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Refractive surgery: Keeping up with the ever-increasing options
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The field of refractive surgery has witnessed a flurry of activity in the second half of this decade.
It all began in October 1995 when the Food and Drug Administration (FDA) granted approval to Summit Technology Inc. to sell its excimer laser for use in photorefractive keratectomy (PRK). One month later, Visx received its approvable letter from the FDA for PRK.
In July 1997 the FDA's Ophthalmic Devices Advisory Committee recommended for conditional approval the laser in situ keratomileusis (LASIK) method developed by Emory University researchers. More and more surgeons are performing LASIK and more and more data are gathered as we wait for final approval from the FDA.
Undergoing FDA trials for use in myopic patients are the STAAR Implantable Contact Lens and the Intrastromal Corneal Ring Segment from KeraVision.
Momentum is building
The popularity of refractive surgery has increased dramatically in the last few years. While less than 100,000 Americans underwent PRK in 1996, as many as 300,000 opted for PRK or LASIK in 1997. As Editor Michael D. DePaolis, OD, says in his editorial on page 5, "with this sort of momentum it is virtually impossible to dismiss refractive surgery as a viable option."
Elsewhere in the issue we offer tips on modifying your practice to accommodate refractive surgery comanagement along with advice on entering into comanagement agreements with laser centers or ophthalmologists. But the first step to take in getting involved in comanagement is to educate yourself about the procedures themselves.
On the next six pages surgeons reveal their individual methods for performing LASIK, PRK and radial keratotomy. Investigators will also share their experiences with the newer developments in refractive surgery: the Implantable Contact Lens and the Intrastromal Corneal Ring Segment. Along with each technique we provide a helpful table outlining the indications, advantages and potential complications of each.
Take this opportunity to either begin or further your education on refractive surgery. And in the words of Dr. DePaolis, let the games begin!
Posterior phakic IOL shows promise in early FDA trials
Clinical trials show this lens gives patients safe results and hogh-quality vision.
Corneal ring segments offer patients quick visual recovery
Adjustabilty is a unique aspect of the Itrastromal Corneal Ring Segment, a new procedure that offers the patient almost immediate results.
'Minimal-touch' epithelial removal techique improves PRK outcomes
Irrigating the corneal surface in higher corrections reduces the incidence of corneal haze.
LASIK offers instant, impressive results
Postoperative care is minimal, and enhancements are easier than with photorefractive keratectomy.
Successful RK is a shared responsibility
An accurate, stable refraction and a problem-solving preop exam by the comanaging OD are vital to the final outcome.