Cataract and refractive surgery in ; a survey of KSCRS members from 1995~2006

PURPOSE

This purpose of this report was to study trends in cataract and refractive surgeries conducted during the past twelve years and to compare results to previous reports from the ASCRS and New Zealand (NZ) in order to forecast future medical services.

METHODS

We surveyed members of the Korean Society of Cataract and Refractive Surgery (KSCRS) every year from 1995 to 2006, and studied changes in cataract and refractive surgeries (RS).

RESULTS

The duration of hospitalization has been gradually decreasing to the point that a one day hospitalization following surgery has become common. The rate of topical anesthesia use has significantly increased since 1998. Sutureless incision methods are now commonly practiced. The use of acryl IOL as an optic material has been gradually increasing for cataract surgeries. KSCRS members showed an interest in the special intraocular lenses as multifocal IOL. While Excimer laser PRK was the most popular refractive surgery during the first stage, KSCRS members increasingly prefer LASIK to the Excimer laser PRK. Regression of the corrected visual acuity, dry eye, night halo, and flashes were the most common complications following refractive surgeries. Medical disputes related to PRK and LASIK have been gradually increasing throughout the study period.

CONCLUSIONS

We confirm that the KSCRS practice styles for cataract and RS are similar to those of the ASCRS and NZ. We infer a world-wide trend from the comparison of these three societies.

PTTL method applied to UV radiation detection during refractive surgery using excimer laser

The method of phototransferred thermoluminescence (PTTL), using CaSO(4):Dy pellets produced at IPEN as sensitive material, was used to detect the spread laser radiation inside the surgery room during refractive surgical procedures using ArF excimer lasers. The purpose of this work was to study the viability of performing the ultraviolet radiation (UVR) exposure detection of patients and the hospital's surgical staff during a refractive surgery. The CaSO(4):Dy pellets were positioned at different distances from the laser source inside the surgery room: patient's ( congruent with 0.15 m), surgeon's ( congruent with 0.5 m) and nurse's ( congruent with 1.0 m) foreheads, lateral ( congruent with 1.5 m) and back ( congruent with 4.0 m) walls. The measurements of PTTL were carried out at two different conditions: five surgeries, each one taking approximately 10 min, and during a period of 4 h (cumulative), when several operations were performed. The detectors positioned as far as 4.0 m from the UV laser source were sensitised, making the UVR detection feasible at large source-detector distances. The absorbed energy was detected in the range from 40 microJ to 30 mJ during a surgery. This result indicates that the method studied can be used to detect the spread UVR.

Refractive Surgery Survey 2004

To determine the refractive surgery (RS) preferences of ophthalmologists worldwide, questionnaires were sent to 8897 members of the American Society of Cataract and Refractive Surgery. A total of 1053 questionnaires were returned by the deadline. The practice distribution included 29.5% cataract surgeons, 48.8% comprehensive ophthalmologists, 11.6% RS specialists, 5.1% cornea and external disease specialists, 1.9% glaucoma specialists, 1.1% retina specialists, and <1.0% oculoplastics/pediatrics/researchers/retired. Results were compared with those in the 2003 survey and demonstrate that refractive surgery continues to develop and change.

[Results of the first 1,000 consecutive elective nonmechanical keratoplasties using the excimer laser. A prospective study over more than 12 years]

BACKGROUND AND PURPOSE

The purpose of this prospective clinical cross-sectional study was to analyse indications, intraoperative, perioperative and postoperative pecularities and complications as well as postoperative functional and morphologic results of the first 1000 consecutive elective round laser keratoplasties.

PATIENTS AND METHODS

The age of the 480 females and 520 males (362 x keratoconus), who had been operated on between 07/1989 and 04/2002 ranged from 20 to 92 years (mean 55+/-19). A total of 6 microsurgeons performed 718 x PK only, 222 x a triple procedure and 60 x additional IOL manoeuvres. Recipient and donor trephinations were accomplished with an 193 nm excimer laser (Carl Zeiss Meditec, Jena, Germany) from the epithelial side.

