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Panelist touts benefits of surface procedures
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NEW YORK – Here at the PRIMARY CARE OPTOMETRY NEWS Symposium on Sunday, David Hardten, MD, discussed the role of surface ablation in his refractive surgery practice.
Dr. Hardten said he considers surface ablation in smaller eyes, those with anterior basement membrane dystrophy and those with thinner corneas. Patients with anterior basement membrane dystrophy fare better with photorefractive keratectomy (PRK) vs. laser epithelial keratomileusis (LASEK) or epi-LASIK, he said. Patients with thinner corneas have a buttonhole risk, so surface ablation may be the best option. The newer lasers with larger optical zones create deeper ablations, he said.
Patients with mild asymmetry (keratoconus suspects or those with contact lens warpage) and atypical topography also fare best with PRK.
Patients with thinner corneas and higher refractive errors would be better off with phakic IOLs, Dr. Hardten added.
“Many of my colleagues have chosen to go to all surface ablation,” Dr. Hardten said. “I do about 90% LASIK, 10% PRK. I still think there’s a value to offering both procedures.” He said recovery time and discomfort has been improved with PRK with bandage contact lenses and narcotics, but patients still prefer the rapid recovery and simultaneous vision correction with LASIK.
Dr. Hardten added that visual recovery, pain and discomfort have been identical among the three procedures (PRK, LASEK, epi-LASIK) within his practice.
Panelist John Potter, OD, national director of clinical affairs for TLC Laser Eye Centers, said that TLC centers perform 4,000 to 6,000 surface procedures per month. “Many of our centers are using Neurontin [gabapentin, Parke-Davis], an anti-convulsive, for pain management,” he said. “It’s approved for post-herpetic pain following herpes zoster. Now the major pain problem is discomfort from the contact lens.”