Laser refractive eye surgery
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2345 (Published 20 April 2011) Cite this as: BMJ 2011;342:d2345
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Cataract constitutes the first cause of reversible blindness in the world, comes from one of the most frequent surgeries of the previous segment and in turn it has been one of the more controverial themes in ophthalmology in the last 50 years (1).
We decided to study the frequency and diffusion of cataract. Most cases are related to the normal process of aging and the increment of life expectancy. Currently, more than 25 % of the Cuban population is older than 60 years (2). This pathology tends to increase in the next years, treatment is surgical, and it is very successful for resetting vision (3).
RESULTS
Four hundred seventy patients were studied in Sancti Spíritus, 56,7 % of them male and 43,2 % female.
Of the studied patients we gathered their preoperative sharp sight, and we found out that 41,06 % had their vision between 0,1 and 0,3; 37,65 % can only see their fingers, 19,57 % had diffuse vision and 1,70 %, luminous perception.
Three months after the operation, 64,89 % had vision of more than 0,7, 25,53 % between 0,4 and 0,7 of vision and 8,29 % between 0,1 and 0,3, which confirms the magnificent visual results in our patients.
REFERENCE
1. Aroca P, Espeso Santos O, Martínez Salcedo I, del Castillo Dejardin D. Protocolo y resultados de la cirugía mayor ambulatoria de catarata en el Hospital Universitario de San Juan Revs. Arch Soc Esp Oftalmol 2004;73:323-6.
2. Programa de Conferencias 5to CONGRESO INTERNACIONAL DE OFTALMOLOGIA . Palacio de Convenciones de La Habana. 2005.
3, Efectos de la CECC con LIO (INTERNET).Centro de Ciencias de la Salud de la Universidad de Texas.2002.Agosto.
Competing interests: No competing interests
Sir,
An additional useful piece of advice for patients considering or
undergoing refractive surgery is to keep a record of their pre- and post-
operative refractions for the future when they, like everyone else, may
need cataract surgery. Ironically, whilst most patients can expect fairly
good unaided vision following cataract surgery, this particular group, who
have often invested a great deal in dispensing with spectacles, are more
likely to need them after cataract surgery.
The instruments used to
predict the power of lens implant required to give good unaided vision
post-cataract surgery, can give erroneous results in this group, due to
the altered corneal curvature affecting the validity of estimates of
corneal power, refractive index, and effective lens position. Whilst
increasing numbers of formulae and adjustments are available to attempt to
correct for this (1), having the patient's pre- and post-refractive
surgery prescription is invaluable, at present, to minimise the likelihood
of a post-cataract refractive surprise.
1. Curr Opin Ophthalmol. 2010 Jan;21(1):35-8.
Cataract surgery after refractive surgery.
Naseri A, McLeod SD.
Competing interests: No competing interests
Sir - We enjoyed the informative review on laser refractive eye
surgery and wish to raise awareness of a potential hazard with concurrent
isotretinoin (1).
Isotretinoin (13-cis-retinoic acid) has revolutionised the treatment
of refractory acne since the 1980s. Acne affects 85-90% of the population
at some time and the age of patients affected by acne approximately
overlaps that of patients undergoing LASIK (2,3). Dry eye is a side effect
of both LASIK and isotretinoin (4-6) and can result in serious sequelae
such as corneal ulceration, infection and loss of vision. Thus, LASIK is
contraindicated in patients taking isotretinoin (2,7), but this fact is
not well recognised, especially amongst British Dermatologists who
prescribe Isotretinoin. Previous surveys have highlighted the need to
routinely screen for isotretinoin use before approving LASIK and have
concluded that patients should wait 6 months after a course of
isotretinoin before having refractive eye surgery (8).
We recently surveyed the British Association of Dermatologists.
Although most physicians routinely counselled their patients about the
ophthalmic risks of isotretinoin, 65% did not know whether any of their
patients had undergone LASIK whilst on isotretinoin, only 30% enquired
about recent or forthcoming surgery and 89% were unaware that isotretinoin
may cause ocular problems if a patient had undergone LASIK in the
preceding 6 months.
Patients should avoid isotretinoin 6 months before or after LASIK
treatment. Similarly LASIK practitioners should check that isotretinoin
has not been taken for 6 months before laser refractive eye surgery.
References
1. Bastawrous A, Silvester A, Batterbury M. Laser Refractive Eye
Surgery. BMJ 2011; 342:d2345
2. James W D. Acne. N Engl J Med 2005; 352: 1463 - 72.
3. Ronge L J. LASIK shatters assumptions. Cornea 1994; 13: 379 - 82.
4. Cumurcu T, Sezer E, Kilic R, Bulut Y. Comparison of dose-related
ocular side effects during isotretinoin administration. Eur J Ophthalmol
2009; 19: 196 - 200.
