Laser epithelial keratomileusis in 2010 - a review.

Photorefractive keratectomy, laser epithelial keratomileusis (LASEK) and Epi-LASIK are all variants of a similar type refractive surgery involving laser on the surface of the cornea and differ mainly in management of the epithelium. Although laser in situ keratomileusis (LASIK) is currently the most popular form of refractive surgery, LASEK is the procedure of choice in some patients. We highlight potential complications of LASEK and how these may be managed. Following laser refractive surgery, corneal thickness is reduced, which has implications for intraocular pressure measurement and glaucoma screening and management. This is particularly important following surface laser procedures where no evidence of previous surgery may be visible. In the event that cataract surgery is required at a later date, correct calculation of the appropriate intraocular lens power can be difficult and it thus important that patients are given their preoperative keratometry readings and refraction. Compared with LASIK patients, those who undergo LASEK are considered to be at lower risk of corneal ectasia. Improved understanding of wound healing post LASEK and better postoperative pain management are ongoing challenges.

US trends in refractive surgery: 2003 ISRS/AAO survey.

PURPOSE: To determine the latest trends in refractive surgery in the United States. METHODS: All U.S. members of the International Society of Refractive Surgery of the American Academy of Ophthalmology were mailed the 2003 refractive surgery survey dealing with volumes, types, preferences of refractive surgery performed, and use of new emerging technology. Questions regarding radial keratotomy (RK), astigmatic keratotomy (AK), limbal relaxing incisions (LRI), photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), laser subepithelial keratomileusis (LASEK), intracorneal ring segments (ICRS), laser thermokeratoplasty (LTK), conductive keratoplasty (CK), phakic intraocular lenses (PIOL), clear lens extractions (CLE), and scleral expansion (SE) procedures were examined in the survey. Use of lasers, microkeratomes, pupillometry instruments, postoperative medications, wavefront analyzers, topographers, etc were examined. RESULTS: In 2003, LASIK continued to dominate for refractive errors between -8.00 to +3 diopters. Surgeons are waiting on the PIOL for high myopes and are performing CLE for high hyperopes. Photorefractive keratectomy, LASIK, LASEK, CLE, PIOL, and CK appeared to have bright futures; whereas, RK, ICR, LTK and SE were on the decline. Bilateral LASIK at the same surgical session is offered by 98% of surgeons. VISX lasers are used 2:1 over all other lasers in the United States. Zeiss-Humphrey still dominates topographers at 37%. The Bausch & Lomb Hansatome (48%) leads microkeratomes. Surgeons are charging, on average, 300-500 dollars more per eye for custom ablations and these ablations have already been accepted and integrated into refractive practices. Comanaging of refractive surgery patients is significantly down from previous years. Fourth-generation fluoroquinolones overtook the postoperative antibiotic prescriptions, with prednisolone and fluoromethalone dominating as anti-inflammatories. CONCLUSIONS: Trends and changes as refractive surgery grows in the mainstream of ophthalmology in the United States continue to be elucidated by this professional organization survey.

Refractive surgery in the United States Army, 2000-2003.

PURPOSE: To examine the history, current status, outcomes, and future direction of the Army Warfighter Refractive Eye Surgery Program (WRESP), which was established to reduce the limitations posed by corrective eyewear in combat arms soldiers. DESIGN: Retrospective study. PARTICIPANTS: Sixteen thousand one hundred eleven Army service members who underwent refractive surgery between May 2000 and September 2003. METHODS: Results were collected from monthly WRESP reports and from questionnaires administered to refractive surgery patients returning from deployments to southwest Asia. Soldiers rated the impact of refractive surgery on their ability to perform select operational tasks as well as their overall readiness. MAIN OUTCOME MEASURES: Visual acuity (VA) and patient satisfaction. RESULTS: Between May 2000 and September 30, 2003, 32 068 eyes of 16 111 soldiers were treated. Postoperative uncorrected VA was better than or equal to 20/20 in 85.6%, 20/25 in 92.4%, and 20/40 in 98.2% of eyes with at least 3 months' follow-up, and 93.7% of 175 surveyed patients rated their overall readiness better or much better after surgery. CONCLUSIONS: This program has provided excellent outcomes and enhanced the overall readiness of over 16 000 Army service members. Reports of night vision difficulties, LASIK flap dislocation, and dry eye are infrequent, and do not seem to have a significant negative impact on military operations or individual readiness. This article contains additional online-only material available at http://www.ophsource.com/periodicals/ophtha.

Refractive Surgery Survey 2004.

To determine the refractive surgery (RS) preferences of ophthalmologists worldwide, questionnaires were sent to 8897 members of the American Society of Cataract and Refractive Surgery. A total of 1053 questionnaires were returned by the deadline. The practice distribution included 29.5% cataract surgeons, 48.8% comprehensive ophthalmologists, 11.6% RS specialists, 5.1% cornea and external disease specialists, 1.9% glaucoma specialists, 1.1% retina specialists, and <1.0% oculoplastics/pediatrics/researchers/retired. Results were compared with those in the 2003 survey and demonstrate that refractive surgery continues to develop and change.