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LASIK maintains corneal integrity despite long-term regression in high myopes
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Long-term analysis of LASIK outcomes in patients with high myopia and astigmatism showed corneal integrity was maintained even though myopia regressed, according to a study.
The retrospective study analyzed outcomes in 39 eyes with 6 D to 18 D of myopia and up to –5 D of astigmatism who underwent LASIK at least 15 years ago.
“Today, most of these patients would not be candidates for refractive surgery performed using the LASIK technique,” the authors said. “Even so, the efficacy in these patients was high over the long term, even taking into account the myopic regression.”
Mean decimal uncorrected distance visual acuity (UDVA) increased significantly, from 0.01 before surgery to 0.51 at 3 months after surgery (P < .001). UDVA also increased significantly from 3 months to 2 years after surgery (P < .001). Subsequent changes were insignificant.
Mean corrected distance visual acuity increased significantly, from 0.64 preoperatively to 0.78 at 2 years (P < .001) and remained stable.
Refraction was within 1 D of attempted spherical equivalent in 46.15% of eyes and within 2 D in 64.10% of eyes at 15 years.
Twelve eyes (30.77%) underwent re-treatment within 5 years, the authors noted.
Disclosure: See the study for a full list of all authors’ relevant financial disclosures.
Perspective
Back to TopChristopher J. Rapuano, MD
To me, the bottom line of this study is that LASIK for high myopia (30% of patients had preoperative spherical equivalent of over –12.5 D) is rather safe and effective for at least 15 years. This is especially remarkable given the outdated technology used to treat these eyes, including early-generation excimer laser (Visx 20/20) and microkeratome (Automated Cornea Shaper). Having said that, the results were not perfect. One eye (out of 40 reported) developed ectasia and only 46% were within 1 D of emmetropia. And 31% of eyes required a re-treatment. While 40 eyes with 15 years of follow-up is impressive, I presume many more eyes with high myopia were treated around the same time and were not included in this study. What we do not know is how those eyes are doing. If just a few more of those eyes developed ectasia, we might conclude that LASIK for high myopia using older technology has an unacceptably high rate of complications. And lastly, this study only included patients older than 25 years at the time of the LASIK, eliminating patients with an additional risk factor for ectasia. Fortunately, with improved preoperative evaluation techniques and better technology, the current results of LASIK should be even better and safer.
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