Barraquer lecturer separates fact from fiction for LASIK

Eric D. Donnenfeld, MD, calls LASIK a procedure 'worth saving.'

LAS VEGAS — Eric D. Donnenfeld, MD, received the José I. Barraquer Award for excellence in refractive surgery at the American Academy of Ophthalmology meeting, and in his lecture on the future of LASIK, he separated fact from fiction from a surgeon’s perspective.

“LASIK has fallen into a precipitous decline in the last couple years,” Donnenfeld said, attributing much of the decline to the change in the economy starting in 2008. Even with an upswing in the economy and consumer confidence, there has not been a rebound for LASIK in either the United States or Europe, he said.

Even though LASIK surgery has not statistically gained back the popularity it once had before the recession, Donnenfeld believes LASIK is a procedure “worth saving.”

“In spite of LASIK’s long-standing clinical and historical presence, misconceptions regarding the risks and benefits persist. It erodes both the reputation of the procedure and those in the field who remain its unwavering supporters,” Donnenfeld said.

Myths and misconceptions

Common myths about LASIK include the notion that contact lenses are safer than LASIK, that LASIK increases the risk for glare and halos, and that dry eye is common after the procedure.

“[R. Doyle Stulting, MD] found that complications in LASIK occurred in 5% of patients after surgery in 1999 and that 4.7% lost two or more lines in visual acuity, but what Doyle noted in his paper was that experience was the most important aspect of LASIK complications,” Donnenfeld said.

Since that time, foundations have been established to educate surgeons and patients. Disseminating information and increasing public awareness about refractive surgery are key to building LASIK’s reputation as well.

Donnenfeld and colleagues have found that dissatisfied patients who experience dry eye after surgery often have dry eye preoperatively; therefore, preoperative testing is recommended.

“Preoperative testing for dry eye results in better outcomes postoperatively, so we have better treatments at hand before and after,” he said. “Corneal sensation returns after 6 months with no persistence of dry eye in most patients.”

LASIK has been a tremendous asset for patients for 20 years by improving the vision of millions of people, including first responders and members of the military, Donnenfeld said.

Moving forward

Today, LASIK is at its highest satisfaction rate in history, with 95% of patients reporting being satisfied and 99% reporting better visual acuity. The procedure has effectively improved in quality and safety over time, Donnenfeld said, but improvement is still needed.

“Ophthalmologists and the industry continue to collaborate and are dedicated to improving technology, technique and outcomes. Our goal is continued improvement of patient satisfaction and patients seeing the same or better without glasses than they did before surgery with their best correction. We need to embrace patients who are dissatisfied with their vision following LASIK and never allow them to feel abandoned,” Donnenfeld said. “We should be proud of what we’ve accomplished but never be satisfied.” – by Patricia Nale, ELS, and Kate Sherrer

Disclosure: Donnenfeld reports financial interests in a variety of companies involved in laser cataract surgery and LASIK.

LAS VEGAS — Eric D. Donnenfeld, MD, received the José I. Barraquer Award for excellence in refractive surgery at the American Academy of Ophthalmology meeting, and in his lecture on the future of LASIK, he separated fact from fiction from a surgeon’s perspective.

“LASIK has fallen into a precipitous decline in the last couple years,” Donnenfeld said, attributing much of the decline to the change in the economy starting in 2008. Even with an upswing in the economy and consumer confidence, there has not been a rebound for LASIK in either the United States or Europe, he said.

Even though LASIK surgery has not statistically gained back the popularity it once had before the recession, Donnenfeld believes LASIK is a procedure “worth saving.”

“In spite of LASIK’s long-standing clinical and historical presence, misconceptions regarding the risks and benefits persist. It erodes both the reputation of the procedure and those in the field who remain its unwavering supporters,” Donnenfeld said.

Myths and misconceptions

Common myths about LASIK include the notion that contact lenses are safer than LASIK, that LASIK increases the risk for glare and halos, and that dry eye is common after the procedure.

“[R. Doyle Stulting, MD] found that complications in LASIK occurred in 5% of patients after surgery in 1999 and that 4.7% lost two or more lines in visual acuity, but what Doyle noted in his paper was that experience was the most important aspect of LASIK complications,” Donnenfeld said.

Since that time, foundations have been established to educate surgeons and patients. Disseminating information and increasing public awareness about refractive surgery are key to building LASIK’s reputation as well.

Donnenfeld and colleagues have found that dissatisfied patients who experience dry eye after surgery often have dry eye preoperatively; therefore, preoperative testing is recommended.

“Preoperative testing for dry eye results in better outcomes postoperatively, so we have better treatments at hand before and after,” he said. “Corneal sensation returns after 6 months with no persistence of dry eye in most patients.”

LASIK has been a tremendous asset for patients for 20 years by improving the vision of millions of people, including first responders and members of the military, Donnenfeld said.

Moving forward

Today, LASIK is at its highest satisfaction rate in history, with 95% of patients reporting being satisfied and 99% reporting better visual acuity. The procedure has effectively improved in quality and safety over time, Donnenfeld said, but improvement is still needed.

“Ophthalmologists and the industry continue to collaborate and are dedicated to improving technology, technique and outcomes. Our goal is continued improvement of patient satisfaction and patients seeing the same or better without glasses than they did before surgery with their best correction. We need to embrace patients who are dissatisfied with their vision following LASIK and never allow them to feel abandoned,” Donnenfeld said. “We should be proud of what we’ve accomplished but never be satisfied.” – by Patricia Nale, ELS, and Kate Sherrer

Disclosure: Donnenfeld reports financial interests in a variety of companies involved in laser cataract surgery and LASIK.