LASIK: A Patient-Friendly Procedure

BY DAVID I. GEFFEN, O.D.
APR. 1997

The refractive surgery field is going through another transformation. Photorefractive keratectomy had become the procedure of choice for most clinicians, but now laser in situ keratomileusis (LASIK) is rapidly gaining popularity.

WHAT'S WRONG WITH PRK?

Pain is one of several drawbacks associated with PRK. Even with the use of bandage contact lenses and nonsteroidal anti-inflammatories, patients still experience a certain amount of discomfort for the first few days following the procedure.

PRK also entails an extended healing time for vision to stabilize. Patients are paying a substantial amount of money for the surgery and are anxious to 'see' the results. Today, the average patient interested in refractive surgery has researched the subject in detail and has heard how rapid the recovery is with LASIK compared to PRK. While the typical PRK patient will see 20/100 at the one-day visit, the typical LASIK patient will often see 20/40 or better.

WHAT'S BETTER ABOUT LASIK?

LASIK is a patient-friendly technique. Patients typically note a mild foreign body sensation following LASIK, compared to the pain they complain about with PRK. Most practitioners use minimal medications with LASIK, usually an antibiotic-steroid combination drug.

Follow-up care is relatively uncomplicated, so there's little worry about patient compliance. The corneal cap is stable within one week of surgery and we see very little corneal haze. Patients can usually return to work the next day with few problems.

I believe also that LASIK is becoming more prevalent because it reaffirms the importance of a highly skilled surgeon. With the mass promotion of PRK, patients tend to discount the importance of the doctor's skill and, therefore, may not be as selective in choosing a surgeon. Highly skilled refractive surgeons are distinguishing themselves from average practitioners who may not be capable of performing LASIK.

WEIGHING THE RISKS

So, why don't all refractive surgery patients have LASIK? LASIK is a much more surgeon-dependent technique. There's a higher risk for complications such as irregular astigmatism, infection and loss of the corneal cap. In addition, the costs are higher to perform LASIK because the surgeon must invest in a keratome (about $50,000) and purchase new blades for each procedure (about $50 each).

It's important to determine at which point a patient is a better candidate for LASIK than PRK. Three diopters appears to be the current average minimum refractive error for which doctors will perform LASIK.

CONTACT LENSES POST LASIK

What happens to the LASIK patient who isn't fully corrected or who has irregular astigmatism? For undercorrected patients, I use soft or RGP contact lenses. Soft lenses will usually fit well, and torics can be used for astigmatism. Visual acuity with soft lenses is comparable to the best corrected spectacle prescription. However, if the patient has decreased visual acuity, especially due to corneal distortion, RGP lenses will provide optimal correction.

Corneal topography following any refractive surgery will show a central flattening of the cornea. I have prescribed spherical as well as aspheric designs. There are also experimental designs, including an aspheric lens I've been investigating from Infinity Optical, Poway, Calif., that show great promise for distorted corneas.

Many presbyopic patients who participate in sports or have other needs for better binocular vision often choose monovision surgical correction. For these patients, you might recommend a contact lens for part-time wear on the near eye.

Addressing the special corrective needs of post-refractive surgery patients has been a great practice builder for our office. CLS

Dr. Geffen is in a joint refractive surgery practice in San Diego.

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