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    Why I changed what I tell patients about refractive surgery

    Consultation discussion should evolve just like laser technology has evolved

     

    In the contact lens-only group, 54 percent of contact lens wearers responded after three years they “strongly agree” with the statement, “I would recommend my current method of vision correction to a close friend or relative.” This compares to the two LASIK groups in which 88 percent of those who previously wore contact lenses and 77 percent of those who previously wore glasses responded they would “strongly” recommend LASIK.

    About 1 percent of respondents in each group at each time period responded they “strongly disagree” with the statement, “I would recommend my current method of vision correction to a close friend or relative.”

    Researchers also surveyed subjects about night driving, starbursts, dry eye, and eye infections. In the contact lenses-only group, the percentage of patients who respond they had no difficulty driving at night remained virtually the same over three years. Some 36 percent of respondents had no night driving difficulty at baseline, and 37 percent had none at three years.

    Related: Measuring LASIK patient satisfaction

    For the contact lens to LASIK group, 60 percent had no problems driving at night at baseline; at the three-year mark more than 60 percent had no night driving problems. Glasses wearers who did not suffer from night driving problems improved from 44 percent to 57 percent. As compared to contact lens wearers, LASIK patients reported better vision while driving at night.

    Dryness happens

    Dry eyes are the most common side effect of LASIK, but opinions of patients who have had LASIK vary about the dryness of their eyes three years after surgery.5 The control group remained the same from baseline to the three-year reporting period with 29 percent indicating they do not feel dry at all. In the contact lens group, there was improvement from 44 percent not feeling dry eye at baseline to 50 percent at three years. The glasses group went from 51 percent to 42 percent at three years and significantly fewer patients reported dryness than the group who remained in contact lenses.

    For both the contact lens-only group and the contact lens to LASIK group, 1 percent reported feeling dry “all the time” at all reporting periods. For the cohort of patients, patients who felt the driest in their contact lenses did not have surgery. After surgery, the LASIK patients felt better than the contact lens patients.

    When asked about experiencing eye infections in the past year, 8 percent of contact lens-only patients and 3 percent of both LASIK groups said yes. A similar trend was shown for questions about ulcer and abrasion. The risk of an eye infection is low but appears less likely with LASIK over time.

    Ask the right questions

    Laser vision correction is not for everyone, and eye surgery may be scary for many patients. It is worth your time and a benefit to your patient to ask, “What are you fearful of with surgery?” I ask this question often, and the most common answer is, “I do not know, it is just scary.”

    New technology has reduced the risks and complications of laser vision correction. Understanding a patient’s subjective symptoms of glare, halos, night driving, and dryness before surgery go a long way in determining what symptoms will be after surgery. Ask your patients the right questions when they inquire about surgery—it will help to deliver “20/happy” patients.

     

    References

    1. Kamiya K, Igarashi A, Hayashi K, Negishi K, Sato M, Bissen-Miyajima H; Survey Working Group of the Japanese Society of Cataract and Refractive Surgery. A Multicenter Retrospective Survey of Refractive Surgery in 78,248 Eyes. J Refract Surg. 2017 Sep 1;33(9):598-602.

    2. WaveLight. Allegretto Wave Eye-Q. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf2/P020050S012d.pdf. Accessed 1/12/18.

    3. U.S. Food & Drug Administration. Summary of Safety and Effectiveness Data (SSED). Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf/P930016S044b.pdf. Accessed 1/12/18.

    4. Department of Health and Human Services. Memorandum. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf/p930016.pdf. Accessed 1/12/18.

    5. Schallhorn SC, Venter, JA. One-month Outcomes of Wavefront-guided LASIK for Low to Moderate Myopia With the VISX STAR S4 Laser in 32,569 Eyes. J Refract Surg. 2009 Jul;25(7 Suppl):S634-41.

    6. Haft P, Yoo SH, Kymionis GD, Ide T, O'Brien TP, Culbertson WW. Complications of LASIK flaps made by the IntraLase 15- and 30-kHz femtosecond lasers. J Refract Surg. 2009 Nov;25(11):979-84.

    7. Moshirfar M, Shah TJ, Skanchy DF, Linn SH, Durrie DS. Meta-analysis of the FDA Reports on Patient-Reported Outcomes Using the Three Latest Platforms for LASIK. J Refract Surg. 2017 Jun 1;33(6):362-368.

    8. Cope JR, Collier SA, Rao MM, Chalmers R, Mitchell GL, Richdale K, Wagner H, Kinoshita BT, Lam DY, Sorbara L, Zimmerman A, Yoder JS, Beach MJ. Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections — United States, 2014.  MMWR Morb Mortal Wkly Rep. 2015;64(32): 865–870.

    9. USA Today. What are the major benefits of laser eye surgery? Available at: http://classifieds.usatoday.com/blog/services/major-benefits-laser-eye-surgery/. Accessed 1/23/18.

    10. Price MO, Price DA, Bucci FA Jr, Durrie DS, Bond WI, Price FW Jr. Three-Year Longitudinal Survey Comparing Visual Satisfaction with LASIK and Contact Lenses. Ophthalmology. 2016 Aug;123(8):1659-1666.

    Read more from Dr. Owen here

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