A Comparison of LASIK Versus PRK Enhancement Outcomes in Eye With Prior Cataract Surgery.

INTRODUCTION: Cataract surgery continues to evolve with increasing levels of precision through the development and introduction of new technologies. Despite these advances, unexpected visual outcomes attributable to residual refractive error still occur. Additional "enhancement" procedures to the cornea can treat this residual refractive error to achieve a satisfactory outcome. Two frequently employed excimer laser enhancement procedures include laser in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). While both of these procedures are widely accepted as safe and effective in treating refractive error, there is a paucity of data comparing the two as enhancements in the post-cataract population. The purpose of this study was to investigate visual and refractive parameters in the pre- and post-enhancement setting on post-cataract surgery patients to compare the effectiveness of both excimer laser-enhancement treatments. METHODS: This study examined patients that underwent post-cataract extraction excimer laser enhancement surgery targeted for emmetropia (±0.50 D). The setting was a private, tertiary surgery center. Refractive enhancement procedures were performed by 3 different surgeons. Post-enhancement uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) was recorded for all available follow-ups and compared for both groups. RESULTS: This study included 822 post-cataract enhanced eyes (491 LASIK; 331 PRK). For patients with at least six months follow up, mean UDVA was 0.05 ± 0.13 logMAR in LASIK-enhanced patients and 0.15 ± 0.20 in PRKenhanced patients. Mean absolute value MRSE was 0.22 ± 0.36 and 0.48 ± 0.62 for LASIK- and PRKenhanced patients at or beyond six months, respectively. A total of 330 (67%) of LASIK-enhanced patients achieved 20/20 or better post-enhancement UDVA, compared to 142 (43%) PRK-enhanced patients. Categorized by pre-enhancement UDVA, LASIK-enhanced patients showed significantly better post-enhancement UDVA than PRK-enhanced patients, except in those with pre-enhancement vision of 20/20 or better, or those worse than 20/50. LASIK-enhanced virgin corneas had mean post-enhancement of 0.05 ± 0.14 UDVA compared to 0.13 ± 0.19 UDVA in PRK-enhanced virgin cornea patients. CONCLUSION: LASIK provides better and more predictable outcomes in UDVA than PRK in post-cataract enhancement patients, even when categorizing patients by their pre-enhancement visual acuity, prior ocular procedures, and allowing for sufficient time for healing and stabilization of the cornea.

Outcomes of LASIK vs PRK enhancement in eyes with prior cataract surgery.

PURPOSE: To compare postenhancement visual acuity between patients who underwent postcataract laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). SETTING: A private, tertiary referral practice in Sioux Falls, South Dakota. DESIGN: 3-year, retrospective chart review. METHODS: Patients who underwent postcataract extraction excimer laser enhancement surgery targeted for emmetropia (±0.50 diopter). Postenhancement uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) was recorded for all available follow-ups and compared for both groups. RESULTS: 822 postcataract enhanced eyes (491 LASIK; 331 PRK). For patients with at least 6-month follow-up, mean UDVA was 0.05 ± 0.13 logMAR in LASIK-enhanced patients and 0.15 ± 0.20 in PRK-enhanced patients ( P < .001). Mean absolute value MRSE was 0.22 ± 0.36 and 0.48 ± 0.62 for LASIK-enhanced and PRK-enhanced patients at or beyond 6 months, respectively ( P < .001). 330 (67%) LASIK-enhanced patients achieved 20/20 or better postenhancement UDVA, compared with 142 (43%) PRK-enhanced patients ( P < .001). Controlling for pre-enhancement UDVA, LASIK-enhanced patients showed significantly better postenhancement UDVA than PRK-enhanced patients, except in those with pre-enhancement vision of 20/20 or better, or those worse than 20/50. LASIK-enhanced virgin corneas had mean postenhancement of 0.05 ± 0.14 UDVA compared with 0.13 ± 0.19 UDVA in PRK-enhanced virgin cornea patients ( P < .001). CONCLUSIONS: LASIK provides better and more predictable outcomes in UDVA than PRK in postcataract enhancement patients, even when controlling for pre-enhancement visual acuity and prior ocular procedures.

