Ophthalmologists must be prepared to perform corneal refractive surgery enhancements after cataract surgery--and LASIK is often the optimal choice, according to Robert K. Maloney, MD.
Although data from MarketScope indicate only about 5.9% of patients require enhancements with laser refractive surgery after premium IOLs, Dr. Maloney believes that is enough to push the envelope.
"A 6% failure rate is not a lot but it is enough to discourage a surgeon pretty quickly,” said Dr. Maloney, Maloney Vision Institute, Los Angeles. “A certain number of patients will need refractive touch-ups for astigmatism, hyperopia, and myopia. Refractive surgery needs to be in your corneal armamentarium.”
Surgeons’ options for premium IOL enhancement after cataract surgery include LASIK, PRK, limbal relaxing incisions (LRIs), and IOL exchange. However, LASIK or PRK is the most common.
Dr. Maloney cited research findings that LASIK is more accurate than PRK.1,2 In one such study led by Manche et al.,1 68 eyes in 34 patients had one eye that had PRK and the second eye that had LASIK.
“The standard deviation of LASIK was less than PRK,” he said. “That’s the best measure of accuracy as it tells you how spread out the data is.”