RESULTS

In 895 eyes with perioperative corneal erosion, epithelial healing took not more than 3 days in half of cases. During a follow-up period of 1.9+/-1.5 years, in 35 eyes episodes of acute diffuse (8 irreversible) and in 12 eyes episodes of chronic focal (5 irreversible) endothelial immunologic graft reactions (4.7%) occurred between 6 weeks and 4.7 years after PK. Before/after suture removal, median values of astigmatism were 1.5 diopters (D)/2.5 D refractive, 3.0 D/3.3 D keratometric, and 4.0 D/4.2 D topographic. Best-corrected visual acuity was 0.50/0.60, respectively.

CONCLUSIONS

More than 12 years of experience with this new technique indicate that besides optical advantages, nonmechanical trephination does not cause intraoperative or postoperative disadvantages for the patient. Under standardised surgical conditions a massive increase of astigmatism after suture removal seems to be avoidable with laser trephination in most cases due to reduction of decentration,"vertical tilt" and especially "horizontal torsion".

Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and photorefractive keratectomy surgery

PURPOSE

To identify physician predictors in LASIK and photorefractive keratectomy (PRK) surgery that correlate with a higher risk for malpractice liability claims and lawsuits.

DESIGN

Retrospective, longitudinal, cohort study.

PARTICIPANTS AND METHODS

A comparison of physician demographic and practice pattern data of 100 consecutive Ophthalmic Mutual Insurance Company (OMIC) LASIK and PRK claims and lawsuits with demographic and practice pattern data for all active refractive surgeons insured by OMIC between 1996 to 2002 was made. Background information and data were obtained from OMIC underwriting applications, a physician practice pattern survey, and claims file records. Using an outcome of whether or not a physician had a history of a claim or lawsuit, logistic regression analyses were used separately for each predictor as well as controlling for refractive surgery volume.

MAIN OUTCOME MEASURE

Malpractice claim or lawsuit for performance of PRK or LASIK surgery.

RESULTS

Logistic regression analysis demonstrated that the most important predictor of filing a claim was surgical volume, with those performing more surgery having a greater risk of incurring a claim (odds ratio [OR] = 31.4 for >1000 surgeries/year versus 0-20 surgeries/year, 95% confidence interval [CI] = 7.9-125, P = 0.0001). Having one or more prior claim was the only other predictor examined that remained statistically significant after controlling for patient volume (OR = 6.4, 95% CI = 2.5-16.4, P = 0.0001). Physician gender, advertising use, preoperative time spent with patient, and comanagement seemed to be strong predictors in multivariate analyses when surgical volume was greater than 100 cases per year.

CONCLUSION

The chances for incurring a malpractice claim or lawsuit for PRK or LASIK correlate significantly with higher surgical volume and a history of a claim or lawsuit. Additional risk factors that increase in importance with higher surgical volume include physician gender, advertising use, preoperative time spent with the patient, and comanagement with optometrists. These findings may be used in the future to help improve the quality of care for patients undergoing refractive surgery and to provide data for underwriting criteria and risk management protocols to manage proactively and perhaps reduce the risk for claims and lawsuits against refractive surgeons.

[PRK with InPro-Gauss excimer laser: statistical analysis of results]

PURPOSE

To analyse retrospectively the pre- and postoperative refraction and visual acuity according to Standard Graphs proposed by Waring for refractive surgery.

METHODS

Ninety-three eyes with myopia ranging from -1.50 to -8 diopters (D) and/or with astigmatism ranging from 0.75 to 3 D were treated between July 1998 and June 2001. The laser delivers a broad beam with a regular gaussian energy repartition obtained by means of a plate containing an array of diffractive micro-lenses.

RESULTS

The coefficient of linear correlation between the attempted and achieved spherical equivalent refraction was 0.97. A postoperative spherical equivalent refraction between -0.50 and +0.50 D was found in 92.3% of eyes. The defocus equivalent refraction (spherical refraction added to one-half of the cylindrical component, ignoring the sign) represents more accurately the reality of the refractive state, and in our study was within +/- 0.50 D for 86.4% of the eyes. A preoperative best corrected visual acuity of 10/10 was found in 78% of eyes and 64% achieved postoperatively an uncorrected visual acuity of 10/10.

