Eyeworld Supplements

Daniel Durrie, M.D. " We have found that better than 20/20 acuity levels are attainable almost every time with today's advanced equipment " EW Chicago 2012 Advances in cataract and refractive surgery: A clinical update 3 n by Daniel Durrie, M.D. Maximizing patients' visual outcomes By aiming high and using advanced technology, patients can achieve results that exceed 20/20 W ith modern technol- ogy and careful patient screening, it is possible for many of today's laser vision correction outcomes to exceed 20/20 post-op uncorrected visual acuity (UCVA). The goal should be for patients to see better than they ever did with their glasses or contacts lenses. Current research We are constantly evaluating new technology in our clinical research department, where we conduct objective comparison tests. We routinely test patients' vision beyond 20/20 UCVA. We find that the 20/20 mark is achievable for most patients, and even 20/15, 20/12, and 20/10 UCVA outcomes can be reached. In recent years, in cases with well-selected, healthy patients (1-7 D of myopia and up to 3 D of astigmatism who have the capability of seeing 20/20 or better) and using modern advanced equip- ment, we have come to expect our 1-day post-op 20/20 rate to be 95% or greater. In addition, 75% or better will be 20/16, and 50% or better will be 20/12 UCVA. This has become the new stan- dard and represents a significant change. In 1999, the year of approval of LASIK by the FDA, the 20/20 UCVA rates with the VISX (now Abbott Medical Optics, Santa Ana, Calif.) and Summit Technology lasers were 50%; the 20/40 rates were 85% and 90%, respectively. In just 13 years, we have numerous studies with good follow-up that demonstrate approximately 100% are 20/20. The new norm It is important for practice staff to test patients both pre-op and post- op to determine the percentage of outcomes that go beyond 20/20 UCVA. Many practices stop at the 20/20 line. If you do not test patients beyond 20/20, you will not find the patients that exceed that level. As laser eye surgeons and coun- selors to our patients, we need to reset the bar. We have found that better than 20/20 acuity levels are attainable almost every time with today's advanced equipment. We must do meticulous refractions and closely evaluate the topography and wavefront scans. In every case, five wavefront axis readings that are within 5 degrees of each other should be obtained. If these steps are taken, it is possible to talk with patients about their chances of seeing better than they did pre-op with glasses or contact lenses. Patient counseling is critical. Many eye surgeons talk about "under promising and over deliver- ing" results. In my opinion, it is more important to match the patient's expectations with the surgeon's expectations. For example, for a 22-year-old, –3.00 D patient with good tear film, an excellent retina, and a good-looking topogra- phy, I expect a better than 20/20 result. I might not always hit the target; however, by aiming for that high level and discussing my goals with patients, they are comfortable and confident that I am trying my best to get them there. Some sur- geons might feel that if they do not exceed a 20/20 result, patients will be disappointed. I disagree. Today, technology has gotten to the point that if we under promise and over deliver we are underselling expecta- tions. Instead, in an uncomplicated case with a patient who I believe can achieve better than 20/20 acuity, I will tell the patient just that. Careful patient screening is essential. Some potential candidates may require pre-op treatment, such as treating dry eye or blepharitis or making sure their refraction is stable over a period of time. In some cases, it might be best not to operate. It is also important to invest in the highest quality equipment, follow your nomograms, and keep track of your own data in order to evaluate outcomes. Obtaining an outcome measure- ment—comparing a patient's pre-op BCVA to the post-op UCVA—is im- portant. At our practice, we strive to match or improve the acuity, and in most cases, we can show improve- ment over pre-op best corrected vision. Patients can tell when their uncorrected visual acuity exceeds 20/20, and they appreciate it. Even if patients have astigmatism or higher order aberrations, modern LVC can help them see better than they did with their glasses or contacts; we should expect this. I advise eye surgeons to set this goal and see how it energizes the entire practice. This includes every step in the process— from how the technicians measure patients, to how the doctor counsels them and performs surgery, to how post-op exams are done, to how any necessary enhancements are performed—to reach that target. This philosophy changes the game, and if we are going to make this field continue to grow, we must continue to raise our standards. Dr. Durrie is founder of Durrie Vision and the Durrie Vision Research Center in Overland Park, Kan. He can be reached at 913-871- 1166 or ddurrie@durrievision.com. AMO Saturday supplement_Chicago 2012-USE THIS ONE_Layout 1 4/20/12 4:25 PM Page 3

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