ablation zone. J Cataract Refract Surg 2021; 47:450-458. [PMID: 33252566 DOI: 10.1097/j.jcrs.0000000000000476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate refractive and visual outcomes of single-step transepithelial photorefractive keratectomy (transPRK) in the treatment of mixed astigmatism with the use of an aberration-neutral profile and large ablation zone. SETTING Nicolaus Copernicus University and Oftalmika Eye Hospital, Bydgoszcz, Poland. DESIGN Retrospective, observational case series. METHODS This study included patients who underwent transPRK to correct mixed astigmatism and completed the 3-year follow-up. Procedures were performed with an Amaris 750S excimer laser using an aberration-neutral profile and optical zone of 7.2 mm or more. RESULTS A total 48 eyes of 39 patients were included. Preoperatively, mean spherical manifest refraction was +1.37 ± 0.98 diopter (D) (0.25 to 4.00 D), and astigmatism was -4.00 ± 0.76 D (-2.25 to -6.00 D). Three years postsurgery, it was -0.17 ± 0.26 D and -0.41 ± 0.44 D, respectively. Attempted spherical equivalent correction within ±0.50 D was achieved in 45 eyes (94%) and cylindrical correction in 34 (71%). Preoperative corrected distance visual acuity (CDVA) was 20/20 or better in 38 eyes (79%), and postoperative uncorrected was 20/20 or better in 29 eyes (60.0%). No eye had lost 2 or more Snellen lines of CDVA, whereas 3 eyes (6%) gained 2 or more lines. In 4 eyes (8%), haze of low intensity was observed at the periphery, with scores between 0.5 and 1.0, and only 1 eye getting a score of 2 in 0- to 4-degree scale. CONCLUSIONS Mixed astigmatism correction with large-ablation-zone transPRK provided good results for efficacy, safety, predictability, and visual outcomes in a 3-year follow-up.
Collapse
|
2
|
Joffe SN. The 25th Anniversary of Laser Vision Correction in the United States. Clin Ophthalmol 2021; 15:1163-1172. [PMID: 33762815 PMCID: PMC7982707 DOI: 10.2147/opth.s299752] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/24/2021] [Indexed: 01/05/2023] Open
Abstract
Laser Vision Correction (LVC) is an elective, self-pay and safe surgical procedure to correct myopia and hyperopia. Since FDA approval 25 years ago, there have been a progression of technological improvements leading to better outcomes and LVC is now one of the safest surgical procedures. With a potential pool of 50 million patients, 6000 trained ophthalmic surgeons regularly treating in over 1000 centers of which 65% are physician owned. Treatments remain low from an earlier peak of 1.4 million to less than 800,000 over last 10 years. The factors preventing patients undergoing surgery have not changed and include the cost of $2000 ± $1000 per eye and fear of laser surgery on their eyes. The latter is overcome by word of mouth referrals and positive social media messaging. In addition, press misinformation and lack of optometrists participating in co-management have not helped grow LVC procedures despite the positive results of the FDA’s Patient Reported Outcomes with LASIK studies known as PROWL. The surgery is quick, and patients can be “in and out” in less than two hours with a rapid recovery, minimal postoperative restrictions and within 24 hours have 20/20 vision. Volume and price drives center and physician profitability with a scheduling capacity of two to four patients’ treatments per hour. Laser vision correction and especially LASIK, remains the treatment of choice for myopic and hyperopic patients wanting to remove their dependency on glasses and contact lenses.
