Doctors` Note - LASIK Ft. Worth
Transcription
Doctors` Note - LASIK Ft. Worth
DOCTORS’ NOTE FAL L / W INTE R 2014 Texas Eye and Laser Center is committed to constantly improving communication with our referring doctors and co-management partners. Because we share the common goal of providing the best possible surgical outcomes and comprehensive postoperative care for our patients, we are happy to introduce Doctors’ Note, a new quarterly newsletter for our referring doctors and co-management partners. This newsletter is written to keep you up to date with new clinical and surgical techniques as they evolve. TEXAS EYE AND LASER CENTER NOW OFFERS iFS™ Advanced Femtosecond Laser Technology to Its LASIK Patients Texas Eye and Laser Center is bringing the next generation in laser vision correction technology to the area with iFS™ Advanced Femtosecond Laser for performing all-laser LASIK vision correction. Coupled with the iFS technology is our custom LASIK procedure with Laser Tracking and Iris registration. Texas Eye and Laser Center is one of only a few laser centers offering this in Dallas and Ft. Worth. We have always been committed to bringing the safest and most advanced technology to its patients, and with the addition of the iFS™ laser, we’re raising the standards of laser vision correction yet again. STAR S4 IR™ Excimer Laser Laser Tracking and Iris Registration iFS™ Advanced Femtosecond Laser FOR MORE INFORMATION, PLEASE CONTACT TEXAS EYE AND LASER CENTER AT (817) 540-6060 OR VISIT TEXASEYELASER.COM. The Femtosecond Difference by Perry Binder, M.D. With the latest femtosecond laser technology, surgeons can make customizable, stable, and safer flaps more quickly than ever. Femtosecond technology now provides surgeons with the ability to biomechanically design the LASIK flap by controlling its shape (diameter, hinge size, side-cut architecture, elliptical or round) and thickness, while also increasing safety and speed. The technology has evolved tremendously since its commercial introduction in 2001. Now, a fifth-generation femtosecond laser (iFS Advanced Femtosecond laser, Advanced Medical Optics, AMO, Santa Ana, Calif.) allows the flap to be created in less than 10 seconds. SPEED The increased speed allows surgeons to use less energy per spot and to place the spots and lines closer together. Less pulse energy has the potential to decrease the incidence of the opaque bubble layer (OBL). In addition, faster flap creation means less suction time on the eye, which contributes to patient comfort. Arturo Chayet, M.D., Tijuana, Mexico, conducted the first two clinical studies using the iFS laser. The first series determined the optimal settings for the laser, while the second series looked at the clinical advantages of customizing flap dimensions for a given patient. With the iFS laser, the spot line separation can be decreased from the current 8 to 9 microns and line separation to as low as 5 x 5 microns (although the software permits even tighter placement). Thus flap lifts are virtually effortless and the beds potentially smoother than even those with the current IntraLase FS system. MECHANICAL STABILITY OVAL-SHAPED FLAPS The iFS uses new software that allows surgeons to customize the shape of the flap based on the patient’s corneal diameter, shape, and the excimer laser ablation profile. The surgeon may choose the elliptical flap option, which creates a larger stromal bed area. While maintaining the vertical diameter, the horizontal diameter is enlarged, pushing the hinge away from the ablation zone. This prevents the risk of hinge ablation or allows the creation of a wider hinge, enhancing flap stability. Perhaps the most interesting and unique feature of the new iFS laser is the ability to create an inverted “bevel-in” side cut. The new iFS laser side cut can be programmed from 30 to 150 degrees (similar to a mechanical microkeratome). The purpose for making a more vertical flap edge was initially based on a pig eye study that measured how much force it took to dislocate a flap. When the walls are more perpendicular it is more difficult to move that flap. Studies conducted independently and most recently by Prof. John Marshall and Prof. Dr. Michael Knorz prove that the 140- to 150-degree bevel-in side cut is an essential component to a biomechanically stable cornea, Prof. Knorz’ comparative study concluded that flaps created with the iFS laser, utilizing a 140-degree side cut, required three times as much force to dislodge than those created with a modern microkeratome. Side-cut architecture with the iFS femtosecond laser may also decrease the incidence of epithelial in-growth, which is common after enhancing a microkeratome flap, but it’s much less common after enhancing a femtosecond flap. Femtosecond lasers have many clinical applications. In addition to flapmaking capabilities, surgeons also have the ability to create channels for the implantation of intracorneal ring segments, wedge resections, corneal tattooing, limbal stem cell transplantation, lamellar and full thickness corneal transplants, retinal keratoplasty, corneal biopsies, and IntraLase Enabled Keratoplasty (IEK) patterns. The iFS laser enables the surgeon to change the shape of a flap from round to a 12% oval, in which the vertical meridian is 12% shorter than the horizontal meridian. This shape is beneficial in hyperopic ablations for preventing the excimer laser from ablating the hinge. With a circular flap, the surgeon would have to decrease the hinge’s arc length from a width of 45° to 30° in order to move the hinge away from the path of the ablation. The tradeoff is that a hinge with a shorter width can decrease the strength and stability of the flap. By choosing an oval shape, the surgeon can maintain the same hinge angle or even increase it without crossing the ablation’s path. The oval flap shape can be made with either a nasal or a temporal hinge. Long-time contact lens wearers who have significant blood vessels in the cornea’s vertical meridian may also benefit from this option, because the surgeon can avoid cutting across those vessels and inducing bleeding in the interface. There is some preliminary anecdotal evidence that creating an oval flap severs fewer nerves and corneal lamellae. Preserving these tissues would contribute