A Survey of Eye Care Needs Among Community Health Patients in Western South Dakota.

INTRODUCTION: Community Health Centers (CHCs) provide healthcare to underserved communities, including the uninsured and underinsured. Ocular disease and visual impairment affect individuals of all ages, race, and socioeconomic standing, but are disproportionately detrimental to individuals with limited access to care. The purpose of this study is to assess the need for and potential utilization of an on-site eye care clinic at a CHC in Rapid City, South Dakota. METHODS: A 22-question survey was distributed to patients 18 years and older at Community Health Center of the Black Hills (CHCBH) to gather demographic, socioeconomic, medical, and subjective interest data. RESULTS: A total of 421 surveys were included in the analysis. Of these, 364 respondents (87%) indicated being "Very likely" or "Somewhat likely" to use an on-site eye clinic at CHCBH. A total of 217 respondents (52%) endorsed a diagnosis of an existing eye condition and/or diabetes, and 215 respondents (51%) rated their vision as "Poor" or "Very poor." Less than half of respondents indicated having health insurance such as private insurance, Medicaid, Medicare, State Children's Health Insurance Program (CHIP), Indian Health Services, Military insurance, or other public or government insurance programs (191, 45%) but showed a comparably high likelihood of using an on-site eye clinic when compared to their uninsured counterparts, 90% and 84%, respectively. Finally, 50 (12%) respondents indicated they had been referred to an eye doctor in the past, with affordability as the most cited reason for not following through with the referral. CONCLUSIONS: Survey data indicate a medical and socioeconomic need for eye care services among CHCBH patients and a high likelihood patients would seek care at an on-site clinic.

A Survey of Eye Care Needs Among Community Health Center Patients in Western South Dakota.

BACKGROUND: Community health centers (CHCs) provide healthcare to underserved communities, including the uninsured and underinsured. Ocular disease and visual impairment affect individuals of all ages, race, and socioeconomic standing, but are disproportionately detrimental to individuals with limited access to care. The purpose of this study is to assess the need for and potential utilization of an on-site eye care clinic at a CHC in Rapid City, South Dakota. METHODS: A 22-question survey was distributed to patients 18 years and older at Community Health Center of the Black Hills (CHCBH) to gather demographic, socioeconomic, medical, and subjective interest data. RESULTS: A total of 421 surveys were included in the analysis. Of these, 364 respondents (87 percent) indicated being "Very likely" or "Somewhat likely" to use an on-site eye clinic at CHCBH (95 percent CI 83-90 percent). A total of 217 respondents (52 percent) endorsed a diagnosis of an existing eye condition and/or diabetes, and 215 respondents (51 percent) rated their vision as "Poor" or "Very poor." Less than half of respondents indicated having any form of health insurance (191, 45 percent) but showed a comparably high likelihood of using an on-site eye clinic when compared to uninsured respondents, 90 percent and 84 percent, respectively. Finally, 50 (12 percent) respondents indicated being referred to an eye doctor in the past, with affordability as the most commonly cited reason for not following through with the referral. CONCLUSIONS: Survey data indicate a medical and socioeconomic need for eye care services among CHCBH patients and a high likelihood patients would seek care at an on-site clinic.

Bouveret Syndrome: A Rare and Dangerous Cause of Gastric Outlet Obstruction.

Bouveret syndrome is a rare and dangerous complication of cholelithiasis in which a gallstone lodges in the distal stomach or proximal duodenum, resulting in gastric outlet obstruction. We report the case of an 85-year-old female that presented without many of the clinical symptoms and complaints characteristic of gallstone ileus, further complicated by significant cardiac pathology. We review the existing studies of this uncommon disease and discuss its clinical presentation, diagnosis, and therapeutic options.