CONCLUSION

The InPro-Gauss excimer laser gives good refractive results. The Gauss profile delivery system provides reliability and quality of the ablated surface of cornea.

[Refractive surgery in Slovakia]

Since 1991 the chief specialist evaluates different spheres of ophthalmology based on data provided by all departments in Slovakia. In the submitted article the author summarizes the 10-year period of refractive surgery in Slovakia.

[Scientific evaluation and quality assurance in refractive surgical interventions. Evaluation of the Datagraph med computer program]

BACKGROUND

During recent years refractive surgical procedures have been increasingly used to correct refractive errors. Exact saving and assessment of pre-, intra- and postoperative results for scientific evaluation are desired and are necessary for quality management. The purpose of this investigation was to evaluate the database program Datagraph med (version 2.5) which has been developed for data processing and assessment in refractive surgery.

MATERIAL AND METHODS

Pre-, intra- and postoperative data of 169 eyes treated with different refractive surgical methods (laser in situ keratomileusis, photorefractive keratectomy, laser thermal keratoplasty, phacic IOL) were collected, entered in the database and then evaluated by the above-mentioned program (with a follow-up of up to 12 months). The exactness of the Datagraph results was compared by means of manual recalculation.

RESULTS

Datagraph med was able to precisely process the patient data and save them in a database. Statistics and graphs presented by Datagraph were as data has been entered. Furthermore all standard graphs requested by the international consensus for evaluation of refractive surgical data (stability, predictability, efficacy, safety and complications) could be imaged.

CONCLUSIONS

Datagraph med is a helpful and precisely functioning program for processing and evaluation of refractive surgical data. It can be used for both scientific studies and for quality control. A continuous development and improvement of the program as well as the addition of statistical functions will be necessary due to the on-going progress in refractive surgery.

Intractable eye pain: indication for triptans

Management of pain is difficult in many eye diseases. Particularly in patients undergoing surgical procedures, postoperative intractable pain is a major concern and severely influences the patient's comfort. We present 13 patients (eight male, five female, mean age 36 years) in whom sumatriptan, a highly selective 5-HT1B/1D agonist that is normally used as a specific anti-migraine drug, was used for the treatment of pain following photorefractive keratectomy (PRK). In two patients both eyes were operated on different days, resulting in a total of 15 operated eyes. A positive clinical response was achieved in all patients. In particular, in four patients, who received a second dose prophylactically 4 h following the first dose and before the recurrence of pain, we achieved excellent efficacy and stable control of pain. Further controlled studies are needed to investigate the usefulness of 5-HT1B/1D agonists in painful eye conditions.

Refractive Surgery Survey 2001

In February 2001, a questionnaire on the practice of refractive surgery was sent worldwide to all 8196 members of the American Society of Cataract and Refractive Surgery; 1511 responses (18.4%) were received. Although laser in situ keratomileusis (LASIK) was the most common refractive procedure reported, phakic intraocular lenses, clear lens extraction, and photorefractive keratectomy were also widespread. Nineteen percent of the respondents said they had had refractive surgery, and that group reported performing significantly more procedures than those who had not had a refractive procedure (P < .0001). The most common complication of LASIK was dry eyes, occurring in more than half of the cases in one fourth of the practices; however, only 30% of surgeons said they perform a Schirmer test before surgery. High-volume surgeons reported seeing fewer cases of flap striae (P = .002) and slipped flaps (P = .02) than low-volume surgeons. Seventy-seven percent said that wavefront LASIK ablation will increase the quality of vision and of those already performing wavefront ablation, 92% stated they believe it will improve outcomes.

Current trends in cataract and refractive surgery in Japan: 1999 survey

PURPOSE

The eighth annual survey was carried out by mail in February 2000 to investigate the current trends in cataract and refractive surgery in Japan.

RESPONDENTS

Questionnaires were sent to 930 ophthalmologist members of the Japanese Society of Cataract and Refractive Surgery. Data received from 457 (49.1%) of the recipients were cross-analyzed and compared with those from the previous surveys.

