OCULAR SURGERY NEWS 11/15/2005

As new technologies dominate, physicians are finding few faults and positive patient outcomes for most of them.

Joan-Marie Stiglich, ELS; Mary E. Archer, ELS; Tim Donald, ELS; Michelle Dalton;
David W. Mullin; Lauren Wolkoff; Daniele Cruz

CHICAGO – LASIK and corneal surface ablation approaches to refractive surgery are
"complementary procedures," each with their own set of advantages and
disadvantages, said Scott M. MacRae, MD. Scott M. MacRae

He spoke on the topic "Surface vs. lamellar: Which is best" during the Refractive
Surgery Subspecialty Day here at the American Academy of Ophthalmology meeting.

Surface ablation allows the surgeon to treat patients with thin corneas who might be
contraindicated for LASIK, Dr. MacRae said. A surface approach also
"causes less tendency toward dry eye in patients with borderline tear film,"he said.

In addition, the newer surface procedures such as epi-LASIK offer faster recovery
from neurotrophic dry eye, there is less risk of ectasia, no risk of flap
complications, and the techniques are simpler and easier to teach than LASIK, he said.
The disadvantage of surface ablation compared with LASIK is the longer recovery period,
Dr. MacRae said. In his experience, on average, patients need 3 to 5 days
after surface ablation before returning to work, driving or recreational activities.

The disadvantage of surface ablation compared with LASIK is the longer recovery
period, Dr. MacRae said. In his experience, on average, patients need 3 to 5 days
after surface ablation before returning to work, driving or recreational activities.

"The biggest obstacle is really the slower recovery period," he said.
"It usually takes 1 to 8 weeks for full visual recovery."

The surgeon also needs to quell patient anxiety during the recovery period, he said.
And the surgeon cannot predict exactly how long it will take an individual to recover.

In his practice, Dr. MacRae said, the incidence of postoperative corneal haze
has become minimal after PRK with the use of mitomycin and scanning-spot lasers.
Regarding the advantages of LASIK, Dr. MacRae noted that new microkeratomes now allow thinner flap creation.
"We've found that flaps under 100 µm have a better postop visual acuity
compared with thicker flaps," he said.

With customized LASIK, Dr. MacRae said, the postoperative induction of higher-order
aberrations has been reduced. In a study in 48 eyes of 24 patients
in whom one eye underwent conventional
LASIK and one underwent customized LASIK, the mean
induction of higher-order aberrations was 35% in the conventional LASIK eyes
and 18% in the custom-treated eyes, he said.

Dr. MacRae said he still performs LASIK in about 85% of patients in his practice, and surface ablation procedures are reserved primarily for patients with dry eye or anterior basement membrane disease, patients with thin corneas and patients with higher myopia.

"LASIK offers a quicker recovery time, the patient is more comfortable
immediately postoperatively, and it's more accepted," he said.
Look for more in-depth coverage of these and other topics in upcoming
issues of Ocular Surgery News.