Post-LASIK Education: Let Patients Know They Still Need You

Providing ongoing care for post-LASIK patients keeps them in your practice and ensures that they receive the services and products they need.

LASIK has become a common procedure improving the lives of many of those who undergo it, but many of those same patients don’t realize that they still need to visit their eye doctor annually. In addition to co-managing pre- and post-operative care for LASIK patients, ODs need to educate these patients about why they still need to visit for a comprehensive exam each year. Education also is needed about which products, such as sunwear, are still beneficial, and why a successful LASIK procedure doesn’t mean a patient won’t need to address presbyopia.

Vision and Eye Health Could Change

Although patients can now see well, they need to be examined on an annual basis. For those getting close to presbyopia, they may need reading glasses in the near future and need to continue monitoring their eye health for such issues as glaucoma, cataracts and macular degeneration. Other LASIK patients are very non-compliant and literally disappear after their surgeries, either showing up rarely or never again.

Monitor and Treat LASIK-Related Dry Eye

Many LASIK patients are people who have had dryness issues that affected their ability to wear contact lenses and require treatment methods for anyone who has dryness including lubricants, Omega 3 supplements and punctal plugs when necessary.

Educate On Added Need for Sunwear and Driving Eyewear

LASIK patients are more prone to glare problems after surgery, especially at night. Many patients have LASIK with a monovision modality, so their eyes are unbalanced for distance vision and these patients can often benefit from night driving eyeglasses, as well, that balance both eyes to distance.

Monitor Eye Health Long-Term

Continue to monitor post-LASIK patients for the same medical eyecare problems that can affect anyone such as glaucoma and cataracts. Also monitor the cornea for any signs of a condition called ectasia, which is an abnormal thinning and bulging of the cornea. Since the surgery leaves the cornea thinner, this can happen, although it is uncommon.

Anticipate the Rare Poor LASIK Outcome

In most of these cases, the problems were not medical, but a result of a patient with unrealistic expectations. Some patients who had the oldest refractive surgery, radial keratotomy (RK) have had massive shifts in their refraction over the years, ending up extremely hyperopic. In addition, their best corrected visual acuity is often not correctable easily to 20/20 vision.

Generate Post-LASIK Patient Referral

Ask for referrals of the patient’s friends, family and co-workers who may be interested in LASIK surgery. Often, the patient’s happiness and enthusiasm is highest right after the surgery, so this is a good time to ask for referrals. The referred patients will not necessarily be excellent candidates for surgery, but will then continue coming to our office for their eyeglasses and contact lens needs.

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Optical Coherence Tomography Useful for Macular Edema

In patients with diabetic macular edema, visual acuity (VA) correlates with the magnitude of change in central macular thickness (CMT). The strongest correlation with VA is the absolute and relative change in CMT from baseline to the first laser photocoagulation. CMT taken at a single time point is not as strongly correlated with CMT.

Diabetic macular edema is the leading cause of vision loss among patients with diabetes. Prevalence estimates of macular edema in patients with diabetes range from 2-10%. The response of macular edema to treatment varies.

Overall, 73.9% of patients with diabetic macular edema had an OCT type 1 pattern of diffuse retinal swelling. The type 1 pattern correlated better with VA than the type 2 pattern.

Eye Exam 101

Getting a comprehensive eye exam is an important part of staying healthy. But do you know what the exam should cover?
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A comprehensive eye exam is a painless procedure that should check on the following:
• Your medical history — assessed through questions about your vision and family history.
• Your visual acuity — tested by reading a standardized eye chart.
• Your pupils, evaluated to determine how well they respond to light.
• Your eye movement, which is tested to ensure proper eye alignment and ocular muscle function.
• Your prescription for corrective lenses — evaluated to ensure proper vision correction.
• Your side vision, tested for possible vision loss and glaucoma risk.
• Your eye pressure, tested as a possible glaucoma symptom.
• The front part of your eye, examined to reveal any cataracts, scars or scratches on your cornea.
• Your retina and optic nerve — assessed through a dilated eye exam using special eyedrops, which allows your Eye M.D. to thoroughly examine the back of the eye for signs of damage from disease.

Each part of the comprehensive eye exam provides important information about the health of your eyes. Make sure that you are getting a complete examination as part of your commitment to your overall health.

Bevacizumab, Aflibercept Reduce Macular Edema

Two new studies show that bevacizumab and aflibercept can reduce macular edema and improve visual acuity in patients with central retinal vein occlusion (CRVO). The two drugs block vascular endothelial growth factor (VEGF), as appeared in Ophthalmology.

Visual acuity in the bevacizumab group improved by a mean of 7.5 letters at 6 weeks. 11.4 letters at 12 weeks, 13.9 letters at 18 weeks, and 14.1 letters at 24 weeks. More patients in the bevacizumab group had no residual edema at 24 weeks.

In a second study using aflibercept, at week 24 56.1% of eyes treated had gained 15 letters or more from baseline. Macular edema declined to a significantly greater extent with aflibercept than with a sham treatment.

No serious adverse events with bevacizumab, but there was one case each of endophthalmitis, maculopathy, ocular discomfort, and retinal artery occlusion attributed to aflibercept treatment.