Collapse
Affiliation(s)
- Stephen N Joffe
- History of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Surgery and Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| |
Collapse
|
3
|
de Ortueta D, von Rüden D, Verma S, Magnago T, Arba-Mosquera S. Transepithelial Photorefractive Keratectomy in Moderate to High Astigmatism With a Non-wavefront-Guided Aberration-Neutral Ablation Profile. J Refract Surg 2018; 34:466-474. [PMID: 30001450 DOI: 10.3928/1081597x-20180402-04] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/02/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the outcomes of transepithelial photorefractive keratectomy (PRK) in moderate to high astigmatism with a non-wavefront-guided aberration-neutral ablation profile using SmartPulse allocation. METHODS In this retrospective study, myopic patients with a preoperative cylinder of 2.00 diopters (D) or greater were analyzed at 3 months of follow-up. Transepithelial PRK treatments were performed in each patient with the Amaris 1050RS laser (SCHWIND eye-tech-solutions, Kleinostheim, Germany) creating aspheric ablation profiles by applying a SmartPulse allocation. Standard examinations and wavefront analyses were included for low and high ocular residual astigmatism subgroups. RESULTS Fifty-eight eyes (44 patients) were included in the cohort. The eyes were divided into separate ocular residual astigmatism subgroups: 17 eyes presented with less than 0.50 D (low ocular residual astigmatism) and 24 eyes with greater than 0.75 D (high ocular residual astigmatism). The mean refractive cylinder in the entire cohort was 2.84 ± 0.86 D preoperatively and 0.40 ± 0.39 D postoperatively, with 81% of the eyes within 0.75 D of the target astigmatism. At 3 months of follow-up, significant improvement (P < .05) was seen in terms of sphere, cylinder, spherical equivalent, and uncorrected (UDVA) and corrected (CDVA) distance visual acuity. CDVA improved in 40% of eyes and 3% of eyes lost one line of CDVA. No clinically relevant changes were seen in higher order aberrations. The refractive changes showed an excellent match with the keratometric changes. The difference between the low and high ocular residual astigmatism subgroups was not significant except for the change of Snellen lines of CDVA (P < .05). CONCLUSIONS Transepithelial PRK using a non-wavefront-guided aberration-neutral ablation profile performed by applying SmartPulse allocation yielded excellent visual outcomes. The preoperative astigmatism was reduced to subclinical values. Both subgroups were effective in terms of UDVA, CDVA, spherical and astigmatic correction, and preserving higher order aberrations. However, the low ocular residual astigmatism subgroup was slightly more prone to gain lines of CDVA. [J Refract Surg. 2018;34(7):466-474.].
Collapse
|
4
|
Gros-Otero J, Garcia-Gonzalez M, Teus MA, Iglesias-Iglesias M, Gimenez-Vallejo C. Femtosecond laser-assisted sub-Bowman keratomileusis versus laser-assisted subepithelial keratomileusis to correct myopic astigmatism. JOURNAL OF OPTOMETRY 2018; 11:33-39. [PMID: 27751694 PMCID: PMC5777929 DOI: 10.1016/j.optom.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/12/2016] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To compare femtosecond laser-assisted sub-Bowman keratomileusis (FSBK) versus laser-assisted subepithelial keratomileusis (LASEK) to correct moderate to high myopic astigmatism. METHODS Retrospective, nonrandomized, interventional, comparative case series. A total of eight hundred and fifty-two eyes with myopic astigmatism of -1.5 diopters (D) or higher were included in the study. We compared 427 eyes treated with FSBK versus 425 eyes treated with LASEK with or without mitomycin C. Visual and refractive results were evaluated 1 day, 1 week, 3 and 6 months postoperatively. RESULTS Six months postoperatively, the residual spherical defect was slightly but significantly higher in the LASEK group (+0.15±0.62D) than in the FSBK group (+0.09±0.35D) (P=0.05). The postoperative residual astigmatism was also slightly but significantly higher in the LASEK group (-0.38±0.52D) than in the FSBK group (-0.26±0.45D) (P=0.0005). No significant differences were found in the efficacy (0.98±0.17 versus 0.98±0.36, P=0.6) and safety indexes (1.04±0.16 versus 1.05±0.37, P=0.1) between FSBK and LASEK. The enhancement rate was significantly higher in the FSBK group (22.6%) than in the LASEK group (15.5%) (P=0.01). CONCLUSIONS Both FSBK and LASEK are safe and effective procedures to correct moderate to high myopic astigmatism. Slightly better visual and refractive results were observed in FSBK-treated eyes in a 6-month follow-up.
Collapse
Affiliation(s)
- Juan Gros-Otero
- Clínica Rementería, C/Almagro 36, 28010 Madrid, Spain; Hospital Universitario "Príncipe de Asturias," University of Alcalá, Carretera de meco s/n, Alcalá de Henares, Madrid, Spain.
| | - Montserrat Garcia-Gonzalez
- Clínica Rementería, C/Almagro 36, 28010 Madrid, Spain; Clínica Novovisión, C/Castellana 54, 28046 Madrid, Spain
| | - Miguel A Teus
- Hospital Universitario "Príncipe de Asturias," University of Alcalá, Carretera de meco s/n, Alcalá de Henares, Madrid, Spain; Clínica Novovisión, C/Castellana 54, 28046 Madrid, Spain
| | | | | |
Collapse
|
5
|
El Bahrawy M, Alió JL. Excimer laser 6(th) generation: state of the art and refractive surgical outcomes. EYE AND VISION (LONDON, ENGLAND) 2015; 2:6. [PMID: 26605362 PMCID: PMC4655460 DOI: 10.1186/s40662-015-0015-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 02/11/2015] [Indexed: 12/03/2022]
Abstract
After nearly three decades of innovation in excimer laser, today we are presented with a state of the art generation targeting minimally invasive refractive surgery with high speed laser, faster trackers, pupil monitoring systems and better customization profiles. These systems are capable of delivering better treatments with less induced postoperative high order aberrations. The results reported by many authors had confirmed the superiority in efficiency and safety profiles of this generation compared to previous generations. Still, current technology is facing major challenges in the correction of high hyperopic errors and in presbyopic treatments, with upgrades in ablation centration and thermal control needed, which will ensure better biomechanical results, as a step closer to perfection in refractive surgery.
