Recent Advances In Laser Refractive Surgery l1b1f

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Current trends in Laser Refractive Surgery Dr. Choong Yean Yaw MBBS(Mal), FRCS Ed, M.Med(S’pore), Am(Mal)

Cornea and Refractive Surgeon Medical Director Pusat Pakar Mata Centre for Sight KPJ 24-6-14

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More common

LASIK PRK/ASA/Lasek All laser Lasik/Femtosecond Lasik Relax Smile

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Lasik

 Elective operation, reserved for patients who want to reduce or eliminate a dependence on eyeglasses or lenses  More than 50 millions procedure performed  As with any surgery, LASIK has potential risks, complications and side effects – Less than 1%  well trained surgeon  proper preop evaluation and assessment  reliable equipment

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Satisfaction after laser refractive surgery?

 K. Soloman et al. LASIK World Literature Review Quality of Life and Patient Satisfaction. Ophthalmology Volume 116, Issue 4, Pages 691–701, April 2009 – 309 database articles – An average 95.4% of patients were satisfied with their outcome – One of the most successful elective surgeries

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EXCIMER LASER    

Argon Floride laser Cold laser Smooth ablation Cause no damage to surrounding tissue

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Disadvantages of Excimer laser

 Subject to inconsistency – differences in corneal hydration – laser fluence projection – reflection losses – temperature and humidity in the laser room – other environmental factors

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What has changed?

 Improvement in predictability, accuracy & reproducibility  Reduction in side effects  Reduction in complications – – – – –

Better diagnostic equipments Better laser platform Better understanding of corneal biomechanics Digestion of data from numerous scientific papers Improved treatment profile

 Treatment to improve patients suffered side effects from previous surgery

 Femtosecond laser – Not affected by environment factors KPJ 24-8-14

ASA/PRK

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 Advantages – – – –

Effective, predictable Safe Thin cornea Epithelial basement membrane dystrophy

 Disadvantages – Discomfort – Slower visual recovery – Haze  Incidence reduced with newer technology  Mitomycin C

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LASIK Laser Assisted In Situ Keratomileusis

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LASIK

 Advantages – Rapid Visual Recovery – Pain Free – Early Stability

 Disadvantages – – – – –

Higher rate of vision threatening complications Additional Step of Flap Creation Additional Step of Flap Repositioning Potential Posterior Segment Complications Dry eye KPJ 24-8-14

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Flap creation

 Microkeratome – Long tract record – Improvement in design and safety profile

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Flap Creation

 Femtosecond laser – Safer for new/inexperience surgeon – Gaining popularity due to surgeon preference

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ReLex Smile (latest technology)

Refractive Lenticule Extraction Latest technology in refractive surgery Femtosecond-only laser vision correction No flap, minimally invasive, key hole surgery Potentially changing the way how refractive surgery is performed now

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Relex Smile

 Advantages – – – – –

Minimally invasive Flapless, no risk of flap displacement Painless Less dry eye Stronger cornea architecture1,2

 Disadvantages – New procedure – Limitation of only correcting shortsightedness and astigmatism 1. Di Wu et al.Corneal biomechanical effects: Small incision lenticule extraction versus femtosecond laser-assisted laser in situ keratomileusis. J Cataract Refract Surg 2014; 40:954-962. 2.Abhijit Sinha Roy et al. comparison of biomechanical effects of small incision lenticule extraction laser-assisted laser in situ keratomileusis. Finite element analysis. J Cataract Refract Surg 2014; 40:971-980.

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Results

 Studies showed comparable results to Excimer laser1-4  FDA clinical trial completed in June 2014, expected approval in 2016

1. Kazutaka Kamiya et.al. Early clinical outcomes, including efficacy and endothelial cell loss, of refractive lenticule extraction using a 500 kHz femtosecond laser to correct myopia. Journal of Cataract & Refractive Surgery, Volume 38, Issue 11, November 2012, Pages 1996-2002 2. Rupal Shah et.al. Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery. J Cataract Refract Surg 2011; 37:127–137 3. Anders H. et.at. Efficacy, safety, predictability, contrast sensitivity, and aberrations after femtosecond laser lenticule extraction. J Cataract & Refract Surg, Volume 40, Issue 3, March 2014, Pages 403-411 4. Marcus Blum et.al. Five-year results of refractive lenticule extraction. J Cataract & Refract Surg, Volume 40, Issue 9, September 2014, Pages 1425-1429

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Are you a suitable candidate?

 unhappy with glasses or s  motivated to improve his or her uncorrected vision  short sightedness up to –12.00

 long sightedness up to +5.00 D  Astigmatism up to 5.00 D

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Ideal candidate

 Satisfy the following criteria :      

Be at least 18 years of age Have had stable vision for at least one year (stable refractive prescription of + 0.5 Diopter) Healthy cornea Healthy eye that is free from any diseases Good general health Must not be pregnant or nursing KPJ 24-8-14

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PREOPERATIVE EXAMINATION

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Visual acuity (ucva, bcva) Refraction (manifest, cycloplegic) Pupil size Anterior segment examination (ruled out endothelial changes)  Posterior segment examination  Corneal topography  Corneal thickness

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Change of lifestyle

 Able to see the clock when waking up  Looks confidence in front of the mirror without optical aids  No more hassle of cleaning up lenses  No more misty vision when – taking hot meal – Coming out from air-con room

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Change of lifestyle

 Enjoy fullness in sports, outdoor activities  No hassle of wearing multifocal glasses

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 No worry of optical aids in any disaster scenarios

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Laser Refractive Surgery

 In general – – – – –

Highly predictable Highly reproducible High safety margin Various options to suit different need Side effects or complications are minimal with well trained surgeon – Exciting technology (Relax Smile) is NOW available!

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Conclusion

 LASIK is not a cosmetic procedure – It improves the function of the eye – It can be life changing

 Continuous improvements in laser technology and surgical techniques have made LASIK safer and more effective year after year  There are now new and better treatment options for many of the non-permanent side effects KPJ 24-8-14

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Thank you KPJ 24-8-14