Well this is the inaugural issue of my blog...
What is it all about??? Refractive Surgery happenings..
Who am I??? Charles W. Titone, MD an Ophthalmologist
Well the past year has been busy with the introduction of wavefront corrected laser ablations for the big three laser companies ( Visx, Bausch&Lomb and Alcon). A newcomer Wavelight AG marketed a wavefront corrected laser with a prolate beam profile. After all is said and done each laser can be used to achieve excellent results. There are patients that might have special needs that may be treated better with one laser over the others and this is true of all of the above mentioned lasers but each laser is better able to give excellent results than the last generation. The big story will be ICL's (Implantable Contact Lenses) more on that later
The big evolution this year will be twofold, the automated tracking will get a big boost when Visx releases it's Iris registration of wavefront corrections coupled with it new Fourier transform driven wavefront capture device. This will leave the other manufacturers scrambling to catch up. This upgrade will increase the ability to detect distortions and the registration will allow them to meaningfully be corrected. It is one thing to measure the aberrations but there is no benefit to applying the correction if it is not exactly lined up to where it is needed.
The future holds some promise for multi focal ablations.. ie laser treatments to correct distance and near vision in each eye. Right now the best we can do is Mono vision, one eye sees distance and the other near the brain sorts all this out and the patient functionally has "normal" vision. There is a loss of depth perception and some decrease in night vision. Multi focal ablation would improve on this. Some early trials have shown promise. One way to achieve these results right now is an off label use of CK (Conductive Keratoplasty marketed by Refractec) The surgeon treats a patient with previous myopic lasik with 8 spots of CK an more often than not the patient retains good distance vision and gains near vision. There are only a few CK doctors doing this as it is an off label procedure and it can only be done if there is enough residual cornea in the treatment zone >500um.
Well Now comes the real exciting NEWS... ICL's!
Two company's have developed an ICL for the US market to be introduced this year, both are FDA approved the AMO Verisyes released to market 2 weeks ago and the STAAR Visian ICL just receiving its approval. The Verisyes is a variant of an old design, the Iris Claw anterior chamber lens. Surgeons clamp AMO's Verisyes lens directly to the front of the iris. It's inserted through a 7mm incision and sits close to the tissue responsible for keeping the cornea clear. That means perfect surgical technique is mandatory. This lens will be recommended only for high myopia. The Verisyes has been used in Europe successfully over the past several years. The STAAR Visian ICL is a new revolutionary design that allows it to be placed behind the iris for exceptional stability and biocompatibility. This lens is a foldable design allowing it to be passed through a much smaller incision (3mm) than the AMO lens.
Now that there are Two Choices Laser or ICL which should you choose??
Well ultimately the decision is made by you and your Ophthalmologist but people with cornea's that were too thin for laser treatment and were rejected during an evaluation should be able to have an ICL implanted. Persons with myopic (nearsighted) eyes above the treatable range of laser and some within the treatable range, ie > -8.00 would probably have better vision with an ICL because it induces little or no aberrations unlike laser in these higher range corrections. Even the lower minus corrections can have ICL's but in this range it is probably a personal choice as the outcomes are virtually identical.
Where can I get more information??? treatment??
Well stay tuned right here
You can go take a look at www.staar.com