RESULTS

In cataract surgery, 17% of respondents were doing 51 or more cases per month, 94% preferred phacoemulsification, 58% employed the self-sealing wound closure technique, and 26% used topical anesthesia for phacoemulsification. In refractive surgery, excimer laser surgery and astigmatic keratotomy attracted notably high interest, while less attention was directed toward radial keratotomy and intrastromal corneal ring. Laser in situ keratomileusis, photorefractive keratectomy, phakic intraocular lens, intrastromal corneal ring, and radial keratotomy were judged to be useful refractive surgical procedures by 69.0%, 40.0%, 24.6%, 14.2%, and 8.0% of the respondents, respectively.

CONCLUSION

There are trends toward more surgical procedures performed by a surgeon, shorter period of hospitalization, and increasing preference for small incision cataract surgery. Refractive surgery is not yet widely performed, but laser in situ keratomileusis is viewed as the most promising procedure.

[Using the excimer laser in refractive eye surgery. Results of a survey of German ophthalmologists]

BACKGROUND

Little information about the cost-effectiveness of excimer laser operations is available. As the number and structure of providers of these services in Germany are relatively unknown, only rough estimations can be made about the number of operations.

PURPOSE

In this study the market for excimer laser operations is defined, structured from an economic view and examined according to medium-term demand and supply trends. The aim of the study is an applicable estimation of the current level of dissemination and of existing economic conditions for providers of excimer laser operations.

METHODS

In a postal survey 219 ophthalmologists in Germany were asked to provide the number of excimer laser operations they had carried out and the organizational and financial details of these services. The questionnaire was answered anonymously.

RESULTS

One can conclude that the annual number of interventions is increasing, although less significantly than in the United States. In most cases, providers of German health insurance have rejected inclusion of this service in their reimbursement catalogue.

CONCLUSIONS

As of yet, excimer-laser-related turnover has frequently not met expectations. However, because of modifications of technological, health-economic and demand conditions an increase in the number of operations within this area is expected in the future.

Practice styles and preferences of ASCRS members--1999 survey

A survey of the practice styles and preferences of members of the American Society of Cataract and Refractive Surgery with United States ZIP codes was performed in September 1999. Approximately 27% (1342) of 4932 questionnaires mailed were returned before the November cutoff. Three profile questions were used to cross-tabulate: age of the opthalmologist, geographic location, and volume of cataract surgery per month. Current data were compared with data of previous surveys.

Current trends in cataract and refractive surgery in Japan: 1998 survey

PURPOSE

A seventh annual survey was carried out by mail in February 1999 to investigate the current trends in cataract and refractive surgery in Japan.

METHODS

Questionnaires were sent to 925 ophthalmologist members of the Japanese Society of Cataract and Refractive Surgery. Data received from 411 (44.4%) of the recipients were cross-analyzed and compared with those from the previous surveys.

RESULTS

In cataract surgery, 93% of respondents preferred phacoemulsification, 58% employed the self-sealing wound closure technique, and 23% used topical anesthesia for phacoemulsification.

CONCLUSIONS

There have been trends toward more surgical procedures performed by a surgeon, shorter period of hospitalization, and increased number of outpatient procedures. In refractive surgery, surgeons remained rather conservative; with 26% and 5% of surgeons doing astigmatic keratotomy and refractive keratotomy, respectively. Photorefractive keratectotomy, laser in situ keratomileusis, phakic intraocular lens, and intrastromal corneal ring were judged to be useful refractive surgical procedures by 58.2%, 69.5%, 25.4%, and 8. 8% of the respondents, respectively.

The New Zealand cataract and refractive surgery survey 1997/1998

BACKGROUND

This study documents the current practice for cataract and refractive surgery in New Zealand.

METHOD

A postal questionnaire was distributed in late 1997 to all consultant members of the Ophthalmological Society of New Zealand that were resident in the country at that time. Most questions were identical to the 1997 survey of the American Society of Cataract and Refraction Surgeons (ASCRS) to enable a comparison.

RESULTS

There were 98 returns from 101 surveys distributed. Of the returns, 72 performed cataract surgery, 23 performed PRK and 11 performed LASIK. ASCRS members did more refractive surgery than did New Zealanders: 28 versus 1% of 1-5 RK per month, 7 versus 1% of 1-2 clear lens extractions per month and 85 versus 51% had access to an excimer laser. For cataract surgery, ASCRS members used more topical anaesthesia (30 vs 5.5%), used no sutures more often (73 vs 51%), used more preoperative antibiotics (76 vs 26%) and used fewer injections of antibiotic/steroids (38 vs 61%). Otherwise the two groups were broadly similar.

