| 7 questions to consider before getting an enhancement |
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| It is generally accepted in laser eye surgery that a certain percentage of patients (varying with the type of correction) will be “undercorrected” or “overcorrected” or will “regress”. In many cases this is treated by doing additional laser surgery in attempt to reach the original target. Full article |
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Something to say? Write to the editor at editor@lasermyeye.org. Don't forget to give us your location and name or an online username. If live debate is more your style, join the bulletin boards at LaserMyEye D'Eyealogues. |
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| Quality Control in Laser Vision Correction |
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| The patient undergoing laser vision correction (LVC) has faith in his surgeon. The surgeon has faith in the laser. For half a million dollars, shouldn't it work every time? Full article |
| No current guest column. For previous columns, please visit our archives. |
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| Be our next guest columnist! Click here for instructions! |
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| “Another consideration in the preoperative examination is pupil size in dim light, because pupillary size and degree of myopia are the most important risk factors in night visual disturbances (i.e. glare, halos, starbursting).” |
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| P. 42 chapter entitled “Preprocedure Selection and Workup”, “LASIK Clinical Co-Management”, Milton M. Horn O.D., F.A.A.O, 2001, Butterworth-Heinemann |
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| So you're considering laser vision correction, and you think you know your way around an eyeball? Test yourself with this week's quiz! |
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| What does 20/20 uncorrected visual acuity mean?
A) A visual acuity score of 20/20 with glasses before surgery |
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| Correct answer at the bottom of the page. |
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| FORMER SENIOR FDA OFFICIAL TESTIFIES AGAINST ALCON IN LADARVISION LAWSUIT... On November 19, Morris Waxler reportedly was deposed as expert witness for EBW Laser in their ongoing lawsuit against Alcon over allegedly faulty lasers. Stay tuned. (Related links here and here.) |
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| THE FOOD CHAIN... Advanced Medical Optics announced in November that they are to buy VISX, the market leader in excimer laser. Click here for press release. Additionally, Zeiss announced they are purchasing Laser Diagnostic Technologies. Click here for OSN article. |
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| COMERS AND GOERS… Wavelight has captured 20% of the US market for sales of excimer lasers, according to Dave Harmon at Market Scope. B&L’s US market share is reportedly picking up as well. Not too difficult to understand who’s buying them; according to the rumour mill, Alcon seems to be barely making as much money from laser sales as from royalties from current LADARVision users. |
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| CONFLICTS OVER CONFLICTS... Eyeworld reported in its November issue that ASCRS has criticised the ACCME for its stringent new guidelines about conflicts of interests. Click here for article. |
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| THE MANY FLAVOURS OF REFRACTIVE SURGERY... In addition to lens implants behind, instead of or in front of the natural lens, we also have lens implants in the cornea itself. A study in November/December JRS (vol. 20, issue 6, pages 778-782) reports results of intracorneal lenses for hyperopia. Click here for abstract. |
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| MIDDLE-AGED? MALE? RGP WEARER? ALL OF THE ABOVE? You’re more likely to need an “enhancement” (2nd surgery) after LASIK, according to a study in JRS (vol. 20, issue 6, pages 783-789) which explored the factors influencing the need for enhancements. Of most interest to us is the fact that people who wore RGPs within 6 months prior to surgery were at greater risk. Click here for abstract. |
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| FDA 101... Eyeworld has started running a quarterly column about ophthalmic device regulation. Recommended reading. Click here for the first installment. |
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| THINNER OR THICKER FLAPS... Comments by the authors of an interesting study in JRS (Vol. 20, Issue 6, pages 790-796 appear to contradict the conventional microkeratome wisdom that states that thin flaps are a problem. Not so much that they’re not, that is, but that the increased risk of ectasia with thick flaps is more so. The authors favour the safety profile of thin flaps. Click here for abstract. |
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| WHY CHOOSE BETWEEN ONION RINGS AND FRIES WHEN YOU CAN HAVE BOTH? Refractive surgery combo-meal-deals are on the rise. A study in JRS (vol. 20, issue 6, pages 818-822) presents INTACS before and after LASIK for correction of moderately high myopia with thin corneas. The results seemed reasonable, but it’s always slightly worrying when things are described in terms of which is less worse (e.g. less induced astigmatism with one than the other, less overcorrection with one than the other). Click here for abstract. |
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| THE NEXT BIG “WOW”… Eric Donnenfeld MD predicts that phakic IOLs will have a significant impact on refractive surgery, despite the “800-pound gorilla” of LASIK, according to Ocular Surgery News. Click here for article. |
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| A MOUTHFUL (AND AN EYE-SORE)... LASIK-induced neurotrophic epitheliopathy was discussed in JRS (vol 20, issue 6, 803-809). Basically, the cornea becomes less sensitive, resulting in less frequent blinking, which in turn results in dry eye because you’re not triggering tear production. We are pleased to see increased discussion of dry eye in the medical literature. When we see screening practices making a reasonable attempt to identify at-risk patients, we’ll be even more pleased. Click here for abstract. |
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| AS IF THE CK ADS WEREN’T AGGRESSIVE ENOUGH... Eyeworld’s November issue covered claims that CK monovision is better than contact lens monovision. Click here for article. |
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| STAARS IN OUR EYES? LET’S SEE A LITTLE MORE SHINE FIRST... STAAR Surgical has not gotten off to a brilliant start. Between its faltering share price, the FDA’s 36-point clean-up requests for their manufacturing facility, and an embryo shareholder’s class-action lawsuit, they may be busy for a little while. Click here for Ophthalmology Times article. |
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| A BETTER COMBO FOR ABERRATION-COUNTING AND -BUSTING? Dan Reinstein MD, MA (Cantab), FRCSC claims that the WASCA aberrometer can measure almost any eye, even the highly aberrated ones, and that they are seeing some success in treatment of LASIK-induced night vision symptoms using the Mel-80 with WASCA aberrometry and the CRS-Master software. Click here for Ophthalmology Times article. |
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| ARE YOU LEAVING RGPs OUT LONG ENOUGH BEFORE SURGERY? We welcome the new report in JCRS (Vol 30, issue 11, pages 2290-2294) on the difficulty of predicting how long it will take for one’s refraction to stabilise after discontinuing RGP wear. Not, of course, that there weren’t several good ones already in existence indicating just this, but judging from many clinical practices, a firm reminder is in order. (Ca-a-an you say serial topography?) Click here for abstract. |
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| YUP, YOU’RE GETTING THE HANG OF IT...A study by Macsai et al in JCRS (Vol 30, Issue 11, pages 2336-2343) showed that transitioning ablations out to 1.0mm beyond the scotopic pupil size resulted in a low incidence of glare and halos. Click here for abstract. |
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Answer to this week’s quiz |
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The correct answer is: D) The typical goal of laser eye surgery. See our encyclopedia entries for 20/20, visual acuity, and UCVA for more about what the 20/X scale tells you – and doesn’t tell you! – about your vision and why you, the prospective laser eye surgery consumer, should care. |
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