Refractive Surgery LASIK is the clear choice for treating hyperopia, surgeon says Compared with PRK, LASIK allows for quicker visual recovery, causes less postoperative pain and produces stable vision more quickly. May 15, 1999 WAIKOLOA, Hawaii - Compared with photoablative correction for myopia, laser treatment of hyperopia is relatively new, and according to Frank Price, MD, a corneal specialist in private practice in Indianapolis, laser in situ keratomileusis (LASIK) offers patients clear advantages over photorefractive keratectomy (PRK). "I am not a proponent of PRK and I think there are better vehicles to treat hyperopia," Dr. Price told attendees of Hawaii ’99, sponsored by Ocular Surgery News and the New England Eye Center. "One of those vehicles is LASIK." While the long-term visual prognoses may be similar for all successfully treated hyperopia patients, regardless of whether they underwent PRK or LASIK, it is the period immediately following surgery where LASIK shines, he said. Dr. Price said he prefers LASIK to PRK in the treatment of hyperopia because LASIK provides the patient with more rapid visual recovery, less postoperative pain and discomfort, and stable vision more quickly. LASIK, he said, typically does not require postoperative topical steroids and, generally, re-treatments are easier to perform when they are necessary. More risk, less convenient Comparatively speaking, hyperopic PRK entails slightly more risk and is less convenient, he said. "The big problem with hyperopic PRK is that we have to remove the epithelium," he said. "Just as in myopia treatments, this leads to discomfort, slow visual recovery and prevents surgeons from performing simultaneous, bilateral cases. Long term, there may not be a difference between PRK and LASIK in terms of visual acuity, but it is those first 2 or 3 months out that is the problem." LASIK is easier on the hyperopic patient after surgery because treatment for hyperopia with PRK requires that 10 mm of the epithelium be stripped for a 9-mm treatment zone. In PRK for myopia, a 6-mm treatment zone with a 7-mm epithelial removal usually is acceptable. "In hyperopic PRK, we must add significantly to the amount of epithelium that must be stripped, so it is going to take a lot longer to heal," he said. Dr. Price’s argument for hyperopic LASIK is similar to the arguments heard in the past when LASIK was being compared with PRK for the treatment of myopia. However, because hyperopic corrections require larger diameter surface ablations, more intensive postoperative treatment is necessary, and those arguments may be more poignant. Less recovery time With non-steroidal anti-inflammatory drugs (NSAIDs) such as Acular (ketorolac tromethamine, Allergan) and Voltaren Ophthalmic (diclofenac sodium, CIBA Vision) and the use of a bandage contact lens, post-PRK pain can be effectively managed. However, NSAIDs have been shown to slow healing, and even when pain is effectively managed, most hyperopic PRK patients are not in a position where they can readily resume normal day-to-day functioning. On average, according to Dr. Price, it takes hyperopic PRK patients 6.8 days to heal. Most of his LASIK patients are able to resume normal daily activity 1 day postoperatively, and any post-surgical discomfort tends to last only about 6 hours. "It is the rare LASIK patient who is unable to return to work after 2 days," he said. Laser tracking is important Laser refractive surgery for hyperopia, which steepens the cornea from its periphery rather than flattens its center, may surgically be less forgiving than treatments for myopia. As a result, the tracking capability of a laser is significantly more important in the treatment of hyperopia. Even when tracking is precise, however, there is a possibility that a geometrically stable pattern is not always achieved. "The refractions we get postoperatively when we are treating hyperopia are not as stable as they are when we are treating myopia," Dr. Price said. For this reason, too, LASIK may be a better choice than PRK because it is generally easier to re-treat LASIK patients, he added. For Your Information: * Frank Price, MD, can be reached at 9002 N. Meridian St., Ste. 100, Indianapolis, IN 46260; (317) 844-5530; fax: (317) 844-5590. Dr. Price has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned. Copyright 1999, SLACK Incorporated. Revised 7 May 1999.