We noticed you’re blocking ads

Thanks for visiting CRSToday. Our advertisers are important supporters of this site, and content cannot be accessed if ad-blocking software is activated.

In order to avoid adverse performance issues with this site, please white list https://crstoday.com in your ad blocker then refresh this page.

Need help? Click here for instructions.

Up Front | Oct 2001

Custom Ablation’s First Job

Let's not leave behind the complicated cases.

Like all of us, I am eagerly awaiting the new “paradigm” in refractive surgery—customized ablation. I've been lucky enough to have this technology to study here in Houston with the Bausch & Lomb (Claremont, CA) Zyoptix™ system. We've completed our initial treatment group, which randomized one eye of each patient to Zyoptix™ and the other eye to PlanoScan 2000™, the approved Bausch & Lomb algorithm. The examiners as well as the patients were both masked in a powerful, prospective study design, and I have been impressed with the results. The Zyoptix™ patients see better, and with an improved quality of vision than our “a-few-sizes-fit-all” previous approach. Other laser systems from various manufacturers have also posted impressive early data. Customized ablation may be exactly what the ailing LASIK market needs—the ability to offer better vision than what the patient achieves with glasses or soft contacts. That's something we have not been able to do in the past. This shortcoming has been a major limiting factor of LASIK. We're left selling “almost as good as,” not an improvement.

FOCUS ON THE BAD CASES
No doubt custom ablation promises to be a good thing, but are we forgetting something in all this? Although there is a huge effort in our industry to be the first to offer 20/15 to all of us 20/20 uncorrected yuppies, what about the problem patients? Here, I mean the complicated eyes that we have left behind on the refractive surgery highway—those people who have lost best-corrected vision from any refractive surgery LASIK, PRK, RK, ALK—the whole alphabet. Comparatively little work is being carried out on this front, and that's a mistake. We need to focus on those bad cases—it should be as high a priority as anything else. Sometimes in refractive surgery we get a little removed from traditional medicine, the old “fighting blindness,” but here is a population with a loss of sight that we are responsible for, in some way. We all took oaths to “do no harm,” and yet in some cases we have. Let's not forget those patients with naturally occurring problems such as scars, dystrophies, or other corneal surgeries.

ANY IMPROVEMENT IS WELCOME
Custom ablation for complicated eyes is a natural place to start. These patients have no other practical option unless they can wear a hard contact lens. Surgically, they are facing a lamellar graft or even a penetrating keratoplasty. Many of these people are disabled in their work as well as personal lives, and would welcome any improvement. Custom ablation for these patients is even somewhat “fail-safe”—if it makes them worse or if there is no improvement, then the surgeon can proceed with a graft. Surgical eyes are even a “bigger target” for custom ablation, with corneal first surface aberrations usually a large order of magnitude, ten times greater, than naturally occurring aberrations. They are predominantly an “even” order or spherical/defocus in nature, easier to treat. I would think the FDA would be more receptive to such treatments of patients in need, just as PTK was studied and approved long before PRK. We would be learning all along.

ONE LAST THOUGHT
Much of what is being developed is useful to both groups, but we need to vigorously pursue the regulatory pathways, start IDEs, begin studies, and share data on the treatment of complicated eyes. It would benefit us all, morally, professionally, and economically. It's not the number of successful cases you perform, but the number of bad cases you avoid or are able to fix, that determines your success. We've all seen the USA Today front page or the CBS News Report. Our industry is not hurting from the millions of positive results, but the few unfavorable results. If you could buy a laser that is approved to fix all your patients who have reduced corneal best-corrected vision, or a laser that is approved to fix 20/20 eyes to 20/15, which would you buy? I've asked that question to every group I've spoken to lately and the ophthalmologist's choice is overwhelming: the one that fixes problems. Throw in the obvious fact that a laser that could fix problem eyes could also fix 20/20 eyes, and you've got a no-brainer—a laser for complicated eyes. That's the laser I'll buy next.

Stephen G. Slade, MD, FACS, is the National Medical Director for TLC Laser Eye Centers, in Houston, Texas. He is a consultant for Bausch & Lomb. Dr. Slade may be reached at (713) 626-5544; sgs@visiontexas.com
Advertisement - Issue Continues Below
Publication Ad Publication Ad
End of Advertisement - Issue Continues Below

NEXT IN THIS ISSUE