AAO- Dr. Jeff Machat and LASIK Patient Expectations

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Presentation Description

Dr. Jeffery Machat on the development of LASIK and the requirement of proper and careful patient selection, informed consent, and the use of advanced technologies like Custom LASIK and Intralase.

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Patient Expectations and Satisfaction after LASIK:

Patient Expectations and Satisfaction after LASIK Jeffery J. Machat MD

No Financial Interest :

No Financial Interest Not a Paid Consultant

LASIK Satisfaction:

LASIK Satisfaction In 1991 when I began performing LVC, patient expectations were low and achieving 20/40 was considered “ success ” . Recovery was slow Comfort poor Safety variable Cost unchanged Numerous referrals

LASIK Satisfaction:

LASIK Satisfaction The delayed and painful PRK visual recovery was replaced with the overnight visual recovery of LASIK LASIK eliminated concerns for Corneal Haze and reduced the risk of Infection

LASIK Satisfaction:

LASIK Satisfaction LASIK allowed patients to have a procedure today and see tomorrow ! It was the procedure patients wanted.

LASIK Satisfaction:

LASIK Satisfaction But with the miracle of overnight vision came increased surgical risks

LASIK Satisfaction:

LASIK Satisfaction And even new post-operative risks With time, these risks were better understood and managed

LASIK Satisfaction:

LASIK Satisfaction More importantly, as visual results improved Quality of Vision became the principal post-operative issue.

LASIK Satisfaction:

LASIK Satisfaction Technology and techniques developed for a dramatically improved LASIK safety profile Wavefront optimized and Wavefront guided ablations Iris registration Femtosecond Laser created Flaps

Slide 10:

Custom Intralase 30 KHz Intralase 60 KHz IR Fourier Data Courtesy of Louis Probst, MD All Procedures Enhancement Rates 95-99% of procedures Microkeratome & Conventional Custom & IntraLase

Uncorrected Visual Acuity:

Uncorrected Visual Acuity 100% of eyes treated with wavefront-guided LASIK were 20/20 or better by 2 weeks Courtesy of Dave Tanzer, MD

Slide 12:

Mechanical vs. Femtosecond Flaps: Change in 25% mesopic LCA @ 3 Months Improvement in distribution difference for the femtosecond laser eyes at postoperative Month 3 (BCVA) Steve Schallhorn, MD CSCRS, April 2006 p=0.03

Mechanical vs. Femtosecond Flaps: Change in 5% CA @ 3 Months :

Mechanical vs. Femtosecond Flaps: Change in 5% CA @ 3 Months Mean Difference: +0.01 LM (loss) -0.02 LM (gain) * Loss >=2 : 6% 3% P=0.01

Preop to Postop Difference in Night Driving Simulator Performance with Glare:

Preop to Postop Difference in Night Driving Simulator Performance with Glare Conventional with Mechanical Keratome flap WFG with femto flap Preop to postop change in feet Worse after surgery Improved after surgery Courtesy of Steve Schallhorn, MD Detection and Identification of pedestrians, signs, etc. Night driving simulated at 55 miles per hour.

LASIK Satisfaction:

LASIK Satisfaction Both the Military and NASA recognized these improvements and approved LASIK for their personnel

LASIK Satisfaction:

LASIK Satisfaction Wavefront technology not only assisted surgeons in avoiding or minimizing complications, but in retreating patients with night glare and other higher order aberrations Wavefront Error 0-343-91-63 Patient ID: Notes: Physician: Patient: *************, ************* © Copyright 2001, VISX Inc. Operator: Mary Ann OD 14-Dec-2001 20:26 -4.49 DS +0.48 DC x 136° @ 12.5 mm (4.0 Pupil) Hi Order: Pupil (mm): 8.7 % 6.00 OS 14-Dec-2001 20:27 -4.14 DS +0.80 DC x 51° @ 12.5 mm (4.0 Pupil) Hi Order: Pupil (mm): 6.2 % 6.00 Eff. Blur (D): 4.25 Eff. Blur (D): 3.66 Acuity Map Bille Aberration Map microns 28.00 24.00 20.00 16.00 12.00 8.00 4.00 0.00 -4.00 -8.00 -12.00 -16.00 -20.00 -24.00 -28.00 0 30 60 90 120 150 180 microns 1.75 1.50 1.25 1.00 0.75 0.50 0.25 0.00 -0.25 -0.50 -0.75 -1.00 -1.25 -1.50 -1.75 0 30 60 90 120 150 180 Acuity Map Bille Aberration Map microns 28.00 24.00 20.00 16.00 12.00 8.00 4.00 0.00 -4.00 -8.00 -12.00 -16.00 -20.00 -24.00 -28.00 0 30 60 90 120 150 180 microns 1.75 1.50 1.25 1.00 0.75 0.50 0.25 0.00 -0.25 -0.50 -0.75 -1.00 -1.25 -1.50 -1.75 0 30 60 90 120 150 180 All Grid Spacing: 1 mm. Rms Err.(µ): 5.52 Rms Err.(µ): 4.76 Rms Err.(µ): 0.48 Rms Err.(µ): 0.29

LASIK Satisfaction:

LASIK Satisfaction Perhaps the most important improvements surrounded our understanding of who is and is not an ideal candidate for LASIK

LASIK Satisfaction:

LASIK Satisfaction Regardless of the vast improvements in LASIK techniques and technologies - some patients still develop serious adverse effects

LASIK Satisfaction:

LASIK Satisfaction On April 25 , 2008, the FDA conducted a post-surveillance panel meeting following the review of LASIK complaints Some stories were truly heart-breaking and as surgeons we all need to learn from their plight

LASIK Satisfaction:

LASIK Satisfaction LASIK is an amazing procedure, truly life changing and often described as one of the greatest life experiences Results today can exceed glasses and contacts But be it chronic dry eye pain or LASIK induced ectasia, the potential risks must not be minimized but balanced for candidates

LASIK Satisfaction:

LASIK Satisfaction Take Home Messages: Proper & Careful Patient Selection and Candidate Screening Proper & Careful Informed Consent Use of Advanced Technology and Techniques to minimize adverse effects Communicate with your patients

Thank You:

Thank You Jeffery J. Machat MD

Slide 23:

The information provided in this PowerPoint presentation is for your personal informational purposes only.  It is not medical advice, medical diagnosis or treatment, or recommendation for medical care or treatment. All medical questions or concerns about a medical condition, care, diagnosis or treatment should be presented to a medical physician, health care provider, or health care professional. You acknowledge that your use of this information is at your sole risk, and that you assume and accept full responsibility for all risk associated with any reliance upon the information presented.

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