[Multicentric study regarding assessment of the driving ability of LASIK and orthokeratology patients compared with conventionally corrected persons]. / Multizentrische studie zur fahreignungsbegutachtung von LASIK- und orthokeratologie-patienten im vergleich zu konventionell korrigierten personen.

PURPOSE: Corneal optical zone induced by LASIK and orthokeratology (Ortho-K) treatment modifies the refraction of the incoming light bundle in its border area in situations of dawn and darkness. Considering the legal regulations of the driver's license and the recommendations of the German Society of Ophthalmology (DOG) and the American Academy of Ophthalmology (AAO), the vision for driving suitability of ortho-K patients is tested and compared with that of LASIK patients and a reference group (juvenile: < 30 years, adult: > 40 years) under different criterions. The examination of the visual acuity, contrast sensitivity under mesopic conditions and glare contrast sensitivity are main topics of the study. METHODS: This multicentre retrospective study includes 333 eyes of 167 subjects. 65 subjects were habitual wearers of reverse-geometry contact lenses, 60 subjects were treated by LASIK. 42 subjects use glasses, contact lenses or none of them. The follow-up time was 22.8 ± 11.9 months. The measurement of the visual acuity was based on DIN Standard 58220 part 3 and the ISO Standard 8596. The Mesotest II (Oculus Inc.) was used for testing contrast sensitivity under mesopic conditions and glare contrast sensitivity. Detecting the personal evaluation of vision and satisfaction, subjects were instructed to complete a questionnaire (NEI-RQL-42). RESULTS: Relating to the legal requirements in Germany, sufficient visual acuity was found in 76.7 % of the LASIK group, in 73.9 % of the Ortho-K users and in 85.7 % of the reference group (72.7 % in the adult group, 100 % in the juvenile group). Considering the DOG recommendations under inclusion of mesopic vision and glare sensitivity, 71.7 % of the LASIK subjects and 95.7 % of the Ortho-K subjects are suitable for driving a motor vehicle of the German classes A, A1, B, BE, M, S, L and T. With regard to the legal situation in the USA, 100 % of the Ortho-K users, 93.2 % of the LASIK group, 86.4 % of the adult reference group and 100 % of the juvenile reference group are fit to drive. The evaluation of the subjective questionnaire showed very high ratings in the Ortho-K (mean 85 of 100 points) and the LASIK (mean 86 of 100 points) group with no statistically significant differences. CONCLUSION: Considering the legal regulations, the volume of the subjects of Ortho-K and LASIK showed no significant difference of individuals considered fit to drive in comparison to a reference group. Neither LASIK nor Ortho-K patients have any restriction in the ability to drive a vehicle. The requirements of the DOG with regard to contrast sensitivity under mesopic conditions and glare contrast sensitivity for driving a vehicle are better fulfilled in the Ortho-K group compared to the group of LASIK patients. According to the DOG recommendations there are fewer subjects that are suitable for driving a motor vehicle as in the reference group. This fact must be discussed preoperatively.

[LASIK - a new treatment or the standard]. / LASIK - Neulandbehandlung oder medizinischer Standard.

Classification of LASIK in refractive surgery and treatment by health insurance, and education by the physician. Results in clinical studies and case law in Germany 2010.

[Problems and strategies of corneal surgery in China].

Corneal surgery covers corneal refractive surgery and corneal transplantation. Though China has ranked the first in the number of LASIK performed in the world, lack of accredited subspecialty division, surgical admission system and professional administration in the field of refractive surgery prevents the further development of LASIK techniques. However, corneal transplantation techniques of China have been greatly improved in the international level. But the major constrains are legal, storage and screening standards of donor corneas.

Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and photorefractive keratectomy surgery.

PURPOSE: To identify physician predictors in LASIK and photorefractive keratectomy (PRK) surgery that correlate with a higher risk for malpractice liability claims and lawsuits. DESIGN: Retrospective, longitudinal, cohort study. PARTICIPANTS AND METHODS: A comparison of physician demographic and practice pattern data of 100 consecutive Ophthalmic Mutual Insurance Company (OMIC) LASIK and PRK claims and lawsuits with demographic and practice pattern data for all active refractive surgeons insured by OMIC between 1996 to 2002 was made. Background information and data were obtained from OMIC underwriting applications, a physician practice pattern survey, and claims file records. Using an outcome of whether or not a physician had a history of a claim or lawsuit, logistic regression analyses were used separately for each predictor as well as controlling for refractive surgery volume. MAIN OUTCOME MEASURE: Malpractice claim or lawsuit for performance of PRK or LASIK surgery. RESULTS: Logistic regression analysis demonstrated that the most important predictor of filing a claim was surgical volume, with those performing more surgery having a greater risk of incurring a claim (odds ratio [OR] = 31.4 for >1000 surgeries/year versus 0-20 surgeries/year, 95% confidence interval [CI] = 7.9-125, P = 0.0001). Having one or more prior claim was the only other predictor examined that remained statistically significant after controlling for patient volume (OR = 6.4, 95% CI = 2.5-16.4, P = 0.0001). Physician gender, advertising use, preoperative time spent with patient, and comanagement seemed to be strong predictors in multivariate analyses when surgical volume was greater than 100 cases per year. CONCLUSION: The chances for incurring a malpractice claim or lawsuit for PRK or LASIK correlate significantly with higher surgical volume and a history of a claim or lawsuit. Additional risk factors that increase in importance with higher surgical volume include physician gender, advertising use, preoperative time spent with the patient, and comanagement with optometrists. These findings may be used in the future to help improve the quality of care for patients undergoing refractive surgery and to provide data for underwriting criteria and risk management protocols to manage proactively and perhaps reduce the risk for claims and lawsuits against refractive surgeons.