Collapse
Affiliation(s)
- Mohamed El Bahrawy
- />Clinical research fellow in Vissum Corporación Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge L Alió
- />Vissum Corporación Alicante, Alicante, Spain
- />Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
- />Avda de Denia s/n, Edificio Vissum, 03016 Alicante, Spain
| |
Collapse
|
6
|
Comparison of the visual outcomes between PRK-MMC and phakic IOL implantation in high myopic patients. Eye (Lond) 2014; 28:1113-8. [PMID: 24993326 DOI: 10.1038/eye.2014.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/14/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the visual outcomes between PRK-MMC and phakic IOL in patients with more than 8 diopter (D) of myopia. METHODS This comparative study was performed on 23 eyes under treatment with Artiflex (group A) and 23 eyes under treatment with PRK-MMC (group B). Artiflex phakic IOL (Ophtec BV) was used in group A, and the VISX STAR S4 Excimer Laser (Abbott) was used for PRK-MMC in group B. RESULTS The safety index was 1.11 ± 0.23 and 1.05 ± 0.25 (P = 0.100) and the efficacy index was 1.02 ± 0.11 and 0.98 ± 0.10 (P = 0.266) in group A and B, respectively. At 1 year after surgery, the manifest refraction spherical equivalent was -0.17 ± 1.18 and -0.25 ± 0.18 D in group A and B, respectively (P = 0.471). Mesopic CS showed no significant difference between the two groups in any spatial frequency. Total coma was 0.24 ± 0.17 and 0.67 ± 0.40 μm (P < 0.001), spherical aberration was -0.11 ± 0.11 and 0.41 ± 0.18 μm (P < 0.001), and RMS HOAT was 0.50 ± 0.20 and 0.96 ± 0.45 μm (P<0.001) in group A and B, respectively. CONCLUSION Phakic IOL implantation was better than PRK-MMC in the correction of high myopia in terms of visual quality, but the two methods had no difference with regard to visual acuity. Therefore, PRK-MMC can be used when the anterior chamber depth is a limiting factor in the implantation of phakic IOLs.
Collapse
|
7
|
Alió JL, Plaza-Puche AB, Martinez LM, Torky M, Brenner LF. Laser in situ keratomileusis using optimized aspheric profiles and cyclotorsion control to treat compound myopic astigmatism with high cylinder. J Cataract Refract Surg 2012; 39:28-35. [PMID: 23128029 DOI: 10.1016/j.jcrs.2012.07.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 07/26/2012] [Accepted: 07/26/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the visual outcomes after laser in situ keratomileusis (LASIK) surgery to correct primary compound myopic astigmatism with high cylinder performed using a fast-repetition-rate excimer laser platform with optimized aspheric profiles and cyclotorsion control. SETTING Vissum Corporation and Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain. DESIGN Retrospective consecutive observational nonrandomized noncomparative case series. METHODS Eyes with primary compound myopic astigmatism and a cylinder power over 3.00 diopters (D) had uneventful LASIK with femtosecond flap creation and fast-repetition-rate excimer laser ablation with aspheric profiles and cyclotorsion control. Visual, refractive, and aberrometric outcomes were evaluated at the 6-month follow-up. The astigmatic correction was evaluated using the Alpins method and Assort software. RESULTS The study enrolled 37 eyes (29 patients; age range 19 to 55 years). The significant reduction in refractive sphere and cylinder 3 months and 6 months postoperatively (P<.01) was associated with improved uncorrected distance visual acuity (P<.01). Eighty-seven percent of eyes had a spherical equivalent within ±0.50 D; 7.5% of eyes were retreated. There was no significant induction of higher-order aberrations (HOAs). The targeted and surgically induced astigmatism magnitudes were 3.23 D and 2.96 D, respectively, and the correction index was 0.91. The safety and efficacy indices were 1.05 and 0.95, respectively. CONCLUSIONS Laser in situ keratomileusis for primary compound myopic astigmatism with high cylinder (>3.00 D) performed using a fast-repetition-rate excimer laser with optimized aspheric profiles and cyclotorsion control was safe, effective, and predictable and did not cause significant induction of HOAs.
