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Refractive surgery can be a lifelong experience for patients
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SAO PAULO, Brazil — Refractive surgeons should consider the lifelong implications of what they do for patients, said George Waring III, MD, FACS, FRCOphth, speaking here.
At the World Ophthalmology Congress, Dr. Waring said looking at a patient’s refractive surgery experience as a single event may be a false assumption. There is a possibility that the patient will return to the same refractive surgeon for additional surgery.
“A refractive surgeon is more than a LASIK surgeon,” Dr. Waring said. “A LASIK surgeon is not a refractive surgeon.”
To illustrate his point, Dr. Waring traced the refractive surgical history throughout a hypothetical patient’s life.
In childhood, due to rapid changes in refractive error, the eye is changing too fast for surgery, Dr. Waring said. In adolescence, the patient may be motivated to undergo refractive surgery because, socially, that is the most important decade to be spectacle free, he said. So in his teens this hypothetical patient might opt for either LASIK or epi-LASIK to achieve spectacle independence for his minor refractive error.
As this patient reaches his 20s, he experiences a marked increase in high myopia, which is treated, again by the same surgeon, with a phakic refractive lens. Then while the patient is still in his 20s, he experiences a high residual error and unacceptable glare, so he receives his first wavefront-guided LASIK re-treatment.
In his 30s, this same patient undergoes progression of myopia, so he returns to undergo a second re-treatment.
As the patient ages into his 40s he starts to experience increasing presbyopia, so he undergoes another re-treatment for monovision, perhaps receiving a presbyopic corneal inlay.
In his 50s the presbyopia of the patient exceeds the reach of monovision, so he undergoes refractive lens exchange with an accommodating multifocal IOL.
Finally, in his 60s, the patient develops Fuchs' dystrophy and undergoes a corneal procedure that does not adjust his refraction, such as a posterior lamellar graft.
While this is just one example of the lifelong possibilities for interaction between a surgeon and his patient, Dr. Waring said his demonstration was meant to show the different refractive surgeries that are “appropriate throughout life for the patient who wants it.”