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Will LASIK overtake PRK as the preferred refractive surgery choice?
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The use of the excimer laser has already grown beyond its apparent Food and Drug Administration intention in the United States. A number of surgeons have begun performing laser in situ keratomileusis (LASIK) under the premise that the instrument has been approved, but the surgical procedure is at the doctor's discretion as long as the patient has given informed consent.
The results appear to justify its use in this regard. It was originally believed that LASIK may be the procedure of choice for the higher myope (above 7 D), with photorefractive keratectomy (PRK) being favored for patients in the 1 D to 7 D range. Although U.S. studies have not verified it, it is apparent that LASIK has numerous benefits for those mid-range myopes of 3 D to 7 D.
However, do the advantages outweigh the disadvantages? With LASIK, the patient experiences minimal discomfort, minimal visual recovery time and has no need for long-term medications.
Conversely, the LASIK patient is undergoing a more delicate procedure, and the surgeon's experience and expertise are more important than with PRK. Another instrument has also been introduced into the procedure. The quality and dependability of the microkeratome adds another potential problem to the overall surgical success of LASIK.
From a comanagement perspective, it is much easier to manage a postoperative LASIK patient than a postoperative PRK patient. At day 1 you check for quality of vision, sealing of the cap, debris beneath the cap and possible infection or edema.
Typically, treatment is TobraDex (tobramycin/dexamethasone, Alcon) four times daily for 1 week, with follow-up at 1 week, 1 month, 3 months and 6 months. Vision should normally be very good at day 1 — 20/20 to 20/30 — with a mild decrease at 1 week, then clearing.
The International Cataract and Refractive Surgery Society is conducting a study to evaluate the safety and efficacy of LASIK.
Look for improvements in the microkeratome that will make the procedure safer and more predictable. Don't look for LASIK to overtake PRK in the immediate future, as it will take time for surgeons to gain the experience and expertise to perfect the procedure.
When performed by a qualified surgeon on the properly selected patient, LASIK has been shown to be a successful surgical technique that will have its place as another safe and effective refractive surgery option.
For Your Information:
- Terry F. Hawks, OD, is an advisory panel member of Refractive Surgery Services and a consultant for Vision International. He is a charter member of the Editorial Advisory Board of Primary Care Optometry News. Hawks may be contacted at 5703 W. 95th St., Overland Park, KS 66207; (913) 341-4508.