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Standardization needed in refractive surgery
As the practice of refractive surgery grows in Europe, the need for consistency in diagnostic methods, treatment and result analysis is increased.
BARCELONA – The practice of refractive surgery still lacks a standardization of criteria, methods and goals, according to a leading European ophthalmologist here.
“If there are no standard rules, we will never have reliable solutions and results,” said Philippe Sourdille, MD, here at the winter meeting of the European Society of Cataract and Refractive Surgeons.
“It is going to be a long and certainly not an easy process, but the results will be rewarding. All of us should work in this direction, and associations like the ESCRS are here to direct and support our efforts,” he said.
Objective and subjective testing
Standardization of diagnostic means is the first and most clinically relevant requirement, according to Dr. Sourdille.
“Not that easy, if you bear in mind that in Europe, we aren’t even adopting the same visual acuity scale. It is going to take years,” he said.
The evaluation of patients’ needs should always complement the findings of objective examinations, he added.
“Patients’ habits, attitudes and expectations should be important elements in our decisions, but we cannot rely on our subjective perception of what might be best for them. There are now research groups working on questionnaires for refractive surgery, as well as for other types of treatment, which could become models adopted in all European countries. Hopefully, they will eliminate much of the plethora of do-it-yourself questionnaires produced by single surgical centers and offices,” he said.
Techniques
Techniques should also be standardized as much as possible, Dr. Sourdille said.
“We have freedom of choice, but further studies and a large-scale meta-analysis of the available data should sooner or later provide definitive answers on what is statistically better for different categories of patients and types of treatment.
“LASIK, LASEK and PRK, standard, customized or wavefront-guided surgery have their known and less-known pros and cons, which are still largely controversial. I hope that one day these controversies will cease, and we’ll have just positive conclusions and indications,” he said.
New concepts in the study of optical aberrations have determined a definite change of perspective in refractive correction. According to Dr. Sourdille, final visual outcome is now known to be affected not only by aberrations of the cornea, but also by total eye aberrations resulting from the interaction of the cornea and the lens.
“We need to investigate and define more precisely our understanding of what optical aberration means from a clinical point of view, and have standardized systems of wavefront analysis and treatment. Certainly this is a development that none of us can afford to ignore,” Dr. Sourdille said.
The IOL market
New products and recent technological advances have enriched the IOL market with an increasing number of options in design, optic quality and materials. In this field, cataract and refractive surgery are becoming interdependent, as they both aim at an increasingly better quality of vision.
“IOLs have improved many factors, such as optical transparency and prevention of PCO and photic phenomena. The next step is to improve optical quality,” said Dr. Sourdille.
Aspheric lenses that introduce negative aberration are one of the possible answers.
“Surgeons must weigh the different aspects and adopt a comprehensive approach to treatment,” Dr. Sourdille concluded, “bearing in mind that all aspects should converge in the main objective of improving the patient’s quality of life.”
For Your Information:
- Philippe Sourdille, MD, can be reached at Clinique Sourdille, 8 Rue Camille Flammarion, 44000 Nantes, France; +(33) 240-59-02-22; fax: +(33) 251-83-87-19; e-mail: sourdille.santiago@wanadoo.fr.