What every general practitioner should know about the laser vision correction revolution

With tens of millions of Americans potential candidates for laser vision correction (LVC), increasing numbers of patients are asking their general practitioners for advice and information on this revolutionary procedure. The following article will provide general practitioners a broad view of LVC, including valuable data and resources to share with their patients. The latest techniques in LVC--including step-by-step descriptions of the procedures and clinical outcomes--are outlined in detail, along with what steps MCOs are taking to address this growing trend.

Current trends in cataract and refractive surgery in Japan: 1997 survey

PURPOSE

A sixth annual survey was carried out by mail in January 1998, to investigate the current trends in cataract and refractive surgery in Japan.

RESPONDENTS

Questionnaires were sent to 816 ophthalmologist members of the Japanese Society of Cataract and Refractive Surgery. Data received from 409 (50.1%) of the recipients were cross-analyzed and compared with those from the previous surveys.

RESULTS AND CONCLUSION

In cataract surgery, there have been trends toward more surgical procedures performed by a surgeon, shorter period of hospitalization, and increased number of outpatient surgery. Ninety-two percent of respondents preferred phacoemulsification, 54% used the self-sealing wound-closure technique, and 19% used topical anesthesia for phacoemulsification. As for refractive surgery, surgeons remained rather conservative; with 28% and 7% of surgeons doing astigmatic keratotomy and refractive keratotomy, respectively. Photorefractive keratectomy, laser in situ keratomileusis, and phakic intraocular lens were judged to be useful refractive surgical procedures by 56.6%, 43.3%, and 25.1% of the respondents, respectively.

[The outlook for the surgical treatment of refractive anomalies in flight personnel]

The authors discuss one of the important problems in aviation ophthalmology--correction and treatment of refraction anomaly in flying personnel. They disclose the methods of professional medical rehabilitation provided by the modern science development and analyze the surgical methods of refraction anomaly treatment with their pros and cons. Furthermore, the authors evaluate the prospects of keratotomy and excimer laser keratectomy's application for professional rehabilitation of flying personnel. In their opinion, the results of the study prove, that the problem of refraction anomaly's surgical treatment needs further research and development.

Cost and demand analysis of excimer laser use: first World Wide Web Internet survey of the interest in refractive surgery

PURPOSE

To determine the actual size of the refractive surgery market in the United States and to identify factors involved in the decision to have refractive surgery.

SETTING

World Wide Web.

METHODS

A survey was placed on the World Wide Web. Questions covered price sensitivity, preferred type of refractive procedure, and factors involved in the decision to have a refractive procedure.

RESULTS

Average age of respondents was 34 years; refractions ranged from -0.50 diopter (D) to -12.00 D. The recommendation of ophthalmologist, friends, and relatives; the refractive surgeon's credentials; and office staff were critical factors in the decision-making. Sixty-six percent said they would have a refractive procedure if it were free. Only two said they would have photorefractive keratectomy (PRK) if it cost over $1500 per eye; none would have radial keratotomy (RK) if it were over $1500 per eye. Forty-eight percent rated their opinion of PRK as high to very high; 45% rated RK as high to very high.

CONCLUSIONS

We conclude that the actual number of refractive procedures performed with the laser will be the same as before-between 100,000 and 250,000 annually. The survey suggests that PRK will share this potential market with RK, and the total number of potential patients converting to PRK may be considerably less than predicted unless the price falls to $500 per eye.

Photorefractive keratectomy: the Sankara Nethralaya experience

BACKGROUND AND OBJECTIVE

Excimer laser photorefractive keratectomy (PRK) is quickly establishing itself as a dependable treatment modality for the correction of myopia. We review in this report our experience with the Summit OmniMed UV200 excimer laser (Summit Technology, Inc., Waltham, MA) in the treatment of low to high degrees of myopia.

