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Surface Epi-Laser: Closing In On The
Perfect Procedure
At the Shealy Eye Laser Center, pain has
been reduced to that of LASIK and Dr. Shealy prefers it because of better
outcomes and less LASIK complications.
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If their
enthusiasm is
any indication, this
could signal the beginning
of a major shift in the
marketplace! |
We have performed nearly 20,000 LASIK procedures with
excellent results. Since 2006, in nearly 550 patients we've performed
Surface Epi-Laser and no longer have the drawback of greater patient pain,
but only slightly longer healing times. Surface
Epi-Laser (in which an
epithelial flap is mechanically pushed back using a blunt, plastic
oscillating separator, followed by laser ablation at the surface) is
eliminating the drawbacks of LASIK. This improvement has made believers
out of many surgeons and their patients. If our experience is any
indication, this means that the days of LASIK surgery are numbered in the
marketplace.
Back to the top.
Dr. Shealy's Move to Surface Epi-Laser
Most of the surgeons we spoke to began using Epi-Laser
because some patients were poor candidates for LASIK; eventually, they ended
up favoring it. Rick Milne, MD, who is in private practice at the Eye Center
in Columbia, South Carolina, is a case in point. Dr. Milne has now performed
close to 1,000 Epi-Laser procedures; his practice was one of the 10
international investigational sites for the prerelease of Moria's Epi-K
system. "Ninety-nine percent of the laser vision
correction I do today is Epi-Laser - specifically, a version that most people
are calling 'advanced surface treatment,' or AST, in which you completely
remove the flap," he says. "Initially, I reserved Epi-Laser for patients who
weren't good LASIK candidates, but they did so well that I kept finding more
and more excuses to ablate the surface instead of performing LASIK.
Eventually I asked, why am I still doing LASIK at all?"
Dr. Shealy, who agrees with Dr. Milne, has now performed
550 consecutive Surface Epi-Laser
procedures since early 2006. This represents 100% of his laser vision correction today except
for occasional surface procedures performed on previous LASIK patients for
residual prescriptions. He has found that
- It eliminates flap complications.
About 90% of his complications in the past have been associated with
LASIK flap making, slipping of the flap, or epithelial ingrowth. Surface
Epi-Laser has avoided all this and it has proved to be safer in patients
who receive scratches or trauma to their eye.
- More patients can be treated.
Surface Epi-Laser treat many patient with thin corneas and larger
prescriptions that have been excluded with LASIK treatment.
- Surface Epi-Laser doesn't weaken the
cornea. Because the cornea is not mechanically weakened,
glaucoma measurements can be obtained more accurately when testing for
the intraocular pressure.
- Healing is better than with PRK.
The healing is a lot faster and pain is almost non-existent with
the medications we use. It is better than taking off the epithelium with
a machine than with a brush or alcohol. The toxic effect of alcohol has
been eliminated.
- Surface Epi-Laser reduces the need for
enhancements. Our enhancement rate has dropped from 5 to 8
percent to less than 0.25% using the Allegretto Wave Laser on the
surface.
- It is easier on the surgeon.
Surgery is more enjoyable when you don't have to think about the risks.
Back to the top.
Patients Benefit, Too
Our surgeons also mentioned several advantages from
the patient's point of view:
- Patients see it as safer. Dr.
Shealy also states that his patients have become more conservative in recent
years. "Many of them have decided that they don't want LASIK," he
says. "When their friends are having procedures that they understand
are safe--there's no flap, nothing's being cut--they come in very
eager for the procedure. It removes the fear factor. The only thing
we needed to do was reduce the postoperative pain." In fact, Dr.
Milne notes that his patient referrals have increased. He says this
surprised him, but it seems to be a reflection of how satisfied his
patients are.
- Patients get better visual
outcomes. Dr. Shealy has determined that his rate of gaining
vision is 2.5 times global data results for flap LASIK.
- Epi-Laser doesn't denervate the cornea.
This means patients have a much lower risk of post-surgical dry eye,
compared to LASIK.
- Recovery only take two to three days.
Dr. Milne notes that one argument in favor of LASIK is the speed of
recovery, but he says recovery from AST Epi-Laser is quite rapid. "I
did a study of 100 eyes, and in all but three cases the patients
were able to return to work by day three," he says. "I do
Epi-Laser
on Thursday, and Monday morning the patient is back at work, healed
with the contact lens out.
"These patients are in good shape right after the
surgery," he adds. "They sit up and read the clock. Their vision may
be 20/30 instead of 20/20 one day postop, but for somebody who's
been 20/800 for years, that's huge. They're very wowed by it, and
their vision continues to improve."
Manfred R. Tetz, MD, director of a private surgical
center in Berlin and scientific director of the newly founded Berlin
Eye Research Institute (BERI), estimates that he has performed about
1,000 Epi-Laser surgeries; he was the first surgeon in Berlin to
offer it. He notes that one factor that helps to speed healing with
Epi-Laser is the edge make by the keratome. "You get a very sharp,
distinct edge on the flap," he says. "It's not like in the old PRK
days when you used a hockey knife to remove the epithelium. The
epithelium begins spreading across the cornea again immediately
after the surgery."
