What’s NEW

Ellis Eye & Laser Medical Center would like to provide our readers and patients with some up to date articles on what’s going on inside ophthalmology, LASIK eye surgery and other vision correction options. Before you consider any type of eye surgery procedure please feel free to review our articles to see if these topics relate to your personal visual situation.

BNET Research Service - August, 2007
by Rebekah Blowers, Brien Aho

Navy offers newest technology: laser eye surgery keeps Sailors mission ready

For Sailors and Marines who wear glasses or contacts, the thought of waking up in the middle of the night and fumbling around on the night stand or in their rack for their glasses to see the alarm clock is a nuisance. So is not being able to qualify on mission-essential weapons without squinting through the sites. Most people would like to be able to be rid of their impaired vision.

Sailors and Marines may now have that opportunity thanks to the Navy offering the newest technology in laser eye surgery through a new piece of equipment called IntraLase.

The new procedure offers the Navy many benefits--the most important being that Navy personnel can now be fully operational faster. According to Capt. Joseph Pasternak, a surgeon at National Naval Medical Center (NNMC), Bethesda, Md., Photo-Refractive Keratectomy (PRK) takes up to three months to heal. With IntraLase, only takes a few days.

"Instead of three months out of work, it could mean two weeks. Our goal is to try to make our warfighters operational that much quicker," said Pasternak.

Refractive surgery reduces dependence on glasses and contact lenses. Light must be focused precisely on the retina of the eye for an image to be seen clearly. The light is focused by the eye through a process called refraction or bending of light. When someone is "nearsighted," the light is focused in front of the retina and the person can see objects close up but not far away.

ASCRS - Release: October 16, 2003
By: John Ciccone,

QUALITY OF LIFE IMPROVED THROUGH LASER EYE SURGERY:
First Quality of Life Survey Among Laser Eye Surgery Patients Demonstrates High Satisfaction, Improved Daily Routine and Overall Quality of Life.

Fairfax, VA– The vast majority of Americans who had their vision corrected by laser surgery are highly satisfied with the results and said that the overall quality of their lives and daily routines has improved, according to the results of a Harris Interactive survey released by The Eye Surgery Education Council (ESEC), the public education arm of the American Society of Cataract and Refractive Surgery (ASCRS).

The survey is the first nationwide quality of life survey assessing life implications for laser eye surgery patients. The survey asked patients to evaluate the impact of their eye surgery on the quality of their family life, careers, and sports. These survey findings, along with the ESEC’s newly updated LASIK screening guidelines, can help interested patients make educated choices by weighing the benefits and risks of laser eye surgery.

Of the approximately 3 million Americans who underwent laser eye surgery since 1995, more than 85 percent said the surgery improved their overall quality of life and 93 percent of patients said they were satisfied with the results. Among the benefits of the procedure, respondents cited improvement in several specific aspects of vision, daily living and everyday activities, including:

• Ability to see upon waking (seeing an alarm clock) (89%)
• Freedom from glasses and contacts (83%)
• Improvement in personal safety (69%)
• Increased confidence in personal appearance (65%)
• Better participation in sports or fitness activities (54%)

Specific to the surgery, 87 percent felt that the results met or exceeded their expectations and 73 percent of patients regretted that they did not have the surgery sooner. In addition to the high satisfaction rate, nearly half (47 percent) of the respondents said they began “a whole new life” after laser eye surgery.

An important aspect of the survey also focused on consumer education. Understanding risks and benefits of laser eye surgery prior to undergoing treatment is critical for patient satisfaction and an important factor in determining if a patient is an appropriate candidate. The survey findings showed that 86 percent felt they were well informed about the risks of laser eye surgery before treatment and more than half (54 percent) of respondents reported that they considered laser eye surgery for a year or more before they actually had the procedure. Significantly, those patients who reported that their expectations were not met or that they were not satisfied were also among those people who were less informed about the surgery itself or risks and benefits of the surgery.

“This kind of research is very helpful to physicians as we counsel future patients and understand the quality of life benefits for LASIK patients,” said Dr. Roger Steinert, chair of the Eye Surgery Education Council Medical Advisory Board and associate professor of ophthalmology at Harvard Medical School. “The majority of the patients reported they were well informed about the procedure, which supports the importance of patient education and discussion of realistic expectations prior to having the surgery.”

Custom Technology Redefines LASIK
Today a new procedure, Custom LASIK, is improving patient's quality of vision at greater levels than was possible before. With recently Food and Drug Administration approved wavefront technology, physicians are now able to personalize the LASIK procedure to the unique characteristics of each patient’s eye, making the procedure more precise and, for some patients, providing better crispness and clarity of vision than contacts and glasses have in the past.

“Custom LASIK, which uses wavefront technology to individualize the LASIK treatment for the characteristics of each eye, makes the quality of life contributions of LASIK even more meaningful,” said Dr. Douglas Koch, the Allen, Mosbacher, and Law Chair Professor of Ophthalmology at the Baylor College of Medicine, and Eye Surgery Education Council Member. “Custom LASIK advances and redefines the LASIK technology and can result in even higher quality of vision than conventional LASIK, which has proved to be a reliable and effective way for many people to improve their vision and their lives,” he added.

