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Latest LASIK platforms boost patient-reported outcomes
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A meta-analysis of FDA patient-reported outcomes showed significant improvement in night vision and driving after LASIK with three of the latest FDA-approved laser platforms. Patient satisfaction was high, and dry eye was mild and transient.
The three platforms were the Star S4 IR excimer laser with iDesign Advanced WaveScan Studio system (Abbott Medical Optics, now Johnson & Johnson Vision), the Allegretto Wave Eye-Q laser system with Allegro Topolyzer topography system and T-CAT treatment planning software (Alcon), and the EC-5000 excimer laser system with Final Fit custom ablation treatment planning software (Nidek). Seven hundred eighteen eyes of 530 patients undergoing laser correction for myopia and astigmatism were included in the retrospective study.
Alleviation of night-driving difficulty was significant, with 29% of patients reporting complete resolution of preoperative symptoms and 22% reporting alleviation 12 months after surgery. Light sensitivity was resolved in 11% of the patients who reported symptoms preoperatively. Glare and halos were significantly reduced in 12% and 6% of patients, respectively.
Dry eye slightly increased in the early months but improved over time and was resolved in all patients at 1 year. According to the authors, this might be due to the new lasers, in addition to the more accurate detection of tear dysfunction preoperatively.
On average, 96% of patients were satisfied with their laser vision correction.
The authors believe that “patient-reported outcomes are an important index of LASIK.” They said that “the combination of improved visual outcomes, excellent patient-reported outcomes and high satisfaction may be attributed to modern lasers with improved ablation profiles, in conjunction with experienced surgeons and careful preoperative examinations, making LASIK a safe and effective procedure.” – by Michela Cimberle
Disclosures : Moshirfar reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Jorge L. Alió, MD, PhD
This is one of the few reports that focuses on patient outcomes cited by patients.
Overall, this paper offers confirmatory information that excimer laser surgery with the new platforms is no longer to be considered as a potential source of postoperative negative symptoms, but rather as a way to address preoperative negative symptoms identified by the patients with the use of contact lenses or spectacles. The outcomes demonstrate that the progress in technology has been outstanding and rather than having problems with visual deterioration following excimer laser surgery, patients should expect an improvement in their visual condition, especially regarding photic phenomena related to the use of glasses.
Based on the outcomes cited in this paper, FDA data can be used to reassure our patients preoperatively that laser refractive surgery will have a positive outcome, not only in terms of efficacy, predictability and safety, but also in terms of subjective satisfaction. This is great news and indeed it is relevant for the practice of LASIK in the hands of modern refractive surgeons using modern excimer laser platforms.
This paper paves the way to research into equivalent information that should be obtained from other lasers that are not available in the U.S., but are even more technologically advanced than those included in this study. The evaluation could be extended to other emerging corneal refractive surgery technologies such as femtosecond assisted SMILE, which would have to match these positive outcomes in similar retrospective or prospective trials. The follow-up of this study should be a prospective evaluation, not retrospective, as has been done, in order to go into more depth about the benefits of LASIK for vision.
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Moshirfar M, et al. J Refract Surg. 2017;doi:10.3928/1081597X-20161221-02.
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