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Editorial Spotlight | May 2015

Firsthand Understanding of the Patient Perspective

This surgeon decided to experience two excimer laser platforms in his own eyes.

LASIK treatments account for 32% of refractive surgical procedures performed at the Eyereum Eye Clinic, and surface ablation treatments comprise 68%. Of the LASIK treatments, 90% use a customized protocol. Of the surface ablation treatments, 81% use a transepithelial PRK (trans-PRK) approach.

In November of last year, I decided to undergo laser vision correction to address my own hyperopia. Previously, I had been able to accommodate well, despite my hyperopia, from approximately 3.00 to -2.00 D, and I had good vision at near and far distances. The first symptoms of presbyopia appeared when I reached 40 years of age. Near vision became a challenge, both in my daily clinical work and in my leisure activities. It was clear to me that I would soon need laser correction, and I decided to act sooner rather than later.

At the time I decided to undergo laser vision correction, the SmartPulse technology (Schwind eye-tech-solutions; Figure 1) had recently become available. This technology ensures that, immediately after ablation, corneal smoothness is achieved. At Eyereum, I am able to choose from numerous laser platforms from different manufacturers. I decided on the Amaris (Schwind eye-tech-solutions) because of the good results I have seen with it when treating my patients. Key features such as static and dynamic cyclotorsion control, a 1,050-Hz repetition rate, and the SmartPulse technology ensure reliable, effective, and safe laser treatment with the Amaris laser.

TREATMENT APPROACHES

My preoperative refractions were +2.50 -0.12 X 177º, yielding 20/20 BCVA in my right eye, and +2.75 -0.25 X 180º, yielding 20/20 BCVA in my left. The laser correction was performed at the Eyereum Eye Clinic by Choi Jin Young, MD, and Ha Byung Jin, MD. Dr. Choi treated my right eye using the Amaris 1050RS with SmartPulse technology (Figure 2), and Dr. Ha treated my left eye using the Amaris 750S without SmartPulse technology. Both surgeons used corneal wavefront analysis with the Keratron Scout corneal aberrometer (Optikon) in planning femtosecond LASIK (femto-LASIK) surgery for each eye.

One might ask why two different lasers were used to treat my two eyes. Simply, I use both lasers regularly in my clinical practice. It seemed only fair to my patients that I should experience for myself the process of undergoing laser treatment with each; I believe that I am now a better physician and an ophthalmologist because of it. Having been treated with both and knowing firsthand the difference that my patients will undergo has surely increased my understanding from the patients' points of view.

At a Glance

• Key features such as static and dynamic cyclotorsion control, a 1,050-Hz repetition rate, and the SmartPulse technology ensure reliable, effective, and safe laser treatment with the Amaris laser.
• In Dr. Kang's experience, the rapid recovery of visual acuity with SmartPulse technology and the quality of vision immediately after the treatment were impressive.

This same reasoning applied in the choice of treatment method. I asked my operating surgeons to use a femto-LASIK approach and to employ corneal wavefront analysis for treatment planning. I chose femto-LASIK because rapid recovery of visual acuity was important to me. A customized treatment plan was important because this is my treatment of choice for most patients. How could I convince my patients of the benefits of a customized treatment method if I did not experience it myself?

Incidentally, what I remember most vividly about undergoing the treatment is the sights and sounds. For example, the noises made by the laser sounded quite different from a lying position, as opposed to my usual position sitting at the microscope. I also recall my perception of the aiming light, which looked rather like a large green halo, and the actual laser pulses resembled a fireworks display.

RESULTS

Postoperatively, I achieved a UCVA of 20/13 in each eye. In terms of visual outcome, there was no significant difference between the results in my left and right eyes. However, my visual acuity recovered significantly faster in my right eye, which was treated with SmartPulse technology.

I had excellent scotopic vision postoperatively, right from the outset. Then the winter arrived, which brings a dry climate in Korea. My eyes became very dry, especially in the morning, but then everything was fine after 1 or 2 months.

Immediately after the operation, I tried not to blink, even though I knew that not blinking would actually cause the cornea to become drier. This was probably due to the topical analgesia and the fear that I might lose the therapeutic contact lenses. Now I have a better understanding about why some of my patients do not blink following laser correction, although we encourage them to do so.

On the morning after the treatment, my newly acquired quality of vision became fully apparent. I was able to read the newspaper without squinting my eyes or reaching for my reading glasses. After a few months, my eyes felt as good as though I had never had laser eye surgery.

CONCLUSION

I am pleased that I made the decision to have laser vision correction. The rapid recovery of visual acuity with SmartPulse technology and the quality of vision immediately after the treatment really were phenomenal. My patients also experience this so-called wow effect, especially after LASIK treatments.

I consider it likely that I will have further laser treatment in the future on account of advancing presbyopia. At present, my residual accommodative ability is sufficient to provide good near and far vision.n

David Sung Yong Kang, MD
• Clinical Director, Eyereum Eye Clinic, Seoul, Korea
kangeye@eyereum.com
• Financial disclosure: None

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