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  Many of us have had patients who are not good candidates for LASIK. Frank's article reviews several treatment options for these patients and discusses details that must be considered. As always, enjoy!
Lori Youngman, OD
PCLI—Vancouver, WA |
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 Counseling, expectations and surgical options for high myopes can pose challenges for ODs and surgeons. While LASIK is usually our preferred treatment, other options may be more appropriate for high myopes-especially when they have:
Counseling High Myopes
Pre-op counseling is important for all refractive surgery patients, but high myopes require additional discussion concerning:
Options to Consider
RLE is often the best option for presbyopic patients. But PRK and ICLs should be considered for younger eyes when corneas are too thin or flat, or pupils are too large for LASIK.
When corneas are thin:
To avoid weakening corneas, LASIK is not advisable when pachymetry measurements are less than 500 microns. But PRK and ICLs are alternatives. Since there is no flap with PRK, less corneal thickness is required for the same amount of treatment. ICLs are a safe option as they do not affect corneal tissue.
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When corneas are flat:
Patients with flat corneas may be good candidates for ICLs. Normal corneas are prolate in shape—being steeper centrally and flatter peripherally. LASIK and PRK performed on high myopes will significantly flatten the central cornea and may result in glare or foggy vision that gets worse in reduced light. In extreme cases the prolate shape may become oblate with the central cornea flatter than the peripheral. Wavefront analysis has helped us understand the importance of maintaining prolate corneas. While laser vision correction advances allow us to do a better job of preserving prolate corneas, treatments for high myopia can require such extreme changes in corneal curvature that the risk of unwanted aberrations is high. ICLs may be a better option.
When pupils are large:
 PRK may be the best option for patients with large pupils. With laser vision correction, these folks are at risk of annoying glare and night vision problems and will generally benefit from the larger treatment zones of PRK. Because the amount of tissue removed is directly related to treatment zone size, larger treatment areas result in deeper ablations. When high myopia is combined with large pupils, there may not be enough corneal thickness for LASIK-even when the cornea is thicker than 500 microns. Because no flap is required with PRK, less corneal depth is required and larger treatment zones are possible. ICLs are not a good option for patients with large pupils. Current lenses are only 6mm and will cause disturbing glare and halos.More About ICLs
Conclusion
Successful refractive surgery requires careful patient selection, counseling, appropriate procedure, and follow-up care. While most patients are well served with LASIK, consider other options for high myopes. Click here to request or download patient education materials we have produced on PRK, ICLs and RLE.
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Laser Vision Correction of Astigmatism
Our success in treating higher amounts of astigmatism is summarized in this table.
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Continuing Education—Alaska Style
This summer Dr. Paul Barney, optometric physician in our Anchorage office, provided 10 hours of COPE-approved education to a group of his adventurous colleagues. If you know Paul, he loves getting into the wild—so this invitation was right up his alley! |
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A small group of doctors flew in to a hunting and fishing lodge in Chignik, a remote village near the start of the Aleutian Islands. Big bear country for sure! Click here to see some fun pictures.
If you are interested in attending CE events in Alaska, contact Paul Barney, OD at paul.barney@pcli.com
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6 Hours of Free CE
 Presented by PCLI in cities throughout the Northwest.
Schedule
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PCLI’s Web Services
Visit the “For Doctors” section of our website for free services that can benefit your practice.
See the top of this page for shortcuts to these services.
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Corporate Office
2517 NE Kresky Avenue
Chehalis, WA 98532
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Copyright © 2008 Pacific Cataract and Laser Institute. All rights reserved.