- Recovery is far easier than recovery from PRK. "This is nothing like PRK," says Dr. Milne. "We've all
done PRK on patient who were not good LASIK candidates. They have a
five- to seven-day recovery period that isn't pleasant, and that's
not what people want.
"Epi-Laser patients don't go through that at all," he
continues. "It's the non-traumatic way you remove the layer of
cells; the remaining cells heal very differently. That, combined
with the postop medication combination I use has made this a very
pleasant practice. The patients are really happy."
Back to the top.
Should You Remove the Flap?
Removal of the flap at Shealy Eye Laser Center has
faster recovery times. Many times when you leave the epithelium in
place, the new underlying epithelium will interfere with and prolong the
recovery time. Newer soft contact lenses placed over the surface of the
eye as a bandage allows quick re-epithelization. About 3 to 4 days of
wearing the contact lens is necessary and premature loss of the contact
lens may increase haze.
Haze is usually prevented by applying mitomycin-C to those
patients who have over 75 microns of tissue ablation. It can be used
post-operatively for persistent haze, but as a rule, haze generally
diminishes over a 3 to 6 month period of time. See
Frequently Asked Questions for graphs regarding haze decrease.
Back to the top.
Epi-Laser Is the Way to Go!
Barrie Soloway, MD, AAO 2006
- It is a faster easier procedure than other surface approaches
- There is no application of toxins such as ethanol
- It provides a barrier effect against TGF beta, with a lower incidence of haze
- Shorter duration of pain and only mild discomfort are reported by many patients
- Patients enjoy an earlier return to functional vision
- Fewer higher-order aberrations are reported postop compared to PRK and LASIK
Back to the top.
Why I Hung Up My Microkeratome
Marguerite McDonald, MD, AAO 2006
- The best LASIK out comes are not as good as or superior to the best surface ablation outcomes.
- There are fewer deleterious effects on higher order aberrations.
- The overall safety is outstanding because one cannot have flap complications if one doesn't have a flap.
- It is ideal for surgeons due to its safety profile regardless of their volume.
Back to the top.
Ectasia: How serious is the problem?
R Doyle Stulting, MD, AAO 2006
- First reported by Seiler in 1998
- Literature search shows 149 cases of ectasia after LASIK as compared to only 9 cases after PRK
- Proven pre-operative risk factors known in 2003
- High Myopia
- Forme Fruste Keratoconus
- Low residual stromal bed
- Reduced preoperative corneal Thickness
- Suspected preoperative risk factors
- Increasing myopia and/or astigmatism
- Eye rubbing
- Interventions
- Intracorneal rings
- Riboflavin collagen crosslinking
- Most patients benefit from newer types of contact lenses
Back to the top.
Back to the Surface
A John Kanellopolus, International Meeting of WaveLight Users, Berne, Germany, Scientific Agenda, 2007
- Most doctors are in denial of ectasia which has been severe in one to three patients of all ophthalmologists
- Retreatments of greater than 0.75 diopters within three months indicate mild ectasia, which occurs in 20% of patients
- Incidents of ectasia in the United States range from 0.12% to 0.3% in the severe form according to Ken
Model and Marguerite McDonald at the Aspen Refractive Surgery Symposium 2005
Back to the top.
Corneal Ectasia After LASIK
World Cornea Congress V, April 2005, Washington D.C.
- Occurs two years after LASIK
- More likely occurs forme fruste keratoconus is present vs. too thick flap
- In 1998 up to 200 microns, then 250 microns in 2005; however, no one knows
- No orbscan in 1998; however anterior topography is inadequate, also orbscan measurements not accurate after surgery
- Fit rigid contact lenses
Back to the top.
Are current ectasia risk factors determinate?
Perry Binder, MD, EyeWorld Contributing Editor 2007
- Risk factors not associated with ectasia
- Residual bed thickness of 250 microns or less
- 500 micron corneas or thinner
- 25 years old or younger
- Steep corneas (47 D or steeper)
- Attempted corrections of greater than 2 D
- How to better screen of ectasia
- Carefully screen patients medically and topographically to eliminate any potentially ectatic patients
- Measure flaps intraoperatively in order to leave patients with as thick a residual bed as possible
Back to the top.
MORE!:
Surface ablation technique
slightly edges out LASIK for treating compound myopic astigmatism
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Both treatments had excellent
safety and efficacy outcomes in follow-up to 6 months, but numeric
or statistically significant differences favoring the surface
ablation procedure were seen in almost all endpoints assessed.
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Surface ablation had
significantly less induced higher-order aberrations, significantly
better outcomes in mesopic contrast sensitivity testing, and better
ratings in patient satisfaction.
Back to the top.
Are
Glasses Ruining Your Looks?
Health News, 2004
5 to 15 percent of former LASIK patients
needed follow-up for enhancements to refine their vision and in some cases
LASIK actually ruined their eyesight.
Many LASIK centers were offering LASIK
surgery at $299 to $699 per eye, which is a great deal, however, enhancement
plans range from $150 to $200 per eye with a lifetime enhancement of $400 to
$500 per eye. The restriction was that you return to the eye care practioner
every year at about $150 an eye, or go back to the original procedure.
Now compare this to the retreatment rate of
surface ablation of 1 per 1,000 which is much safer and less expensive to
the patient.
Call for a
FREE consultation!
260-486-0065 or toll free 1-800-644-6393!
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