Survey Methodology
The survey comprised the first nationwide sample on quality of life among laser eye surgery patients. In addition to multiple-choice questions, several open-ended questions were included to capture in-depth responses. Harris Interactive conducted the online survey among 254 laser eye surgery patients who had LASIK (Laser In-Situ Keratomileusis), LASEK (Laser Sub-Epithelial Keratomileusis), or PRK (Photorefractive Keratectomy) to correct myopia (nearsightedness), hyperopia (farsightedness) and/or astigmatism (blurriness). The survey was conducted February 26 to March 10, 2003. The survey’s margin of error is 6.1 percent.

PUTTING BREAKING MEDICAL NEWS INTO PRACTICE™
Medical News in Meeting Coverage, AAO

AAO: Topical Cyclosporine Speeds Recovery After LASIK Surgery
By Charles Bankhead, Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
November 15, 2007

NEW ORLEANS, Nov. 15 -- Topical cyclosporine significantly accelerates corneal nerve regeneration after LASIK surgery when added to standard postoperative therapy, results of a small study reported here suggest.

Action Points

• Explain to interested patients that topical cyclosporine appears to improve recovery of corneal sensitivity after LASIK surgery when added to routine care.
• Note that the findings were reported at a medical conference and as a published abstract and should be considered preliminary until they appear in a peer-reviewed journal.

Three months after surgery, corneal sensitivity was significantly better (P<0.01) on five predetermined corneal areas when treated with cyclosporine plus standard therapy versus standard therapy alone, Sunil Shah, M.D., of the Birmingham and Midland Eye Institute in Birmingham, England, told attendees at the American Academy of Ophthalmology meeting.

"This is just a small study, but I have to wonder whether, when we come back next year, people will be doing this routinely," said Dr. Shah.

Following LASIK surgery, nerves that are severed during the procedure recover gradually. The time required for regeneration can vary, particularly in patients who are already compromised for other reasons, said Dr. Shah.

To determine whether topical cyclosporine 0.05% could accelerate recovery of corneal sensitivity, investigators treated 19 patients who underwent LASIK surgery. In each patient, one eye received routine care and the other eye was treated with routine care plus cyclosporine.

Using a Cochet-Bonnet esthesiometer, Dr. Shah assessed corneal sensitivity on four untreated areas of the cornea, four peripheral areas on the corneal flap, and one area in the center of the flap.

One month after LASIK surgery none of the nine areas differed between eyes treated with routine care and those treated with cyclosporine. At 90 days none of the areas on the untreated portion of the cornea differed in sensitivity, whether treated with routine care alone or with cyclosporine.

However, four of the five areas on the corneal flap demonstrated about 85% recovery of sensitivity with cyclosporine compared with less than 70% for routine care at 90 days. An area close to the flap hinge was the only one that was not significantly better with cyclosporine, and that area demonstrated a trend toward improved sensitivity with cyclosporine (P=0.06).

"There was no danger from using cyclosporine in these patients," said Dr. Shah. "This might be something we should consider using once we have more data."

Dr. Shah disclosed financial relationships with Bausch & Lomb, Lenstec, OptiVue, Reichert Inc., and Pfizer.
Complete AAO Coverage

Food & Drug Administration Website
FOR IMMEDIATE RELEASE
Kris Mejia, July 12, 2007

FDA Approves CustomVue Monovision LASIK

The U.S. Food and Drug Administration approved for marketing the first LASIK device designed for treating one eye to see far away objects and the other eye for close-up vision.

"The approval of the CustomVue Monovision LASIK expands permanent vision correction options for nearsighted adults who also have trouble focusing on objects close-up," said Daniel Schultz, M.D., director of FDA's Center for Devices and Radiological Health. "Unlike traditional LASIK, Monovision LASIK may reduce the need for reading glasses in some people over 40."

LASIK, or laser in-situ keratomileusis, is a procedure in which the surgeon cuts a flap in the outer layers of the cornea, removes a small amount of the tissue beneath it with the laser, and then replaces the flap. CustomVue Monovision LASIK produces monovision correction in nearsighted (myopic) adults, with or without astigmatism, ages 40 years or older with normal age-related loss of ability to focus on near objects (presbyopia).

The CustomVue device is designed to correct all nearsightedness in the patient's dominant eye and only part of the nearsightedness in the non-dominant eye. This allows the patient to use the fully corrected eye for distance vision and the under-corrected eye for seeing close up. After a period of time, the brain adjusts to the difference in perception between the two eyes.

People considering CustomVue monovision LASIK should first wear monovision contact lenses for at least a week to determine if they can tolerate having one eye under-corrected. Following monovision surgery, the two eyes may not work together as well as they did before in some patients, especially in dim light or when performing tasks requiring very sharp vision or fine depth perception. Patients may need to wear glasses or contact lenses for some activities such as night driving or reading small type.

CustomVue Monovision LASIK is a permanent operation to the cornea. Side effects may include glare from bright lights, rings around lights (halos), light sensitivity, night driving glare, ghost images, double vision and visual fluctuation.

CustomVue Monovision LASIK is manufactured by AMO/VISX Inc., based in Santa Clara, Calif. The new approval is for the monovision correction, which uses the previously approved wavefront-guided treatments-an eye-mapping system that guides the laser-for myopia and astigmatism. FDA based its approval on the review of a clinical study of safety and effectiveness outcomes submitted by the company.

At FDA's request, AMO/VISX will conduct a post-approval study following 500 patients for six months after surgery to characterize quality of vision and quality of life issues associated with permanent LASIK monovision correction. The objective of the study is to estimate the proportion of monovision LASIK patients who experience visual disturbances that are severe enough to limit activities or adversely affect a patient's quality of life.