Future bodes well for advanced surface ablation techniques

Advanced surface ablation, such as LASEK and Epi-LASIK, defined as an refractive laser technique that does not create a lamellar flap, is the wave of the future, according to Richard Yee, MD. He said that advanced surface ablations are ideal procedures for problem cases, such as those with thin corneas and high myopia and is even better for routine cases. He spoke during Cornea Day 2006 at the American Society of Cataract and Refractive Surgery meeting.

"Advanced surface ablation has short-term complications such as pain and haze compared with the long-term complications of LASIK that are flap-related, such as thin flaps or button holes," he explained. Dr. Yee is professor and Joe M. Green Chair, department of ophthalmology and visual science, University of Texas Health Science Center of Houston Medical School, Houston.

In patients who underwent "successful" LASIK procedures (i.e., those with a visual acuity of 20/20), he said more than 50% of the eyes were not normal. There is epithelial basement wrinkling, microstriae, and epithelial ingrowth. These eyes are not normal after LASIK, he stated.

There is also a greater incidence of keratectasia associated with LASIK - 30 times that seen with advanced surface ablation, according to Dr. Yee.

Other considerations are that the incidence of dry eye is more severe in LASIK, and even higher in patients who underwent LASIK and use computers. Creation of flaps in LASIK increases higher-order aberrations. In addition, keratocytes decrease over the long term.

"The safety profile and physiological optics are much better in patients who undergo advanced surface ablations," he said.

"Surface ablation will prevail because we have a better understanding of wound healing," he said. "When the basement membrane is left on, there is not as much scarring; the key factor in the early reports on LASEK is that the basement membrane was present.

"We can minimize the risk of haze," Dr. Yee said. "We can predict the patients who will develop haze, such as those who are younger and are darkly pigmented, and we can modulate haze and pain using autologous serum to less than half. We can re-treat haze; haze can be consolidated."