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Visual recovery rapid for thin-flap femtosecond LASIK
At 4 hours postop, 100% of patients felt comfortable driving.
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Vision returns rapidly after LASIK with a femtosecond laser, but not fast enough for patients to feel comfortable about driving home or returning to work from the surgery center, according to a study of patients who underwent bilateral simultaneous thin-flap LASIK for myopia.
“We have yet to answer for the patient just how fast vision returns,” OSN Refractive Surgery Section Editor Daniel S. Durrie, MD, said. “Patients are interested in knowing when they can resume normal activities, such as work or drive or use the computer.”
The purpose of the study was to establish a baseline using modern technology and procedures and determine what level of vision can be expected in the early hours after surgery, Durrie said.
Twenty eyes of 10 patients were examined before surgery and at eight postoperative time points: immediately, 15 minutes, 30 minutes, 1 hour, 2 hours, 4 hours, 1 day and l month after surgery.
Daniel S. Durrie
“We were not limited to only testing for high-contrast acuity,” Durrie told Ocular Surgery News. “We also measured their contrast sensitivity, which is a much more sensitive way to assess visual function.”
The study was published in the Journal of Refractive Surgery.
Findings
Within 1 hour of surgery, roughly 90% of patients achieved binocular uncorrected distance visual acuity of at least 20/40, which is the minimum required to pass a driver’s test in most states.
“However, when we looked at ability or willingness to drive on a questionnaire, it was much lower than that,” Durrie said. “When we tested the contrast sensitivity, we found the reason: Contrast sensitivity was slower to recover.”
At 4 hours postop, 100% of patients said they felt comfortable driving. In addition, at 4 hours, contrast sensitivity had not only recovered to the preop level, but it was statistically significantly better at 4 hours than it had been preoperatively, Durrie said.
“This came as somewhat of a surprise because we did not think contrast sensitivity would recover as fast,” he said.
The researchers also found that vision was worse than expected immediately, 30 minutes and 1 hour after surgery, Durrie said.
“The ability with the present surgical equipment for a patient to jump into his car and drive home is not feasible,” he said.
Managing patient expectations
Based on the study’s results, Durrie said he is comfortable telling good surgical candidates that they are very likely to achieve 20/20 vision within 4 hours after LASIK and be able to send text messages from a mobile phone 30 minutes after surgery. Patients can also expect to return to work the day after surgery.
Despite the promising results, patients should still be examined 1 day postop to ensure sufficient visual acuity to pass a driver’s test, Durrie said.
“When we first started performing LASIK surgery in 1991, only 50% of patients actually achieved 20/20 at 3 months after surgery,” Durrie said.
Since that time, advancements in technology and patient selection have improved outcomes.
Durrie and colleagues continue to study methods to shorten visual recovery time, including postoperative intent-to-drive therapy using contact lenses and ocular shields.
“I encourage my colleagues to look at ways that will eventually lead to vision that is so improved at 1 hour after surgery that patients can actually go back to work,” Durrie said.
Reducing recovery time would increase the number of patients who are interested in LASIK, he said. – by Bob Kronemyer