http://www.eyeworld.org/article.php?sid=3063Physicians in the...

http://www.eyeworld.org/article.php?sid=3063

Physicians in the U.S. that have performed Epi-LASIK for at least 18 months praise its safety profile and less pain compared with PRK. “I prefer the safety of Epi-LASIK. If you have a problem, you don’t have much of a problem [to correct],” said Robert N. Brems, M.D., Phoenix. In fact, Dr. Brems will use Epi-LASIK when patients cite safety as their main concern and has occasionally had patients that ask specifically for that procedure.
“There’s little that can go seriously, unfixably wrong with this,” said Marguerite B. McDonald, M.D., F.A.C.S., clinical professor of ophthalmology, Tulane University, New Orleans. “Even the few stromal incursions have subsequently done well. Surface ablation provides better results than LASIK with wavefront surgery (better contrast sensitivity, low contrast acuity, etc); besides, doctors don’t really enjoy making that stromal flap,” which is where LASIK-related problems often stem from, she said.
Physicians also tout Epi-LASIK because it does not induce dryness, as LASIK might. Dr. Brems will often perform Epi-LASIK on patients that use eyedrops and Restasis (cyclosporine emulsion, Allergan, Irvine, Calif.). He finds their dryness is neither better nor worse post-op.
Pain has not been a major issue in Epi-LASIK patients, either, physicians said. The use of intra-op and post-op has helped patients of Mark Volpicelli, M.D., Mountain View, Calif., control prednisone their pain. He prescribes 60 mg a day of Pred Forte (Allergan, Irvine, Calif.) for two to three days, followed by 30 mg a day for another two to three days.

The downsides

The biggest downside of Epi-LASIK is its longer recovery time compared with LASIK, physicians said. The longer recovery time often bothers patients that have friends with previous LASIK. “It’s not like their neighbor who had LASIK yesterday and is driving to their appointment today and going back to work,” said Dr. Volpicelli. “You have to keep their expectations in line with surface ablation,” he said.
Dr. Volpicelli will tell patients to expect scratchy, slightly blurry vision in the 20/40 to 20/50 range the first four to five days. Some doctors even recommend their patients take off of work for a week. Although Dr. McDonald said her patients can often legally drive on post-op day one, three-month Epi-LASIK prospective trial results sponsored by Norwood Eyecare (Duluth, Ga.) have shown that 20/63 visual acuity is the norm on days one to four, followed by 20/40 on day seven and rapid improvement thereafter.
“The study shows that, on average, the patients can usually cook, shop, dress, and do everything but drive during that first week post-op, although many of them can,” she said.
Another possible issue with Epi-LASIK—but one that can be remedied—is overhydration of the epithelium, said Dr. Brems. “When you saturate with balanced salt solution [BSS], the area gets cloudy and milky. These patients tend to heal slower,” said Dr. Brems.
To tackle this, he uses what he described as a relatively dry procedure with 15 mL chilled BSS, which he said also helps patients’ comfort level and leads to clearer corneas.
“The epithelium is nice and clear because there’s not a bunch of fluid,” said Dr. Brems.
Finally, Dr. Volpicelli said he worries about the risk for stromal intrusion with Epi-LASIK. The separation with the epikeratome could put as many as 1% of patients at risk for stromal intrusion, he said. Epi-LASIK creator Ioannis G. Pallikaris, M.D., Ph.D., University of Crete, Greece, is researching how to make a smoother separation process.

Editors’ note: Dr. McDonald is a medical monitor and consultant for Norwood Eyecare. Dr. Volpicelli has no related financial interests.

Contact Information
Brems: 602-200-0770, [email protected]
McDonald: 504-232-3641, [email protected]
Volpicelli: 650-961-2585, [email protected]