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Dr David Robinson - LASIK Vs SMILE

Dr. David Robinson is a well-trained, qualified and experienced corneal and cataract surgeon; not just a standard eye surgeon doing cataracts. He has skill and experience in his field. He uses latest technology and equipmentu2019s in their treatment procedure.

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Dr David Robinson - LASIK Vs SMILE

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  1. A Comparison of LASIK Vs SMILE Dr. David Robinson M.B. B.S. B.Sc. (MED) F.R.A.N.Z.C.O. F.R.A.C.S david@sydneyvision.com.au www.sydneyvision.com.au

  2. Techniques Being Compared SMILE – Small-incision Lenticule Extraction LASIK – Wavefront Guided Femtosecond Laser-assisted Laser in Situ Keratomileusis

  3. Literature Reviews: LASIK articles published between 2008 and 2015 containing clinical outcomes were reviewed and graded. (Sandoval et al.) All studies of SMILE, and wavefront guided femtosecond laser-assisted LASIK published from January 2012 to September 2015 were reviewed. (Pinero et al.)

  4. LASIK Articles Reviewed (Sandoval et al.) • LASIK articles published between 2008 and 2015 containing clinical outcomes were reviewed and graded. • There were 97 relevant articles (67,893 eyes) • Conventional (standard) treatment, and Advanced treatment (wavefront-guided, wavefront-optimized, or topography-guided) were catagorized

  5. LASIK History • LASIK is one of the most commonly performed elective procedures • More than 16 million LASIK procedures performed globally • LASIK was introduced by Pallikaris et al. in 1990. • Excimer laser approved by FDA in 1995 • LASIK approved by FDA in 1999

  6. LASIK Visual Outcomes Loss or gain of CDVA: • In aggregate, more than twice as many eyes gained 2 or more lines of CDVA (1.45%) as lost 2 or more lines of CDVA (0.61%) • The percentage of eyes with a loss of 2 or more lines was statistically significantly lower in advanced group (0.6%), than in the conventional group (0.94%) • The percentage of eyes with a loss of 2 or more lines was statistically significantly higher in eyes treated for hyperopia (2.13%), than myopia (0.95%)

  7. LASIK Visual Outcomes UDVA Results: • 90.8% of eyes had UDVA 20/20 or better p/op • 99.5% of eyes had UDVA 20/40 or better p/op • Postoperative UDVA statistically significantly better in advanced treatment results (-0.04 logMAR), than conventional treatment results (+0.05 logMAR) – the difference being almost 1 line

  8. LASIK Visual Outcomes UDVA Results (cont): • No difference in results between wavefront-guided, wavefront-optimized, or topography-guided treatments in the advanced treatment group

  9. LASIK Visual Outcomes UDVA Results (cont):

  10. LASIK Visual Outcomes UDVA Results (cont):

  11. LASIK Visual Outcomes Residual SE Refrative Error: • 90.9% within +0.50D • 98.6% within +1.0D • In 95% eyes, the mean SE was within +0.25D

  12. LASIK Outcomes Corneal Sensation & Dry Eye: • Multiple studies have shown that corneal sensation returns to normal in almost all cases at 6 months p/op • 0.8% incidence of dry eye 1 year p/op (Bower et al.) • Preoperative dry eye predictive of postoperative dry eye

  13. LASIK Outcomes Patient Satisfaction: • 98.7% of all patients were satisfied or very satisfied after LASIK surgery • 97% of patients (in response to a survey) said they felt they were better off having had the surgery (Kezirian et al.)

  14. LASIK Outcomes Advanced LASIK vs Standard LASIK: • Mean UDVA for conventional LASIK was within a half a line of 20/20 • UDVA in advanced treatment group was nearly 1 line better than in the conventional group

  15. LASIK Outcomes Advanced LASIK vs Standard LASIK (cont): The aggregate data from a large number of recent articles demonstrates the outcomes of modern LASIK are significantly better than when the technology was first introduced. Some reasons for this are likely to be: • Improved diagnostic and laser technology and patient selection, • better refinement of nomograms, • more sophisticated ablation patterns • Introduction of new technology (femtosecond laser for flap creation etc)

  16. SMILE and LASIK Articles Reviewed (Pinero et al.) All studies of SMILE and wavefront-guided femtosecond laser-assited LASIK published from January 2012 to September 2015 were reviewed

