Refractive surgery group holds ninth annual meeting

Issue: October 2004

ByNancy Hemphill, ELS, FAAO

AKRON, Ohio — Here at the ninth annual Optometric Refractive Surgery Society Symposium, optometrists and ophthalmologists presented to 140 attendees the latest developments in wavefront technology and refractive surgery, accommodating IOLs, homeopathy for dry eye and reducing malpractice risk.

New technology

ORSS [logo] According to Dana Ondrias, OD, of the Mann Eye Institute, Houston, the Allegretto Wave laser (WaveLight) is the fastest laser in the United States, with its PerfectPulse Technology. The laser was approved in November 2003 for treating up to 12 D of myopia with up to 6 D of astigmatism and 6 D of hyperopia with up to 5 D of astigmatism.

Dr. Ondrias said the increased speed decreases stromal dehydration, increases patient comfort and decreases eye movement. Her center is using this laser on about 80% of her patients. She said that surgeons in Europe, who also have a wavefront platform available for the Allegretto, use that platform in only 5% of cases performed with the Allegretto Wave. “It is built to give you a custom-type treatment without being wavefront guided,” she said.

William Wiley, MD, of Cleveland, reported that the Crystalens (eyeonics Inc.), an accommodating IOL, has provided 98% of patients with 20/40 vision or better for distance and correction greater than J3 for near.

“Right now, Medicare does not allow us to put this lens in the eye,” he said. “They don’t allow us to balance bill for surgery, so we can’t use the lens and bill the balance to the patient. The ideal patient for Crystalens is in his or her 50s or 60s, with a cataract that is beginning to compromise vision.”

Avoiding malpractice

Ronald Norlund, OD, of Fort Wayne, Ind., discussed the malpractice crisis in the United States and provided recommendations on how to minimize your risk:

Check pupil size, wavefront analysis and pachymetry.
Scrutinize consent forms.
Thoroughly discuss and document any preoperative abnormalities, even if they do not contraindicate LASIK.
Show concern and compassion, and make yourself available to answer questions.
Don’t pressure for payment if the problem is not resolved.
Consult DoctorsKnow.Us: a registry of patients with a significant malpractice history.

He concluded by saying that 90% of all malpractice cases brought to court are litigated in favor of the physician.

Choosing wavefront

Jeff Genos, OD, clinical director at TLCVision Centers, Cleveland, discussed how to determine which patients are suitable for wavefront correction by dividing them into three groups: those who should have it, those who could have it and those who cannot have it or do not necessarily need it.

Patients who should have wavefront correction have pupils greater than 6.6 mm, night requirements, higher prescriptions and a high number of higher-order aberrations (RMS values of >0.3). Those who could have it have pupils between 5 and 6 mm, night vision issues of less importance, lower prescriptions and higher-order aberrations <0.3. Patients for which custom LASIK is either unnecessary or unsuitable are outside the FDA approval range or have thin corneas, pupils less than 5 mm, a large disparity between the manifest refraction and the wavefront aberrometer-derived refraction and any issues that could prevent a scan.

Treating dry eye

Edward Kondrot, MD, a homeopathic physician from Phoenix who is a medical advisor to Natural Ophthalmics, said a National Eye Institute-sponsored study is being conducted at the University of Arizona, focusing on homeopathic treatment of fibromyalgia. Another study on the use of homeopathy for treating age-related macular degeneration is being planned. Dr. Kondrot encouraged practitioners to try some homeopathic products.

Douglas J. Ripkin, MD, of Western Reserve Eye Associates in Hudson, Ohio, reported that Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) restores natural tear production by treating the underlying cause of dry eye disease. He cited a study of cyclosporine use in dry eye patients having LASIK. George Salib, MD, and Marguerite McDonald, MD, found that patients treated with cyclosporine prior to LASIK had better uncorrected visual acuity and best-corrected visual acuity than those treated with placebo. He reported that at 3 months, the cyclosporine group had less burning, grittiness and blurred vision.

Course director and ORSS president, Jeffrey Augustine, OD, recommended that practitioners consider using IntraLase on all patients for whom dryness is an issue.

Wavefront systems

James T. Varnell, OD, of Houston, identified previous LASIK patients who would benefit most from therapeutic LASIK with Visx CustomVue.

Philip C. Roholt, MD, of Canton, Ohio, outlined patient selection criteria, patient work-up, treatment and outcomes analysis with the Bausch & Lomb Zywave system.

Rick Potvin, MASc, OD, FAAO, of Orlando, Fla., representing Alcon Laboratories, explained how the Alcon CustomCornea System works. “The technology is no longer the limiting factor when considering patients for refractive surgery,” he said.

Dr. Augustine told Primary Care Optometry News that this year's meeting saw a significant increase in attendance: more than 140 attendees compared to about 90 last year.