5. Santodomingo-Rubido J, Barrado-Navascues E, Rubido-Crespo M J.
Drug-induced ocular side effects with isotretinoin. Ophthalmic Physiol Opt
2008; 28: 497 - 501.
6. Fraunfelder F W. Ocular side-effects associated with isotretinoin.
Drugs Today (Barc) 2004; 40: 23 - 7
7. Wilson S E. Use of lasers for vision correction of nearsightedness
and farsightedness. N Engl J Med 2004; 351: 470 - 5.
8. Miles S, McGlathery W, Abernathie B. The importance of screening
for laser-assisted in situ kertomileusis operation (LASIK) before
prescribing isotretinoin. J Am Acad Dermatol 2006; 54: 180 - 1.
Competing interests: No competing interests
Sir
Your Clinical Review article: Laser Refractive Eye Surgery
Bastawrous and the other authors of this article raises important issues:-
Radial Keratotomy was subject to ongoing independent assessment at
nine university hospitals in the USA. These found that RK was safe and
effective in treating myopia (short-sight) but that there was frequently
an ongoing effect, many patients becoming hyperopic (long-sighted).
RK surgeons learnt to do mini-RK and be conservative.
Laser Refractive Surgery has two significant complications -
weakening of the cornea that can lead to keratoconus, and impairment of
contrast sensitivity that can affect safe night driving vision.
The US Food and Drug administration (FDA) had public hearings in
April 2008 into Laser Refractive eye surgery. Complications were
reported varying from 1 to 2% to 20 to 30%.
Surely it is time that a fully independent study of Laser Refractive
Surgery be conducted as was done for Radial Keratotomy. Currently, the
FDA states that `Laser Eye Surgery is for risk takers`.
William Jory FRCS(C) FRCOphth
Consultant Ophthalmologist
references:
1) G. Waring et al. Prospective evaluation of Radial Keratotomy (PERK). Ophthalmology, 1985; 92:177-196
2) FDA Public hearings. April 2008
Competing interests: No competing interests
Re: Laser refractive eye surgery
Title: Patient reported outcomes (PROs) in refractive surgery
Authors: Colm McAlinden PhD,[1] Eirini Skiadaresi MD,[2] Jyoti Khadka PhD,[1] Konrad Pesudovs PhD.[1]
[1] Flinders Medical Centre and Flinders University, Bedford Park, South Australia, 5042, Australia.
[2] Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, SA2 8QA, United Kingdom.
Sir,
Bastawrous and colleagues reviewed the current status of laser refractive surgery to help generalists in answering patients’ queries.[1] While they touched on patient satisfaction, they ignored the broader evidence base in patient reported outcomes. The field of refractive surgery has seen the development of several high quality questionnaires using modern psychometric methods such as Rasch analysis; an item response theory model.[2] These questionnaires measure patient outcomes in terms of specific latent traits such as quality of life (QoL)[3] and quality of vision (QoV).[4]
Laser refractive surgery, in particular, laser in situ keratomileusis (LASIK) has been found to provide better QoL than patients wearing spectacles or contact lenses.[5] Although patients who decide to have refractive surgery feel more negative quality of life impacts from their glasses or contact lenses than those people who choose not to have refractive surgery.[6]
Early refractive surgery techniques did cause significant visual symptoms such as glare and haloes. However, current excimer lasers with technological advances such as improved eye trackers and aberration controlled algorithms have been found to induce transient visual symptoms which subside and improve beyond pre-operative levels.[7]
Correspondence:
Dr Colm McAlinden BSc (Hons) MSc PhD
colm.mcalinden@gmail.com
References:
[1] Bastawrous A, Silvester A, Batterbury M. Laser refractive eye surgery. BMJ 2011;342:d2345.
[2] Rasch G. Probabilistic models for some intelligence and attainment tests. Copenhagen: Danish Institute for Educational Research, 1960.
[3] Pesudovs K, Garamendi E, Elliott DB. The Quality of Life Impact of Refractive Correction (QIRC) Questionnaire: development and validation. Optom Vis Sci 2004;81(10):769-77.
[4] McAlinden C, Pesudovs K, Moore JE. The development of an instrument to measure quality of vision: the Quality of Vision (QoV) questionnaire. Invest Ophthalmol Vis Sci 2010;51(11):5537-45.
[5] Garamendi E, Pesudovs K, Elliott DB. Changes in quality of life after laser in situ keratomileusis for myopia. J Cataract Refract Surg 2005;31(8):1537-43.
[6] Pesudovs K, Garamendi E, Elliott DB. A quality of life comparison of people wearing spectacles or contact lenses or having undergone refractive surgery. J Refract Surg 2006;22(1):19-27.
[7] McAlinden C, Skiadaresi E, Pesudovs K, Moore JE. Quality of vision after myopic and hyperopic laser-assisted subepithelial keratectomy. J Cataract Refract Surg 2011;37(6):1097-100.
Competing interests: No competing interests