PATIENTS AND METHODS

We retrospectively analyzed the results of excimer laser PRK in 139 eyes of 127 patients treated between November 1993 and August 1994.

RESULTS

The study population was comprised of 75 males and 52 females with a mean ago of 26.9 +/- 6.21 years (range, 19 to 52 years). All patients were followed for at least six months and the mean follow-up was 11.7 +/- 3.63 months (range, 6 to 22 months). Mean pre-operative myopia was -8.23 +/- 3.32 diopters (D) (-2.63 to -19.50 D). Of 139 eyes, 101 (72.7%) had a pre-operative myopia greater than -6.00 D; and 32 (23.0%) had a pre-operative myopia greater than -10.00 D. At last follow-up, 73 (52.5%) eyes were within +/-1.00 D of emmetropia, 92 (66.2%) eyes had an uncorrected visual acuity of > or = 6/12, and 12 (8.6%) eyes lost 2 or more lines of spectacle corrected visual acuity. Severe corneal haze (grade 3 to 4) was seen in 20 (14.4%) eyes at last follow-up. Complications encountered in this series included steroid response in 15 (10.8%) eyes, and reactivation of herpes simplex keratitis in one (0.7%) eye. Statistical analysis reveals that the only risk factor independently associated with regression > or = 2.00 D following PRK is the occurrence of severe corneal haze (grade 3 and 4).

CONCLUSION

Excimer laser PRK appears to be a safe and predictable method for the treatment of myopia < 6.00 D. With higher degrees of myopia the results appeared to be more guarded, mainly due to the healing pattern of the cornea following single zone myopic ablations.

Evaluation and diffusion of excimer laser treatment of myopia in the United States and in The Netherlands

Excimer laser photorefractive keratectomy (PRK) is an experimental treatment to correct myopia (short-sightedness) that is diffusing into use without convincing evidence of safety and efficacy. It has been claimed that PRK may render conventional methods of correcting myopia, such as wearing glasses or contact lenses, obsolete. Since about 25% of the world's population is myopic, the consequences of this technology in terms of benefits, risks, and costs could be truly enormous. The fee for the procedure in various countries such as the United States, the Netherlands, and Australia varies from about US $1500 to US $2250 per eye. In the United States, the Food and Drug Administration, acting as authorized in the Medical Devices Act of 1976, has limited the use of PRK to patients participating in clinical trials. In the Netherlands, in contrast, where medical equipment is not regulated, the method has diffused without controls, although it is not reimbursed by health insurance agencies. The procedure has become controversial in the Netherlands because it is provided privately and has been aggressively and inappropriately promoted. The case illustrates the limitations of health policy concerning technologies provided privately and raises a number of social and political questions.

PRK vs LASEK vs Epi-LASIK: A comparison of corneal haze, postoperative pain and visual recovery in moderate to high myopia

Introduction: The field of refractive surgery continues to evolve amid continued concerns as to which surgical technique minimizes the risk of inducing ectasia. Purpose: To compare clinical outcomes between PRK, LASEK and Epi-LASIK in moderately to highly myopic eyes (-4.00 D to -8.00 D). Materials and methods: A retrospective chart review of 100 PRK eyes, 100 LASEK eyes (with alcohol) and 97 Epi-LASIK eyes was performed. Post-operative pain, uncorrected visual acuity, and corneal haze data was recorded and analyzed at post-op days 1, 4 and 7 and at post-op months 1, 3, 6 and 12. Results: In all groups surgical corrections ranged from -4.00 D to -8.00 D. There was less pain associated with the epi-LASIK procedure especially early (post-op days 1 and 4). Visual recovery was superior within the PRK group during the first post-operative week but by post-op week 4 all three were equal. Haze scores were similar but a trend for less haze was demonstrated with epi-LASIK at 6 and 12 months. Conclusion: Epi-LASIK has a slight advantage over PRK and LASEK early on in the post-op course with regards to pain. Visual recovery is similar by 4 weeks and is better with PRK early. In addition, epi-LASIK trends toward less significant haze. Keywords: LASIK; epi-LASIK; LASEK; PRK; haze DOI: 10.3126/nepjoph.v2i2.3715 Nep J Oph 2010;2(2) 97-104