Collapse
Affiliation(s)
- Jorge L Alió
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt.
| | - Ana B Plaza-Puche
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt
| | - Lorena M Martinez
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt
| | - Magda Torky
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt
| | - Luis F Brenner
- From the Vissum Corporation (Alió, Plaza-Puche, Martinez, Torky, Brenner) and the Division of Ophthalmology (Alió), Universidad Miguel Hernández, Alicante, Spain; Mansoura University (Torky), Mansoura, Egypt
| |
Collapse
|
8
|
Kugler L, Cohen I, Haddad W, Wang MX. Efficacy of laser in situ keratomileusis in correcting anterior and non-anterior corneal astigmatism: comparative study. J Cataract Refract Surg 2010; 36:1745-52. [PMID: 20870122 DOI: 10.1016/j.jcrs.2010.05.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 04/28/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the efficacy of conventional laser in situ keratomileusis (LASIK) in treating corneal astigmatism and in treating noncorneal ocular residual astigmatism. SETTING Private practice, Nashville, Tennessee, USA. DESIGN Retrospective case series. METHODS The records of dominant eyes of consecutive patients who had LASIK were retrospectively analyzed to compare the efficacy of LASIK in eyes with predominantly anterior corneal astigmatism with the efficacy in eyes with predominantly ocular residual astigmatism (ORA). The ORA was determined by vector analysis using refractive cylinder and topographic astigmatism. Preoperatively, the ratio of ORA to preoperative refractive cylinder (R) was used to divide the patients into 2 groups; that is, eyes with predominantly anterior corneal astigmatism (ORA/R ratio <1.0) and eyes with predominantly ORA (ORA/R ratio ≥1.0). Efficacy was determined by examining the magnitude of the remaining uncorrected astigmatism and comparing the index of success (proportion of preoperative refractive astigmatism that remained uncorrected by LASIK) between the 2 groups. RESULTS The study evaluated 61 eyes of 61 patients. Conventional LASIK was twice as efficacious in the low-ORA group as in the high-ORA group. The index of success was 0.24 and 0.50, respectively, and the difference between groups was statistically significant (P = .036). CONCLUSION The efficacy of astigmatic correction by LASIK was significantly higher in eyes in which the preoperative refractive astigmatism was located mainly on the anterior corneal surface than in eyes in which it was mainly located posterior to the anterior corneal surface.
Collapse
Affiliation(s)
- Lance Kugler
- Wang Vision Institute, Nashville, Tennessee, USA.
| | | | | | | |
Collapse
|
9
|
Hashemi H, Nazari R, Amoozadeh J, Beheshtnejad AH, Jabbarvand M, Mohammadpour M, Hashemian H. Comparison of postoperative higher-order aberrations and contrast sensitivity: Tissue-saving versus conventional photorefractive keratectomy for low to moderate myopia. J Cataract Refract Surg 2010; 36:1732-40. [DOI: 10.1016/j.jcrs.2010.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 04/13/2010] [Accepted: 04/27/2010] [Indexed: 11/24/2022]
|
10
|
Arbelaez MC, Vidal C, Arba-Mosquera S. Excimer laser correction of moderate to high astigmatism with a non-wavefront-guided aberration-free ablation profile: Six-month results. J Cataract Refract Surg 2009; 35:1789-98. [PMID: 19781476 DOI: 10.1016/j.jcrs.2009.05.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 04/29/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the postoperative clinical outcomes and higher-order aberrations (HOAs) in eyes with astigmatism greater than 2.00 diopters (D) that had laser in situ keratomileusis (LASIK) using a non-wavefront-guided aberration-free ablation profile. SETTINGS Private practice. METHODS This retrospective study evaluated the 6-month results of LASIK for astigmatism greater than 2.00 D. Standard examinations and preoperative and postoperative wavefront analyses were performed. Aspheric treatments with a non-wavefront-guided ablation profile were planned using software integrated into the Amaris flying-spot excimer laser system, which was used to perform the ablations. The LASIK flaps were created using an LDV femtosecond laser. Clinical outcomes were predictability, refractive outcomes, safety, efficacy, and wavefront aberration. RESULTS At 6 months, 84% of the 50 eyes evaluated achieved 20/20 or better uncorrected distance visual acuity (UDVA) and 40% achieved 20/16 or better UDVA. Forty-four percent of eyes were within +/-0.25 D of the attempted astigmatic correction, and 78% were within +/-0.50 D. The mean SE was -0.12 D +/- 0.25 (SD) and the mean astigmatism, 0.50 +/- 0.26 D. Corrected distance visual acuity (CDVA) improved in 36% of eyes; 4% of eyes lost 1 line of CDVA. The predictability slope for astigmatism was 0.97 and the intercept, -0.15 D. There were no clinically relevant changes in any aberration metric from preoperatively to postoperatively. CONCLUSIONS Excimer laser LASIK using a non-wavefront-guided aberration-free ablation profile yielded excellent visual outcomes. The preoperative astigmatism was reduced to subclinical values with no clinically relevant induction of HOA.
