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Dr. Gulani is director of refractive surgery andchief, cornea & external disease, as well asassistant professor, department of ophthalmology,University of Florida, Jacksonville.
Physician pioneers technique offering higher perspective in surgery, outcomes.
Special to Ophthalmology Times®
In ophthalmology, the meaning of the word premium has come to be associated closely with cataract surgery and in particular the premium intraocular lenses.
This misdirected allocation has led to continued confusion among enlightened patients and providing surgeons.
I teach surgeons that premium is more than simply a lens technology. It is the complete experience, starting with reception and continuing to customer care to artistic surgery and, most importantly, to consistent, successful outcomes.
We are privileged to be in a profession for which industry strives to provide us with exotic innovations and technologies, and we should shoulder the responsibility to use these correctly and to their best potential.
Previously by Dr. Gulani: Show me the patients: Patient satisfaction, not surgical landmarks or chart indices, mark of success
If surgeons consider a premium lens as an ingredient, certainly a very important one but merely a portion of the entire “vision recipe,” they will finally lose their anxiety and patients will lose their distrust and enjoy the fruits of these innovations.
Add to this my experience with LASIK since the early 1990s, long before its FDA approval in the United States, when I would encourage colleagues and industry to measure vison beyond 20/40, and that on day 1 post-LASIK, and you have both of my principles regarding premium.
Apply these 2 concepts to pterygium surgery1, which has most often been handed to a low-level resident in training or at least kept in the unimportant category with less-than-cosmetic expectations or accountability.
What if we could perform pterygium surgery like an artist and deliver postoperative cosmetic outcomes on day 1 in a sutureless, comfortable, and visually responsible approach––one that could also make patients candidates for premium cataract and laser vision surgery? That indeed would be raising the bar to premium.2
Applying premium approach to pterygium correction
Pterygia are not new pathologies and have been recognized from antiquity. Being such, their correction is relegated to surgeries that aim for a very low bar, i.e., one with a lowest recurrence rate with moderate pain and not-so-amazing cosmetic outcomes.3
Over 3 decades, however, I have raised this corrective procedure to an art and turned it into a premium cosmetic procedure SPARKLE (Sutureless Pterygium Amniotic Reconstruction with Lamellar peel Keratectomy).3-5
This premium approach includes the following: receiving patients with pterygium from all over the world; creating a personalized, caring, and empathic ambience; planning for cosmetic outcomes with enhanced vision impact along with the use of tissue glue, mitomycin C, and human placenta technology; and employing techniques (ie, Gulani No-Stitch Iceberg technique)6,7 with a painless and smooth recovery, along with day 1 cosmetic end points focused on a long-term zero recurrence rate.
Related: Celebrating a pivotal moment in laser-vision correction history
This concept and approach further includes turning patients who previously were not candidates for premium cataract and laser vision surgery into candidates, thus facilitating freedom from glasses and contact lens dependence and upholding my motto: see good and look good.
Such an approach does, of course, come at a price similar to premium cataract and laser vision surgery, the price surgeons pay for living up to goals and expectations (without guarantees to patients).
It comes not only from your patients taking to social media immediately after surgery, sharing pictures of their eyes and holding you accountable to a worldwide audience 24/7/365, but also from their daily interactions with their “new” eyes on display, a testimony to the surgeon’s skill.
During my 30 years of performing this technique, I have included the human placenta (amniotic membrane) as a primary ingredient in the approach.
Its transparent and elegant appearance, along with its supportive and ocular surface–rejuvenation properties, compliment the surgical artistry.
Related: Haptic flanging reduces IOL dislocations after cataract surgery
Further, the ambience in our institute-based surgery suite, along with elegantly designed instrumentation (Gulani Premium Pterygium Surgery Instruments, Bausch + Lomb) and options for premium vision corrective surgery, elevate the continuum of care from appearance to vision.
The consistent success of the SPARKLE procedure over decades has resulted in patients with pinguecula, who are often concerned with their cosmetic appearance, being able to have surgery.
Many of them either have already had vision corrective surgery or anticipate having it in the near future.
The premium approach is underscored in this patient population, in which a simple mistake can be considered a complication of what was an elective and cosmetic situation to begin with.
When teaching LASIK and laser vision surgeries, I remind surgeons that they need to be consistently confident in their outcomes and that patients with small refractive errors also can be offered a chance to improve their vision beyond 20/20.
Related: Minimize inflammation after cataract surgery
Any mistakes at this level would be catastrophic, because the patient had near normal sight to begin with.
The premium approach holds our feet to the fire, as we invite each patient on day 1 after surgery to look at their eye in a mirror and comment on its condition.
The ability to produce great outcomes should attract affected patients worldwide who have been told that the surgery is worse than the lesion regarding discomfort, recurrence rate, and the outcome, which may not be an improvement over their preoperative status.
The time has come to raise ocular surface surgery to an art, and the experience and outcomes to a premium level.
About the author
Arun C. Gulani, MD
Gulani, an anterior segment specialist and creator of the Corneoplastique concept of vison correction, is the founder of Gulani Vision Institute in Jacksonville, Florida.
1. Gulani AC, Gulani AA. Cosmetic pterygium surgery: techniques and long-term outcomes. Clin Ophthalmol 2020;14:1681-1687; https://doi.org/10.2147/OPTH.S251555
2. Gulani A. Sutureless amniotic surgery for pterygium: cosmetic out-comes for ocular surface surgery. Tech Ophthalmol 2008;6:41–44. doi:10.1097/ITO.0b013e31817dceb226.
3. Gulani AC. The Art of Pterygium Surgery. 1st ed. Stuttgart: Thieme Medical Publishers, 2019.
4. Gulani A, Dastur Y. Simultaneous pterygium and cataract surgery. J Postgrad Med 1995;41:8–11.
5. Gulani A. Sutureless Amniotic Graft Surgery for Pterygium: Next day cosmetic outcomes. Video J Ophthalmol Article VII, 2008.
6. Gulani, AC. A cornea-friendly pterygium procedure. Rev Ophthalmol 2012 June;52-56.
7. Gulani A. Gulani iceberg technique. Cataract Refract Surg Today Europe 2014;9:48-49.