The Dry Eye Zone

Rebecca's Blog

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Study: State of the refractive surgery nation

This abstract caught my eye - I confess, mostly because I liked this phrase:

“[LASIK, LASIK, PRK] have now been established as fairly safe procedures…”

I’m not sure I have ever seen someone in the peer-reviewed medical literature describe laser refractive surgeries in such lukewarm language and it makes me curious as to the motivation. Presumably the best clue is in the author’s praise of SMILE as providing “greater tectonic strength’ (i.e. not slicing so deep into the cornea) and “less dry eye”. I’m not writing this as a SMILE fan by any means, and I daresay those harmed by SMILE would have some choice words for this characterization, but I like seeing in print even this relatively low-key evidence of a the long term trend away from LASIK. They’re finally starting to put it into words.

Refractive surgery. Kim et al, Lancet 2019 May 18

Refractive surgery has evolved beyond laser refractive techniques over the past decade. Laser refractive surgery procedures (such as laser in-situ keratomileusis), surface ablation techniques (such as laser epithelial keratomileusis), and photorefractive keratectomy have now been established as fairly safe procedures that produce excellent visual outcomes for patients with low-to-moderate amounts of ametropia. Additionally, a broader selection of options are now available to treat a wider range of refractive errors. Small incision lenticule extraction uses a femtosecond laser to shape a refractive lenticule, which is removed through a small wound. The potential advantages of this procedure include greater tectonic strength and less dry eye. In the future, intracorneal implants could be used to treat hyperopia or presbyopia. Phakic intraocular implants and refractive lens exchange might be useful options in carefully selected patients for correcting high degrees of ametropia. Thus, physicians are now able to provide patients with the appropriate refractive corrective option based on the individual's risk-benefit profile.