Collapse
|
11
|
Bucher C, Zuberbuhler B, Goggin M, Esterman A, Schipper I. Corneal limbal marking in the treatment of myopic astigmatism with the excimer laser. J Refract Surg 2009; 26:505-11. [PMID: 19715268 DOI: 10.3928/1081597x-20090814-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 07/23/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine whether preoperative marking of the limbal cornea improves treatment of myopic astigmatism with the excimer laser. METHODS Retrospective study on 108 eyes with myopic astigmatism that underwent LASIK or laser epithelial keratomileusis (LASEK) with the Technolas 217 (Bausch & Lomb) excimer laser. Preoperative limbal marking was performed in 47 eyes (marked group). The 12-month results were used for refractive and visual analysis. RESULTS The achieved cylinder reduction, spherical reduction, and refractive predictability were similar for the marked and unmarked groups in the overall study collective, in the LASIK and LASEK subgroup analysis, and in a higher astigmatism (> 1.25 diopters) subgroup analysis. Limbal marking showed no influence on the refractive results, and vector analysis showed no significant difference in angle of error among groups. CONCLUSIONS Corneal limbal marking failed to improve the refractive outcome in LASIK and LASEK for myopic astigmatism.
Collapse
|
12
|
LASIK world literature review: quality of life and patient satisfaction. Ophthalmology 2009; 116:691-701. [PMID: 19344821 DOI: 10.1016/j.ophtha.2008.12.037] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 12/12/2008] [Accepted: 12/15/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To analyze the patient reported outcome of satisfaction after LASIK surgery. DESIGN Systematic review. PARTICIPANTS Patient data from previously reported studies. METHODS A literature search conducted for the years 1988 to 2008 that included pertinent LASIK surgery information from the review of 2915 retrieved citations. All abstracts from these citations were reviewed and 1581 were deemed to be relevant for review. Complete copies of each of these relevant (1581) articles were obtained, and after thorough analysis each was rated based on the strength of the study design and weight of evidence. A level I rating was assigned to properly conducted, well-designed, randomized clinical trials; a level II rating to well-designed cohort and case-control studies; and a level III rating to case series, case reports, and poorly designed prospective and retrospective studies. Level I and II rated, peer-reviewed articles were entered into a database, and level III articles were eliminated. A total of 309 articles were incorporated into this database, representing level I and level II well-controlled studies of primary LASIK surgery. MAIN OUTCOME MEASURES Patients' satisfaction rates and factors associated with dissatisfaction. RESULTS Nineteen of the 309 database articles (6.1%) reported on both patient quality of life and satisfaction and together encompassed a total of 2198 subjects. The procedures from these 19 articles took place between 1995 and 2003. The overall patient satisfaction rate after primary LASIK surgery was 95.4% (2097 of 2198 subjects; range of patient satisfaction for the 19 articles was 87.2%-100%). The patient satisfaction rate after myopic LASIK was 95.3% (1811 of 1901 patients), and after hyperopic LASIK was 96.3% (286 of 297 subjects). CONCLUSIONS Based on this review, worldwide, an average 95.4% of patients were satisfied with their outcome after LASIK surgery. With 16.3 million procedures performed worldwide, and more than a decade of clinical studies and technological innovation, LASIK surgery should be considered among the most successful elective procedures. LASIK surgery compares more favorably with other elective surgical procedures in terms of generally higher satisfaction rates.
