LASIK MYTH #30 –Since LASIK is an Old Technology, it’s Better to Wait for Something Better to Come Along

FACT: LASIK Has Been a Reputable Procedure for Twenty Years, and is Continuing to Evolve

 

The United States patent for LASIK was granted on June 20, 1989 to Gholam Peyman, MD, and the first LASIK procedure performed by Ioannis Pallikaris MD a year later.  This built upon work by José Barraquer, MD, in 1948 with the design of the first microkeratome, the device used exclusively to create LASIK flaps until femtosecond laser was introduced as a predictably safe flap creation approach in 2001.  It also built upon the same laser reshaping technologies refined from 1983 until 1988, when the first PRK treatment was performed by Marguerite McDonald, MD.

It’s true that LASIK has evolved significantly since 1990 with that first treatment.  Several major leaps are a part of this evolution. The transition to femtosecond laser since 2001 has essentially eliminated during-surgery flap-related complications.  Custom and optimized treatment patterns were introduced in 2002, and this greatly reduced night-time vision concerns and the potential interaction between treatment and pupil size for most prescriptions.  In 2009 and beyond, significant improvements in diagnostic ability (through devices like the Pentacam and epithelial thickness mapping) to detect keratoconus in its earliest stages have let surgeons steer patients away from LASIK and toward other procedures if they would be at risk for long-term complications. [1] 

These improvements aren’t perfect, but the continued evolution of the procedure at this point is iterative, working toward a higher percentage of super-human (better than 20/20) vision, further elimination of edge cases, and improvement in results to exceed pre-surgery vision quality. [2] [3] The baseline expectation for the next generation of technologies, such as new treatment profiles, is similar safety to the previous generation, simply because we’ve reached the point of substantial maturity for LASIK and related procedures.   When considering a large number of people in a study, future approaches will certainly provide even better results… but for any one individual, most likely tomorrow’s results will be very similar to today’s. There’s never been a better time to pursue vision correction.

Enhanced Screening Techniques for LASIK

Biomechanics and enhanced corneal shape information provided important insights

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A Modern Day LASIK Comparison

Although both are safe and effective, for visual outcomes, HOAs may be better treated with topography-guided LASIK

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Patient-Reported Outcomes on 3 LASIK Platforms

FDA data shows that modern lasers have significantly improved patient-reported visual outcomes after LASIK

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Title: Enhanced Screening Techniques for LASIK Evaluations

Article: “Evaluation of corneal shape and biomechanics before LASIK

Authors: Ambrósio R Jr, Nogueira LP, Caldas DL, Fontes BM, Luz A, Cazal JO, et al.

Précis: The Belin-Ambrósio Enhanced Ectasia Display provides information on deviation from normal based on the front and back contours of the cornea, the thinnest point of the cornea, and the change in corneal thickness across its curve, and the relationship of the thinning point of the cornea to its center.  This information has better ability to detect abnormal corneas than previous methods based on the topography (front shape) and thickness alone

Abstract: https://www.pentacam.com/fileadmin/user_upload/pentacam.de/downloads/publikationen/artikel/2011-IIO_200328_2.pdf

Keywords: LASIK, Biomechanics, Ectasia

Title: Topography-guided LASIK or Wavefront-Optimized LASIK 

Article: “Topography-guided versus wavefront-optimized laser in situ keratomileusis for myopia: Surgical outcomes

Authors: Jaeryung Kim, MD, PhD, Sung-Ho Choi, MD, Dung Hui Lim, MD, Chan Min Yang, MD, Gil-Joong Yoon, MD, PhD, Tae-Young Chung, MD, PhD

Précis: Topography-guided ablation, which is one of the most recent innovations available in the United States, provides similar or better visual outcomes compared to wavefront optimized treatments with lower high order aberrations.

Abstract: https://www.jcrsjournal.org/article/S0886-3350(19)30065-3/abstract

Keywords: LASIK, Topography-guided, Wavefront-Optimized

Title: Patient-Reported Outcomes for Three LASIK Platforms

Article: “Meta-analysis of the FDA Reports on Patient-Reported Outcomes Using the Three Latest Platforms for LASIK.

Authors: Moshirfar M, Shah TJ, Skanchy DF, Linn SH, Durrie DS.

Précis: Reports on the three most recently approved FDA laser systems were analyzed.  In addition to excellent safety and improvement in visual acuity, there was a 29% decrease in difficulty driving at night after LASIK compared to prior to LASIK, demonstrating that these modern platforms can provide better vision quality in challenging situations than the glasses or contact lenses which are eliminated through the surgery.

Abstract: https://www.ncbi.nlm.nih.gov/pubmed/28586495https://www.ncbi.nlm.nih.gov/pubmed/28586495

Full reference: 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.

Keywords: LASIK, Outcomes, Safety, Patient-Reported Outcomes