to stronger corneal biomechanics and reduce the symptoms of dry eye as well as the risk of corneal ectasia. This state-of-the-art technology truly represents a significant advance in the field of refractive surgery. iFS™ Advanced Femtosecond Laser TO LEARN MORE ABOUT FEMTOSECOND LASER TECHNOLOGY, PLEASE CONTACT TEXAS EYE AND LASER CENTER AT (817) 540-6060 OR VISIT TEXASEYELASER.COM. (817) 540-6060 TexasEyeLaser.com © 2013 Stubenbordt Consulting, Inc. • ALL RIGHTS RESERVED 2 Update: Pterygium Removal A pterygium is a wedge-shaped, benign, fibrovascular growth pterygium excision include discomfort, infection, bleeding, extending from the conjunctiva onto the cornea. Pterygia scarring, and recurrence. The risk of infection is less than 1%. Patients are given topical antibiotics postoperatively for prophylaxis. In addition, subconjunctival hemorrhages are commonly seen afterward since the lesions are vascular, so it is a good idea to make this known to patients prior to the procedure so that it does not take them by surprise if it occurs. Scarring may sometimes be seen, whether on the cornea or in the form of pyogenic granuloma within the healing conjunctiva. Topical steroids are given to patients postoperatively in order to temper healing and help to reduce scarring. A brief inquiry into whether or not the patient has a history of keloid formation may be a useful part of counseling. are most common in persons from areas near the equator and are frequently found in people who spend much of their time outdoors. As a result of prolonged ultraviolet exposure, conjunctival tissue undergoes a transformation via elastotic degeneration and slowly creeps onto the corneal surface. The benign pterygium rarely undergoes further transformation into a malignant lesion representing conjunctival squamous cell carcinoma. Many times, patients are unbothered by pterygia. Other times, patients may come to the office seeking treatment for reasons ranging from facial aesthetics to loss of vision. If a patient is experiencing inflammatory symptoms such as chronic redness, foreign body sensation, or pain, then it may be worthwhile for the patient to undergo a trial of topical medications. Typically, lubricants are prescribed to the patient. NSAIDs and/or steroids may be used judiciously. Sometimes the symptoms may become more severe, particularly if the pterygium is relatively large and elevated. Patients may complain of dryness and poor vision. Patients may state that they have become contact-lens intolerant because the contact lens abuts the abnormal tissue. If the pterygium becomes large enough, it may also cause increased “with-the-rule” or irregular astigmatism as it flattens the cornea either from the nasal or temporal aspect. Thus, the patient may experience a slow decline in vision as the tissue grows. In some cases, a pterygium may grow large enough to actually block the visual axis. Patients may solely be bothered by the cosmetic aspect of having chronic and unsightly red eye that may draw negative attention. Recurrence rates have been cited between 30% and 50% with bare scleral techniques versus only 5-12% using adjunctive methods like intraoperative or preoperative mitomycin C application, conjunctival autografts, and amniotic membrane grafts. The technique favored by the surgeons utilizes either conjunctival autografts or amniotic membrane transplantation with the usage of mitomycin C intraoperative application to the residual conjunctival tissues. In addition, we prefer the use of fibrin glue versus the older method of suturing the grafts in place. In our hands, our recurrence rate is routinely less than 10%. Also, the procedure itself is far more comfortable and convenient because of the suture-free technique employed. As far as It is important for the doctor and patient to evaluate and discuss whether surgical intervention is necessary. postoperative discomfort is concerned, patients generally complain of moderate foreign body sensation and irritation, which tend to improve with time and heal in approximately two weeks. All pterygia are sent as laboratory specimens to verify that they are benign in nature. If you have a patient who suffers from pterygium, please do not hesitate to have the patient contact our office at (817) 540-6060 for a consultation. It is up to the doctor and patient to discuss and decide whether or not surgical intervention is necessary. The main risks of (817) 540-6060 TexasEyeLaser.com © 2013 Stubenbordt Consulting, Inc. • ALL RIGHTS RESERVED 3 Ft. Worth Hurst 3405 Locke Avenue, Suite 100 Ft. Worth, TX 76107 To Arlington d oo rw No 30 y wy Dr t Fw Wes West F ale To Fort Worth W Vickery Rd Rd Hurstview Dr ood arw WH osed WR ood arw WH Photo Ave Smiley Lovell Ave Trinity MONTGO MERY Locke Ave Brown Trail To Weatherford 1872 Norwood Drive, Suite 200 Hurst, TX 76054 To Euless 121 183 1872 Norwood Drive, Suite 200 Hurst, TX 76054 (817) 540-6060 TEXASEYELASER.COM LASIK and the FAA A pilot’s vision is the most important sense he or she possesses. Their safety, and that of their passengers, depends on how well they see. LASIK has been approved for NASA astronauts and military pilots. Pilots considering LASIK should understand the benefits as well as the risk. Our surgeons can discuss LASIK with pilots during a personal complimentary LASIK consultation; we can also evaluate patient candidacy. Most patients that have LASIK see 20/20 or better and often have improved contrast sensitivity and night vision. The FAA expects that a pilot will not resume piloting aircraft until his or her own treating health care professional determines: • The postoperative condition has stabilized. • There have been no significant adverse effects or complications. • The person meets the appropriate FAA vision standards. If these determinations are favorable and if otherwise qualified, the pilot may immediately resume piloting but must ensure that: • The treating health care professional documents his or her determinations in the pilot’s health care treatment record. • • A copy of that record is immediately forwarded to the Aerospace Medical Certification Division in Oklahoma City. A personal copy is retained. The pilot may continue flight duties unless informed otherwise by the FAA or another disqualifying condition occurs.