Collapse
|
13
|
Kato N, Toda I, Hori-Komai Y, Sakai C, Tsubota K. Five-Year Outcome of LASIK for Myopia. Ophthalmology 2008; 115:839-844.e2. [PMID: 17900692 DOI: 10.1016/j.ophtha.2007.07.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 06/18/2007] [Accepted: 07/09/2007] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate the efficacy and safety of LASIK over a 5-year postoperative period. DESIGN Observational case series. PARTICIPANTS We examined 779 eyes in 402 patients with myopia or myopic astigmatism who underwent LASIK to correct their refractive errors and received regular postoperative assessments for 5 years. METHODS Postoperative examinations were performed 1 day; 1 week; 1, 3, and 6 months; and 1, 2, 3, 4, and 5 years after LASIK surgery. MAIN OUTCOME MEASURES We evaluated changes in uncorrected visual acuity (UCVA) (logarithm of the minimum angle of resolution [logMAR]), manifest refraction, best-corrected visual acuity (BCVA) (logMAR), intraocular pressure, corneal thickness, corneal endothelial cell counts, and complications. RESULTS Preoperative UCVA of 1.27 improved to -0.03 at 1 day after surgery and -0.08 at 1 month and revealed minimal but significant decreases thereafter. Postoperative manifest refraction was also improved by surgery, showing minimal but significant regression after 1 year. Final BCVA loss was seen in 10 eyes of 7 patients; in 7 cases, there were obvious reasons such as the progression of cataracts in 3 eyes, epithelial disintegrity due to dry eye in 2 eyes, irregular astigmatism due to flap striae in 1 eye, and age-related macular dystrophy in 1 eye. Intraocular pressure and corneal thickness decreased by 4.0 mmHg and 76.9 microm, respectively, due to surgery, but remained stable throughout the follow-up period. Corneal endothelial cell counts (2689.0+/-232.9 cells/mm(2) before surgery) showed a statistically significant decrease at 5 years after surgery (2658.0+/-183.1 cells/mm(2); 1.2% loss for 5 years), likely within the range due to physiological age-related loss. No serious, vision-threatening, irreversible complication such as keratectasia or progressive endothelial cell loss was observed. CONCLUSION LASIK surgery is an effective and safe procedure for correcting myopia/myopic astigmatism as long as inclusion and exclusion criteria are strictly respected. However, minimal regression occurred during the 5-year investigative period.
Collapse
Affiliation(s)
- Naoko Kato
- Minamiaoyama Eye Clinic, Tokyo, Japan.; Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.
| | | | | | | | | |
Collapse
|
14
|
Bragheeth MA, Dua HS. Effect of Refractive and Topographic Astigmatic Axis on LASIK Correction of Myopic Astigmatism. J Refract Surg 2005; 21:269-75. [PMID: 15977884 DOI: 10.3928/1081-597x-20050501-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate whether agreement or disagreement between the axis of astigmatism as determined by refraction and corneal topography has any influence on the outcome of laser in situ keratomileusis (LASIK) correction of astigmatism. METHODS Charts of 122 consecutive eyes of 75 patients (46 women and 29 men) who underwent uncomplicated, primary LASIK for myopic astigmatism were reviewed. The series was divided into two groups--group 1, "agreement" (77 eyes) with a difference between refractive and topographic axis of astigmatism < or = 15 degrees, and group 2, "disagreement" (45 eyes) with a difference > 15 degrees. RESULTS The mean difference in axis of astigmatism was 10 +/- 17.20 degrees (range: 0 degrees to 86 degrees), and 63.11% of eyes were within a 15 degrees difference. A significant negative correlation was found between the percentage of corrected astigmatism and the degree of disagreement. The percentage of corrected astigmatism differed significantly between the two groups (P=.002) with better results in group 1 (agreement). CONCLUSIONS Disagreement between refractive and topographic astigmatic axis is common. Approximately one third of eyes with astigmatism have > 15 degrees disagreement. Disagreement between refractive and topographic determination of the astigmatic axis can be considered a prognostic factor for LASIK correction of myopic astigmatism.
Collapse
Affiliation(s)
- Mohamed A Bragheeth
- Division of Ophthalmology and Visual Sciences, University of Nottingham, United Kingdom
| | | |
Collapse
|
15
|
Mantry S, Yeung I, Shah S. Aspheric Ablation With the Nidek EC-5000 CX II With OPD-Scan Objective Analysis. J Refract Surg 2004; 20:S666-8. [PMID: 15521263 DOI: 10.3928/1081-597x-20040903-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the efficacy, predictability, stability, and safety of laser in situ keratomileusis (LASIK) to correct myopia and myopic astigmatism using the Nidek EC-5000 CX II laser and the Customized Aspheric Transition Zone (CATz) profile. METHODS We conducted a retrospective analysis of 100 eyes (50 patients) with myopic astigmatism. A CATz profile was used in all eyes (profile 4) with an ablation zone of 5 mm and a transition zone of 9 mm, using Nidek FinalFit software. RESULTS Average patient age was 39 years (range 21 to 69 yr). Preoperative mean spherical equivalent refraction was -4.70 +/- 2.53 D (range -11.88 to -0.50 D), mean preoperative sphere was -4.31 +/- 2.53 D (range -11.25 to -0.25 D), and mean preoperative cylinder was -0.78 +/- 0.69 D (range -3.25 to 0). Postoperative mean spherical equivalent refraction at 6 months was 0.12 +/- 0.53 D (range -1.63 to +0.88 D), mean postoperative sphere was 0.02 +/- 0.56 D (range -1.50 to +2.00 D), and mean postoperative cylinder was -0.29 +/- 0.50 D (range 0 to -1.75 D). Uncorrected visual acuity was 6/6 or better in 58% (58 eyes) and better than 6/12 in 93% (93 eyes). CONCLUSION LASIK with the Nidek EC-5000 CX II laser and the CATz profile was effective, reasonably predictable, stable, and safe for correction of myopic astigmatism with a spherical component between -0.25 and -11.25 D, and a cylindrical component up to 3.25 D, using the techniques in this study. Astigmatism was undercorrected with the current algorithm.
