Archive for April, 2007

A new University of Illinois at Chicago study appearing in the online edition of the journal Ophthalmology reports on the safety, efficacy and predictability of laser eye surgery (laser in situ keratomileusis or LASIK) in patients 40-69 years old.

“We are seeing an increasing demand for LASIK surgery for older adults, who present special challenges,” said study co-author Dr. Dimitri Azar, Field chair of ophthalmologic research at UIC.

In LASIK surgery, adjustments in correction are routinely made to compensate for the cornea’s strong healing responses in younger patients, Azar said. Increased age has been previously associated with poorer final clarity of vision, as measured on an eye chart (visual acuity).

“We were able to show that fine adjustments in the correction to the cornea in our older patients that compensate for differences in age-related healing resulted in reliable predictability of correction,” said Azar, who is also professor and head of the UIC department of ophthalmology and visual sciences.

The researchers examined the case histories of 710 consecutive laser eye surgeries on 424 patients between 40-69 years old. The LASIK surgeries were performed to correct myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. All surgeries were performed by Azar between January 1999 and September 2005.

The cases were divided into three groups based on age: group one, 40-49 years old (359 eyes); group two, 50-59 years old (293 eyes); and group three, 60-63 years old (58 eyes).

Outcomes of the laser surgery corrections were analyzed for near-sightedness with or without astigmatism (511 eyes) and far-sightedness with or without astigmatism (199 eyes). Patients’ outcomes included a follow-up of at least six months and, where possible, 12 months. The study found no difference in safety between the groups.

At the final follow-up of the nearsighted-corrected patients, 86 percent of eyes in group one, 85 percent of group two, and 100 percent of group three had 20/30 or better visual acuity without glasses. In all groups, there was 20/40 or better visual acuity for 91 to 100 percent of patients.

For farsighted patients, 80 to 84 percent of all groups had 20/30 or better visual acuity at final follow-up, with 91 to 97 percent of all groups achieving 20/40 or better uncorrected vision. There was no statistical significant difference in final visual acuity between the different age groups.

Another challenge for older patients is difficulty with near vision after LASIK due to the loss of the ability to accommodate (presbyopia), Azar said. “As we age, we lose some elasticity of the lens of the eyes, making it impossible to maintain a clear image as objects are moved closer,” he said.

Many patients in the study opted for monovision, a strategy that compensates for presbyopia by correcting one eye for distance and the other eye for near vision.

“Patients who understand that monovision is a compromise that does not restore accommodation, but rather compensates for its loss, are most likely to adapt well to monovision,” Azar said.

“Although LASIK presents different challenges in the presbyopic age group, our study showed that for this age group, 40-69 years old, LASIK correction for near-sightedness and far-sightedness has reasonable safety, efficacy and predictability,” he concluded.

Source: Medical News Today 

Popularity: 5% [?]

THOUSANDS of patients having laser eye surgery are at risk of catching MRSA in the wound, ex­perts said yesterday.

It has been discovered that some who have received the treatment have gone on to suffer a superbug infection in their eye.

Doctors are particularly worried because none of the affected patients was treated in hospitals where the bacteria was rife.

Instead, they may have contracted MRSA from their communities, in what is becoming a growing problem in both America and the UK.

According to experts in the US, 12 patients who underwent laser eye surgery subsequently developed MRSA.
All had been treated in private clinics which are supposed to be so sterile that MRSA cannot survive.

In one case, a male nurse who had a treatment called Lasik in both eyes had almost perfect vision after his operation.

But within two weeks, his left eye had developed an infection that grew worse until his vision was only 20/400 – which meant he was blind in that eye.

It turned out he had been struck down with MRSA, and even after treatment his vision was still left at 20/200, which is severely impaired.

According to a report in the American Journal of Ophthal­mology, patients should be warned that there is a risk of suffering an eye infection – known as MRSA keratitis – after the procedure.

Dr Eric D Donnenfeld, who led the study, said: “MRSA eye infection is a potentially serious complication following refractive surgery.

“Surgeons should now be vig­ilant for community-acquired MRSA keratitis.

“All patients should be in­formed of the risk factors and warning signs of infectious keratitis, and need to be advised to seek medical attention immediately if they develop signs or symptoms.

“A high degree of suspicion, coupled with prompt and appropriate treatment, may result in improved visual recovery.”

Around 100,000 people in Britain had corrective laser sur­gery last year – three times the number in 1996.

There are now almost 100 clinics offering the treatment across the country as people shun the expense and hassle of contact lenses and glasses.

Source: Daily Express 

Popularity: 11% [?]

Researchers identified 13 cases of infection by methicillin-resistant Staphylococcus aureus in eyes treated with laser refractive surgery procedures, possibly representing the first reported series of infectious keratitis caused by the organism, according to the study authors.

“According to a computerized MEDLINE literature search, this is the first case series of MRSA (methicillin-resistant Staphylococcus aureus) infectious keratitis following refractive surgery, the first reports of MRSA keratitis after refractive surgery in patients with no known exposure to a health care facility, the first report of MRSA keratitis after [LASIK] enhancement, and the first reports of MRSA keratitis after prophylaxis with fourth-generation fluoroquinolones,” the study authors said.

Eric D. Donnenfeld, MD, and colleagues reviewed records for 13 cases of MRSA keratitis at 10 centers. The study included eight patients treated with primary LASIK, one patient treated with a LASIK enhancement and two patients treated with PRK. One of the PRK patients developed a bilateral infection, according to the study.

Five patients were health care workers, and four had exposure to health care settings. Three patients denied having any exposure to health care settings, the authors noted.

In all cases, the infection was located at the interface and was associated with interface inflammation. Physicians treated all cases with two topical antibiotics, including fortified vancomycin in all but one case. This one patient received fortified gentamicin and cefazolin, according to the study.

In addition, surgeons performed penetrating keratoplasty in two patients. Another four eyes are awaiting PK and one eye is awaiting phototherapeutic keratectomy (PTK).

“After treatment, in the eyes not scheduled for a PK or PTK, best corrected visual acuity ranged from 20/20 to 20/100,” the authors reported.

“MRSA infectious keratitis is a potentially serious complication following refractive surgery,” the authors wrote.

“Surgeons should now be vigilant for community-acquired MRSA keratitis. All patients should be informed of the risk factors and warning signs of infectious keratitis and need to be advised to seek medical attention immediately if they develop signs or symptoms of infectious keratitis. A high degree of suspicion, coupled with prompt and appropriate treatment, may result in improved visual recovery,” they said.

Source: OSN Super Site 

Popularity: 9% [?]

Our eyes have higher order aberrations that are not correctable with glasses or contact lenses. In order to resolve these higher-order aberrations that are often linked to the visual glare and halos that cause night vision problems and vision quality, Wavefront Lasik Customization can be used.

A wavefront map is used to diagnose and measure the higher order aberrations. This Wavefront map is created by bouncing harmless light rays off the patient’s retina.

Results are then fed into a complex computation program, which calculates a superior ablation profile that not only attempts to retain the natural shape of the cornea but also targets any previous aberrations within a patient’s eye.

Moreover, the higher speed laser shortens the surgery time to provide greater patient comfort and increased reliability.

A specialized laser algorithm called Optimization is then used to retain the natural shape of the patient’s cornea. By trying to keep the natural shape of the cornea, the surgeon personalizes the surgery to adjust for the natural shape, thickness, and prescription of each patient’s eye.

The benefits are as follows:

1. Improved treatment accuracy

2. Increased quality of vision

3. Reduced chance of night vision problems, such as halos

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Popularity: 10% [?]