  17. Visual Outcomes (cont): • SMILE – 66.7% of studies reported 80% or more eyes achieving 20/20 or better UDVA • LASIK – all studies reported 80% or more eyes achieving 20/20 or better UDVA (Figure 2) Comparison of studies:

  18. Visual Outcomes (cont): • SMILE – 40% of studies reported 90% or more eyes achieving 20/20 or better UDVA • LASIK – 75% of studies reported 90% or more eyes achieving 20/20 or better UDVA (Figure 2) Comparison of studies:

  19. Visual Outcomes (cont): Figure 2

  20. Visual Outcomes (cont): • No clear difference in loss of lines of CDVA • Higher percentage of eyes gained lines of CDVA with LASIK than SMILE (possibly due to less corneal backscatter present early post LASIK) CDVA:

  21. Refractive Outcomes: • SMILE – Mean P/OP SE of -0.01D to -0.33D • LASIK – Mean P/OP SE of -0.02D to -0.17D (figure 5) Spherical Equivalent:

  22. Refractive Outcomes: • SMILE – 67.6% - 100% within + 0.50D of target SE • LASIK – 80% - 100% within + 0.50D of target SE • SMILE – 95% - 100% within +1.0D of target SE • LASIK – 96% - 100% within +1.0D of target SE (figure 5) Spherical Equivalent (Cont):

  23. Refractive Outcomes (SE): Figure 5

  24. Refractive Outcomes: • Suggests a slight trend toward myopic residual SE in SMILE which would explain the lower UDVA Spherical Equivalent (Cont):

  25. Refractive Outcomes: Mean P/OP Astigmatism at 12 months: • SMILE: -0.40D +0.32D (Gyldenkerne et al.) • SMILE: -0.36D +0.38D (Qian et al.) • LASIK: -0.28D +0.30D (He et al.) • LASIK: -0.09D +0.13D (Prakash et al.)

  26. Refractive Outcomes: Further P/OP Astigmatism results: • SMILE: 95% eyes 0.5D cyl or less (Reinstein et al.) • SMILE: 92% eyes 0.5D cyl or less (Sekundo et al.) • SMILE: 79.1% eyes 0.5D cyl or less (Yao et al.) • LASIK: 87% eyes 0.5D cyl or less (He et al.) • LASIK: 95% eyes 0.5D cyl or less (Yu and Manche) • LASIK: 94% eyes 0.25D cyl or less (Prakash et al.)

  27. Ocular & Corneal Aberrometric Outcomes • SMILE: 0.24um to 0.706um • LASIK: 0.15um to 0.28um Higher levels of coma seem to be related to mild levels of treatment decentration Mean Coma RMS:

  28. Corneal Sensation and Dry Eye Outcomes • Corneal sensitivity: Significantly less decrease in corneal sensitivity in SMILE than LASIK in early postoperative measures (1 week, 1 month, 3 months) • No significant difference in corneal sensitivity at 6 months post op. • TBUT: Less decrease in SMILE in the early postoperative period • Schirmers Test: Less decrease in SMILE in the early postoperative period

  29. Re-treatment Comparisons: • Limited evidence of the outcomes of SMILE re-treatments • Results of surface ablation re-treatments in SMILE eyes are poor • Successful re-treatments have been reported post LASIK

  30. Other Comparisons of note: • Increase in backscattered light intensity early postoperatively after SMILE compared with LASIK which may be the cause of the limitations in early postoperative SMILE outcomes • Biomechanical changes occur after both procedures with no evidence supporting the superiority of one technique over the other • Scientific evidence supporting the stability of results exists for LASIK, but does not yet exist for SMILE

  31. References • Sandoval H.P, Donnenfeld E.D, Kohnen T, Lindstrom R.L, Potvin R, Tremblay D.M, Solomon K.D. Modern Laser in situ keratomileusis outcomes. J Cataract Refract Surg 2016; 42:1224-1234 • Pinero D.P, Teus M.A. Clinical outcomes of small-incision lenticule extraction and femtosecond laser-assisted wavefront-guided laser in situ keratomileusis. J Cataract Refract Surg 2016; 42:1078-1093

  32. Thank You! Dr. David Robinson M.B., B.S., B.Sc. (MED), F.R.A.N.Z.C.O.,F.R.A.C.S. david@sydneyvision.com.au www.sydneyvision.com.au

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