Collapse
|
16
|
Bharti S, Bharti R, Samantaray D. Comparison of Cross Cylinder Ablation Using the Optimized Ablation Transition Zone and the Torsion Error Detector for Correction of Astigmatism. J Refract Surg 2004; 20:S663-5. [PMID: 15521262 DOI: 10.3928/1081-597x-20040903-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the safety and efficacy of laser in situ keratomileusis (LASIK) in correcting high myopic astigmatism using two different ablation profiles using the Nidek EC-5000 CX II laser). METHODS Fifteen patients (25 eyes) had LASIK for compound myopic astigmatism, using the Optimized Ablation Transition Zone (OATz) ablation profile and activated torsion error detection (TED). Results were compared with those obtained with a cross cylinder ablation profile for myopic astigmatism. RESULTS For eyes treated with TED, on postoperative day 7, 76% had visual acuity equal to or better than baseline best spectacle-corrected visual acuity (BSCVA) and 56% of eyes had overcorrected astigmatism. On postoperative day 20, none of the eyes had residual astigmatism more than 1.00 D and 72% eyes were within +/-0.50 D cylinder; 92% of eyes had residual astigmatism within 30 degrees of the preoperative axis and 12% remained astigmatically overcorrected at 20 days. Eighty-eight percent of eyes were either fully corrected or had mild myopic astigmatism. Comparison of results with cross cylinder ablation showed that 24% had overcorrection and 60% of patients with high astigmatism were overcorrected up to 1.75 D and developed hyperopic astigmatism in the opposite axis. Results with the cross cylinder ablation profile were good up to 2.00 D of myopic astigmatism. CONCLUSIONS Correction of astigmatism using the OATz profile and TED with the Nidek EC-5000 CX II laser produced good results in high as well as pure astigmatism treatments, compared to the cross cylinder ablation profile. Ablation depth was greater in OATz with TED-based corrections. Overcorrections were less with OATz with TED, and residual astigmatism was at the same baseline axis, thereby increasing patient satisfaction.
Collapse
|
17
|
Caster AI, Hoff JL, Ruiz R. Nomogram Adjustment of Laser in situ Keratomileusis for Myopia and Myopic Astigmatism With the Alcon LADARVision System. J Refract Surg 2004; 20:364-70. [PMID: 15307399 DOI: 10.3928/1081-597x-20040701-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual and refractive results of conventional (non-wavefront) laser in situ keratomileusis (LASIK) for treatment of myopia and myopic astigmatism using the Alcon LADARVision 4000 excimer laser system and nomogram adjustment techniques. METHODS A retrospective analysis of 499 eyes that had LASIK for myopia and myopic astigmatism was performed. Preoperative manifest spherical equivalent refraction ranged from -0.43 to -6.00 D and preoperative astigmatism ranged from 0 to -4.75 D. Patients were evaluated during 3 months following surgery. RESULTS One month after surgery, 72% of eyes examined (298/415 eyes) had uncorrected visual acuity (UCVA) of 20/20 or better. Three months after surgery, 83% of eyes examined (216/261 eyes) had UCVA of 20/20 or better. One and three months after surgery, 82% and 83% of eyes, respectively, were within +/-0.50 D of attempted correction; 97% of eyes were within +/-1.00 D at both 1 and 3 months. No eye lost more than 1 line of best spectacle-corrected visual acuity (BSCVA) at 3 months after surgery. At the 3-month examination, 83% of eyes had UCVA better than or equal to preoperative BSCVA. CONCLUSIONS Conventional LASIK to correct myopia and myopic astigmatism was safe and effective using the Alcon LADARVision 4000 excimer laser system. Outcomes were substantially improved throughout development of an accurate nomogram, derived from continually updated regression analysis of previous refractive results.
