We're now a decade and a half into the LASIK era, not exactly long-term by medical standards but long enough that some of the risk associated with the procedure have been put to rest, or at least better understood and managed. Post-LASIK dry eye, for example, in most patients can be avoided or successfully treated until the eye recovers normal function.

A focus on better patient selection, improved diagnostic capabilities and more precise technology to create the flap are a few reasons that the incidence of post-LASIK ectasia does not appear to be on the rise as LASIK procedures have increased. While ectasia can't yet be consigned to the "problem solved" pile, there is heartening news on both the treatment and diagnostic fronts of this rare but disabling complication.

First, a combined Irish and U.S. study published this past spring was one of the first to include a large number of patients (107 eyes) and long follow-up (range five to 11 years).1 Despite some study limits, the authors  conclude that, even in their study of highly myopic eyes, "If careful preoperative screening and preoperative surgical planning are performed to avoid thin residual stromal beds and intraoperative pachymetry is performed to identify unexpected thick flaps, ectasia will not be a long-term issue after LASIK."

This is coming at an opportune time as more refractive surgeons are confronting the issue of enhancement, and how to safely proceed with further ablation on a LASIK eye.

Our own article on the topic this month finds improvements in both the treatment of ectatic and keratoconic eyes, and in the assessment of risk for postop ectasia. Not in the least surprisingly, the latter appears to reinforce a common theme in medicine: that there are multiple risk factors that need careful consideration, and the "magic bullet" (250 microns, anyone?) approach once again fails. You can read about these advances in "Update: Managing and Predicting Ectasia."

There is much to be learned about this condition, and post-LASIK ectasia can still occur in an individual patient who shows no obvious preoperative warning signs. The ectasia story seems to reinforce an oddity in medicine: You need large numbers and a long time to make any solid judgments; but that judgment still comes down to you and a single patient.

 

1. J Cataract Refract Surg 2007;33:583-589.