Faster visual recovery next goal for refractive surgery

Kansas City, KS-Although patients undergoing thin-flap LASIK performed with modern femtosecond and excimer lasers can expect excellent vision on the day after surgery, faster visual recovery might enhance the procedure’s appeal, according to Daniel S. Durrie, MD.

“Patients considering refractive surgery want to know how quickly they will be able to get back to work,” said Dr. Durrie, professor of clinical ophthalmology and director of refractive surgery, University of Kansas Medical Center, Kansas City. “I think we could really grow our refractive practices if the surgery developed to the point where patients became immediately functional, and therefore did not have to bring a driver with them to their procedure.”

With that goal in mind, Dr. Durrie has been evaluating a possible role for an investigational silicone ocular shield (NexisVision). The device is rigid in the center and soft at the edges, and by trapping fluid beneath it, the shield supplements the optics of the healing cornea and therefore may improve vision.

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Investigation of the potential benefit of the shield is a work in process, he said, but preliminary data show it significantly improved the speed of visual recovery in patients undergoing sub-Bowman’s keratomileusis.

In order to gauge visual recovery, Dr. Durrie has been conducting prospective studies in which patients treated with different excimer and femtosecond lasers have uncorrected visual acuity (UCVA; binocular and monocular) and mesopic contrast sensitivity measured immediately postoperatively, and then at 30 minutes, 1 hour, 2 hours, 4 hours, 1 day, and 1 month after surgery.

Patients are also asked at those time points if they are able to read a text message on their phone and if they would feel comfortable driving.

In a series of patients who had the shield placed after surgery, UCVA was 20/30 or better in 95% of patients immediately after surgery, and in 100% by 1 hour. In contrast, in a cohort of patients without the shield, only 40% saw 20/30 or better immediately postoperatively, and only 71% had 20/30 or better UCVA at 1 hour.

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Patients with the shield also had significantly better mesopic contrast sensitivity early after surgery, and subjectively, they felt their visual function was better as well. Nevertheless, even with the shield, the majority of patients still did not feel comfortable driving at 30 minutes or 1 hour after their procedure.

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