Treating more patients with LASIK

By Christopher L. Blanton, MD; Special to Ophthalmology Times

The millennial gener­ation-many of whom are just now reaching adulthood-is even larger than the baby boomer generation that drove LASIK volumes in the past. Unlike previous generations, millennials are already comfortable with the safety and efficacy of LASIK and already prioritize convenience and lifestyle decision making.

Aberrometry-guided LASIK, the laser vision-correction procedure that can be customized to the patient, will continue to be the best option for the millennial generation because of its well-established track record, excellent outcomes, and precision.

Additionally, the latest generation of wavefront technology is enabling us to treat more patients than ever before.

Expanding range of candidates

iDesign-guided LASIK (Johnson & Johnson Vision) expands the range of refractive error that can be measured and treated. It has also now been approved for patients as young as 18 years old (compared to 21 years previously) as long as their vision is stable.

I encourage patients to consider that LASIK gives them a lifetime of distance vision correction-and the value of that is greater the younger they are when they have the procedure. An 18- or 25-year-old has many more years than a 40-year-old to enjoy post-LASIK vision before the onset of presbyopia and cataract requires them to wear spectacles or undergo other procedures.

We can also capture more eyes with iris registration (IR) than ever before, allowing more people to have wavefront-guided treatments. My IR capture rate has gone from 86% with the WaveScan device to 98% with iDesign, which is able to capture pupil sizes ranging from quite small (4.0 mm) to quite large (9.5 mm).

Outcomes also improving

We know that LASIK outcomes were already very good, but the new aberrometry technology has made them even better.

Analysis of a large number of eyes (11,000) treated with iDesign-guided LASIK at laser vision correction centers in the United Kingdom revealed that 97.4% of patients said they were satisfied/very satisfied with their uncorrected vision after surgery, a number that was statistically significantly higher than the percentage giving that response after Wave­Scan-guided LASIK.

The share of eyes seeing 20/20 or better and 20/16 or better was significantly higher with iDesign than with the WaveScan, as was the percentage of eyes with better postoperative uncorrected vision compared to their preoperative best-corrected vision.

A recent paper in which iDesign-guided LASIK was compared to small lenticule extraction (SMILE) found that 98% of the LASIK eyes, versus only 82% of the SMILE eyes, achieved a postoperative spherical equivalent within 0.50 D.¹ There was no loss of lines of corrected distance acuity in the LASIK eyes, compared to 6.8% of the SMILE eyes.

Reduced need for adjustments

There are a number of reasons for the enhanced precision of the new aberrometry system. First is the higher-resolution wavefront sensor, which measures more than 1,200 spots over a 7.0-mm pupil.

In addition to the aberrometry, the system simultaneously captures refraction, topography, keratometry, and pupillometry, and ensures that all these measurements can be spatially registered to each other. This means that accurate Ks, calculated from topometric data, can be factored into the treatment design to adjust for the cosine effect without any manual data entry.

The iDesign aberrometer now builds in a correction for chromatic aberration (CA) from the laser light. In the past, physicians used nomogram adjustments to bring the wavefront refraction in line with the manifest. The built-in CA adjustment has brought the wavefront refraction closer to the true refraction and reduced the need for nomogram adjustments.

In a review of my past 50 eyes treated, there was a 48% reduction in nomogram adjustments needed to match the wavefront and manifest refractions.

We learned in the past that when patients had very small amounts of residual error, they were happier if that error was slightly on the hyperopic side rather than on the myopic side.

For this reason, many of us aimed for a refractive target of +0.25 D instead of 0.00 D. By simply correcting for infinity (instead of correcting for a 20-foot exam lane), the iDesign system builds in that slight boost, making it possible now to aim for superlative distance vision.

These changes to the algorithms mean that it is important for surgeons who start using the new aberrometry system to ensure that patients aren’t accommodating, and to avoid using previous nomogram adjustments until they have evaluated 50 cases or so without adjustments.

Reaching millennials

Success depends on reaching new LASIK candidates in ways that make sense to a new generation. Old-school print or radio marketing efforts may miss their mark with millennials.

My practice utilizes search engine optimization techniques and other digital marketing strategies, but what’s had the most impact has been encouraging our patients to review us on Yelp!

Right after the procedure, they are seeing well and thrilled with the experience-and happy to post a review. It becomes a self-feeding loop because those reviews are read by young people who trust the Yelp! platform.

Surgeons have a large new pool of candidates for LASIK and current technology that affords the opportunity to capture and treat more of them, achieving better outcomes than we did with earlier wavefront technology. iDesign-guided LASIK treats the widest range of refractive error, has an immediate wow factor, and can be enhanced easily when needed.

The biggest reason I believe LASIK will continue to dominate the refractive surgery marketplace is that it is aberrometry-driven and truly custom, which will continue to be attractive to our patients. 

Reference

1.   Khalifa MA, Ghoneim A, Shaheen MS, et al. Comparative analysis of the clinical outcomes of SMILE and wavefront-guided LASIK in low and moderate myopia. J Refract Surg 2017;33:298-304.

Christopher L. Blanton, MD

p: 909/825-3425
e: blanton007@aol.com

Dr. Blanton is president and CEO of Inland Eye Institute, Colton, CA. He serves as a consultant and medical monitor for Johnson & Johnson Vision.