New technologies are helping to change refractive surgery

New technologies and surgical techniques are redefining the refractive surgery arena in ophthalmology. With the progress of customized wavefront-guided LASIK and the use of phakic intraocular lenses (IOLs), today's refractive surgeon can offer a wider range of services to the patient.

During an educational symposium Tuesday at the World Ophthalmology Congress, Randall Olson, MD, of the United States moderated an international panel of refractive surgeons who addressed these new technologies and techniques. Advanced Medical Optics sponsored the symposium.

Renato Ambrosia, MD, of Brazil started the symposium by delivering the keynote lecture. Dr. Ambrosia outlined principles of wavefront-driven ablations in laser vision correction. He explained how customized wavefront-guided LASIK offers a better ablation profile, better corrected visual acuity, and less enhancements.

Customized wavefront-guided LASIK is superior, said Dr. Ambrosia. While a physician needs to think about costs, he/she needs to understand value for the services that he/she provides. He also explained that patient and physician education is also important.

Should wavefront-guided ablations be the standard? "Yes," Dr. Ambrosia said. "It's my standard to do the best for the patient. Cost and value have to be very well balanced."

Gustavo Tamayo, MD, of Columbia continued the discussion on the applications of wavefront ablations by outlining the iris registration technology for cyclotorsional error and pupil centroid shift. Dr. Tamayo also presented the results of an international study regarding VISX's cyclotorsional registration.

Eric Donnenfeld, MD, of the United States presented his talk on lamellar epithelial debridement (LED). He said that surgeons have experienced some changes in refractive surgery. "This is the year that we have gone B-to-B - or Back to Bowman's membrane." He pointed out that refractive surgeons have gotten back to surface ablation for a number of reasons, but the biggest concern is over deeper ablations, wide ablation zones, and increased risk of ectasia.

Dr. Donnenfeld said surgeons are getting better visual results with surface ablations and Bowman's membrane may serve as better "regular canvas" than a regular flap. He also said the Amadeus II Epi-LASIK microkeratome creates a smoother surface for an Epi-LASIK bed. He outlined several features of the keratome that helped improved outcomes. Dr. Donnenfeld also presented the results of several studies regarding Epi-LASIK and LED, and LED and PRK using the Amadeus II.

Dr. Tamayo returned to the podium to update the audience about the U.S. Multifocal Ablation Clinical Trial and the long-term outcomes from the Canadian study on multifocal presbyopia ablations. In the on-going study in Canada, Dr. Tamayo presented the results of the study, directed by W. Bruce Jackson, MD, involving 75 eyes. At 1 year 96% of the Canadian subjects were 20/25 distance vision or J3 binocular. Spectacle independence was achieved. The results of the clinical trial conducted in the United States by Coleman Kraff, MD, with 20 subjects repeated the results found in the Canadian study - and in some areas, the U.S. results surpassed the Canadian results.

Marguerite McDonald, MD, of the United States presented the data that lead to the FDA approval for high myopia. The bilateral LASIK treatments were performed at seven independent centers with Fournier wavefront reconstruction. All 184 eyes of 84 patients were targeted for ametropia.

Dr. McDonald said that the uncorrected visual acuity (UCVA) at 6 months found that 65% of the patients were 20/16 or better without correction. Also, 84% were 20/20 or better, 93% were 20/25 or better, and 98% were 20/40 or better. "This is best high-myopia data ever presented to the FDA," she said.

Other presenters included:

• Carlos Argento, MD, of Argentina, who addressed treatment options for the high myope with phakic IOLs.
• Burkhard Dick, MD, of Germany talked about the impact of wavefront-driven IOLs on lenticular surgery.
• Claudio Lottemburg, MD, of Brazil discussed how wavefront-driven bioptics might be the future of customized cataract surgery.
• Virgilio Centurion, MD, also of Brazil outlined how to select the optimal multifocal lens based on patient feedback.
• Dr. Olson presented two talks geared toward the patient relations. The first dealt with managing patient outcomes and expectations. The second covered communicating the value of multifocal IOLs to the cataract patient.