Collapse
|
18
|
Hashemi H, Fotouhi A, Foudazi H, Sadeghi N, Payvar S. Prospective, Randomized, Paired Comparison of Laser Epithelial Keratomileusis and Photorefractive Keratectomy for Myopia Less Than -6.50 Diopters. J Refract Surg 2004; 20:217-22. [PMID: 15188897 DOI: 10.3928/1081-597x-20040501-04] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE We compared predictability, efficacy, safety, and patient satisfaction following laser epithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) for low to moderate myopia with either the Nidek EC-5000 excimer laser or the Technolas 217C excimer laser. METHODS Forty-two patients with spherical equivalent refraction in the range -1.00 to -6.50 D were enrolled in this prospective study, each randomized for choice and sequence of LASEK and PRK on each of their eyes. Patients were examined daily for 7 days, and at 1 and 3 months. Patient satisfaction and quality of vision were assessed using a subjective questionnaire. RESULTS Mean baseline refraction was -3.57 +/- 1.25 D in LASEK eyes and -3.44 +/- 1.13 D in PRK eyes. Follow-up rates were 100% up to 1 month and 76% at 3 months. At 3 months, 32 (100%) of LASEK eyes and 31 (97%) of PRK eyes had uncorrected visual acuity > or = 20/40, 25 (79%) of LASEK eyes and 26 (82%) of PRK eyes had uncorrected visual acuity > or = 20/20, mean refraction was 0.08 +/- 0.53 D in LASEK eyes and 0.12 +/- 0.50 D in PRK eyes, 26 (81%) of LASEK eyes and 23 (72%) of PRK eyes had a refraction within +/- 0.50 D and 29 (91%) of LASEK eyes and 30 (94%) of PRK eyes had refraction within +/- 1.00 D. Epithelial healing time and pain in LASEK and PRK eyes were not statistically different, and patients were equally satisfied. CONCLUSION LASEK had similar predictability, efficacy, safety, and patient satisfaction to PRK in the treatment of low to moderate myopia.
Collapse
Affiliation(s)
- Hassan Hashemi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | | | | |
Collapse
|
19
|
Hardten DR, Hauswirth SG. Comparison of designs of laser systems utilized for refractive surgery. Curr Opin Ophthalmol 2003; 14:213-9. [PMID: 12888720 DOI: 10.1097/00055735-200308000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several different laser types are available on the market for the practitioner to use in refractive surgery. Each laser type has certain parameters that the surgeon must understand to obtain the best refractive outcomes. Studies published in peer-reviewed literature between February 2002 and March 2003 show that refractive results across all types of lasers have improved compared with those of several years ago. A difference in refractive outcomes between lasers is impossible to directly compare, as there are no randomized studies that hold surgeon or patient characteristics constant.
Collapse
Affiliation(s)
- David R Hardten
- Minnesota Eye Consultants, P.A. 710 East 24th Street, Suite 106, Minneapolis, MN 55404, USA.
| | | |
Collapse
|
20
|
Lin RT, Lu S, Wang LL, Kim ES, Bradley J. Safety of Laser in situ Keratomileusis Performed Under Ultra-thin Corneal Flaps. J Refract Surg 2003; 19:S231-6. [PMID: 12699179 DOI: 10.3928/1081-597x-20030302-12] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report on the safety of laser in situ keratomileusis (LASIK) performed under ultra-thin corneal flaps (Micro-LASIK). METHODS We performed a retrospective review of 1131 eyes that underwent LASIK for myopia with the Nidek MK-2000 microkeratome, and Nidek EC-5000 excimer laser. The 130-microm head and 8.5-mm ring were used in 1042 eyes and the 160-microm head and 9.5-mm ring were used in 89 eyes. For 175 eyes, intraoperative ultrasonic pachymetry was used to measure central corneal thickness and central bed thickness. Flap thickness was calculated by subtracting bed thickness prior to laser ablation from central corneal thickness. All 175 of these eyes had keratectomies using the 130-microm head and 8.5-mm ring. RESULTS At last follow-up, 455 eyes (40%) achieved 20/20 or better, 798 eyes (70%) achieved 20/25 or better, and 1077 eyes (95%) achieved 20/40 or better uncorrected visual acuity; 922 eyes (82%) achieved within 1 line of their best spectacle-corrected visual acuity. The following clinically significant complications were observed: four epithelial defects (3.5%), zero irregular flaps (0%), seven stria (0.6%), one diffuse lamellar keratitis (0.1%), one epithelial ingrowth (0.1%), and zero infections (0.0%). Two eyes (0.2%) with stria had 20/40 best spectacle-corrected visual acuity, but lost more than 2 lines of best spectacle-corrected visual acuity. The average measured flap thickness was 87.3 +/- 15.4 microm. CONCLUSION LASIK can be performed safely under ultra-thin corneal flaps.
Collapse
Affiliation(s)
- Robert T Lin
- Vision Institute of Southern California, City of Industry, CA 91748, USA.
| | | | | | | | | |
Collapse
|