ISRS/AAO: Refractive surgery ‘comes of age’

ANAHEIM, Calif. — Twenty-five years ago, the legitimacy of refractive surgery was hotly debated by ophthalmologists, but now it is in the mainstream of the specialty, according to a speaker here.

“In 1978, there was a real debate going on about whether anyone with a healthy eye should have surgery. Was there a reason for cosmetic surgery or should ophthalmologists be performing only functional surgery?” said Daniel Durrie, MD, delivering the keynote address here at the newly combined International Society of Refractive Surgery of the American Academy of Ophthalmology meeting.

Today, Dr. Durrie said, refractive surgery is the most common surgery in the world, with 40% of ophthalmologists performing some type of refractive procedure.

In fact, he said, refractive surgery is now leading to advances in other areas of ophthalmology as well. Diagnostic tests available for refractive surgeons have blossomed from just the phoropter and the keratometer to include tear status analysis, pupil analysis, topography, pachymetry, wavefront analysis, contrast sensitivity and subjective questionnaires.

Refractive laser options now include flying spot treatments, large optical zones, wavefront-driven corrections, advanced eye trackers and greater reliability and cost-effectiveness, Dr. Durrie said. In addition, presbyopia treatments are advancing, corneal inlays are becoming possible and refractive IOL implants “are all coming along,” he said.

With the advent of wavefront technology, “fuzzy 20/20 is a new term we’re getting used to,” Dr. Durrie said. Refractive surgeons are finding that, with even the lowest level of coma in a laser-treated eye, 20/20 vision is not as clear as once thought.

“We can now use wavefront as an ‘upgrade’ from previous refractive surgeries such as photorefractive keratectomy,” he said. Of the three approved wavefront machines on the U.S. market, “it doesn’t matter which one you use, the results are the same: Custom is better,” he said.

For the refractive surgical practice, business models have been enhanced by the introduction of customized wavefront as well, he said. At one time, the fee for performing PRK was $1,200, but discount wars ensued and the procedure became less profitable. The same thing occurred with the advent of LASIK, he said. But with wavefront, “we’re charging a $500 premium for custom ablation and there doesn’t seem to be a trend towards discounting it,” he said.

“With only a 1% to 2% market penetration, refractive surgery will continue to grow dramatically,” Dr. Durrie said. “In the next 10 years, refractive surgery and advanced contact lenses may truly replace glasses.”

The merging of the ISRS with the AAO’s Refractive Surgery Interest Group has now created a refractive surgery society with more than 2,000 members from 80 countries, according to Jack Holladay, MD. “This is the most exciting thing to happen in refractive surgery since Barraquer,” he told attendees of the keynote session.