Surgeon highlights decline of LASIK, emergence of alternative techniques

PARIS — Over the last 15 years, LASIK has been gradually losing ground in favor of other refractive surgery techniques.

“We don’t know yet whether this is due to a decline of LASIK or to the emergence of new alternative techniques that broaden the indications of refractive surgery,” Michael Assouline MD, said at the meeting of the French Society of Ophthalmology.

Michael Assouline

A retrospective analysis of the 52,000 cases of refractive surgery performed in his clinic since 1999 showed that the share of LASIK has gone down from 96% to less than 60%.

“This went along with the advance of new techniques, but also with the findings on iatrogenic ectasia,” he said.

PRK has become the method of choice for many surgeons in Europe for low degrees of myopia and even for moderate myopia with mitomycin C. Visian ICLs (STAAR Surgical) are now the method of choice for high myopia above 8 D.

“In between, for –4 D to –8 D, ReLEx smile (Carl Zeiss Meditec) appears to be gaining ground and has the favor at least of all the surgeons who started it. We don’t know if smile will replace LASIK, but it certainly offers the advantage of not cutting the flap all way round,” Assouline said.

“In this way, we avoid cutting the nerves and prevent dry eye. We avoid flap-related complications. Also, though it is not proven yet, we better preserve the mechanical strength of the cornea, avoiding the risk of ectasia,” Assouline said.

Disclosure: Assouline is a consultant to Carl Zeiss Meditec.