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Refractive surgery 1998: Let the games begin
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Few subjects have commanded as much attention in recent years as refractive surgery. And for good reason. Eye care providers are intrigued by the prospect of surgical correction of refractive errors, a long-awaited alternative to eyeglasses and contact lenses.
The public - 140 million ametropes in North America alone - anxiously view refractive surgery as their salvation, a ticket to naturally clear vision. And then there's the technology. The idea of altering prescription by excimer laser sculpting, by threading tiny PMMA ring segments into the cornea or by slipping a soft contact lens into the posterior chamber is, in and of itself, simply amazing.
Interestingly enough, despite the grandiose predictions, refractive surgery got off to a surprisingly slow start. In its first full year after Food and Drug Administration (FDA) approval, fewer than 100,000 Americans underwent excimer laser photorefractive keratectomy (PRK). Maybe it was the overzealous predictions of industry analysts. Maybe it was that many eye care providers were were taking a wait-and-see attitude. Or maybe it was a combination of patient apprehension and "sticker shock."
Whatever the reason, 1996 was not a banner year for refractive surgery.
However, 1997 has been nothing short of remarkable. Not to be dissuaded, the collective refractive surgery community regrouped. Surgery centers restructured and set their sights on more realistic short-term goals. Research and education flourished, resulting in more defined procedural and postoperative protocols. Patient concerns about discomfort and delayed visual recovery were addressed with newer PRK techniques and with laser in situ keratomileusis (LASIK). And most importantly, technology marched onward. The net effect? Some 300,000 procedures last year alone!
So, what can we expect in 1998? As I see it, another strong year. For starters, refractive surgery is no longer for myopia alone. If safety, accuracy, and long-term data are your objectives, consider PRK. If your goals are minimal postoperative discomfort and rapid visual recovery, there's LASIK. If titration and reversibility are key issues, consider that the intrastromal corneal ring is in FDA phase 3 clinicals. And if you feel the aberrations associated with any high prescription corneal procedure are unacceptable, be patient. Posterior chamber phakic intraocular lenses may be the best solution.
As I see it, refractive surgery is not for every patient, nor is it for every surgeon. However, it's enjoying widespread acceptance by patients and providers alike. With this sort of momentum, it's virtually impossible to dismiss refractive surgery as a viable option.
So, what's a practitioner to do? Read on, roll up your sleeves and let the games begin!