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Myth Busters in Patient Selection for LASIK Steve Schallhorn MD

Myth Busters in Patient Selection for LASIK Steve Schallhorn MD. DISCLOSURES. Consultant to AMO Global Medical Director Optical Express. Thin Cornea.

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Myth Busters in Patient Selection for LASIK Steve Schallhorn MD

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  1. Myth Busters in Patient Selection for LASIKSteve Schallhorn MD

  2. DISCLOSURES Consultant to AMO Global Medical Director Optical Express

  3. Thin Cornea “Patients with a central corneal thickness less than 500 microns should not undergo LASIK because they are much more likely to be abnormal and develop ectasia”

  4. Distribution of Preop Central Corneal Thickness thinnest of 3 ultrasonic pachymetry readings • 81,715 consecutive LASIK • 1 Apr 08 to 31 Mar 09 • IL and mech flaps • 2,181 eyes CCT < 500u • 79,534 eyes CCT >=500u Mean: 549µ Stdev: 31µ 2 STD below: 488µ

  5. Age Distribution

  6. Preop Sphere

  7. Ectasia has been observed in 3 Patients

  8. Preoperative Sphere “Patients with more than 3D of hyperopia should not undergo LASIK because they are much more likely to be unhappy afterwards”

  9. Dissatisfaction as a Function of Treated Hyperopia Average preop sphere: +2.0 ± 0.9D

  10. Preoperative Astigmatism “Patients with high cylinder should not undergo LASIK because they are much more likely to be unhappy afterwards”

  11. Dissatisfaction as a Function of Treated Astigmatism Average preop cyl: 0.76D Patients

  12. Low Light Pupil Diameter “Patients with >=8mm pupils should not undergo LASIK because they are much more likely to be unhappy and have visual symptoms”

  13. 1M LASIK Dissatisfaction vs Low Light Pupil Patients

  14. 1M LASIK Problems with Daily Activities and Night Driving vs Low Light Pupil Patients

  15. Hyperopic Presbyopes “A +2.50D 60 year old should not undergo LASIK. An RLE procedure will result in much higher patient satisfaction and less dry eye”

  16. 12 Month Age Stratified Random Sample

  17. Procedure vs. Satisfaction P = 0.4684

  18. “During the past week, how many times a day do you use artificial tears?”

  19. Refractive Target “It is best to target a little myopia in presbyopic patients to enhance their satisfaction”

  20. Mean 1 M Satisfaction vs Postop Sphere Dominant eye in patients >=40 yrs & patients <=30 yrs More Satisfied 841 1,643 1,648 2,576 7,338 458 1,425 1,173 2,439 8,214

  21. Conclusions • Analysis of large patient datasets can provide a unique insight to improve refractive surgery • Patient selection • Refractive target • “Myth busters”

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