Ronald Krueger, MD, an ophthalmologist at the Cleveland Clinic talks about a new twist on Lasik surgery that has patients seeing better than ever.
Interview conducted by Ivanhoe Broadcast News in August 2016.
What is laser vision correction surgery and who benefits from it?
Dr. Krueger: Well, it’s basically using laser technology to actually change a prescription of somebody’s eye so they can see well at a distance or any target that they like without glasses or contacts. The person who qualifies is the one who has a prescription problem and is tired of glasses and contacts; and everything with their eye exam is normal.
What is new in the field?
Dr. Krueger: The newest thing that’s come about this within this past year in 2016 is topography guided correction. We’ve had customization of Lasik surgery for at least the last fourteen, fifteen years and that keeps evolving and getting better. We see different levels of customization and this is the latest form of customization. It really takes the front surface of the eye, the curvature of your cornea and the contour in a unique shape and customizes that to get you a very uniform cornea that really gives you a good visual outcome. It’s really been the best outcomes in any FDA study of laser vision correction to date.
Who are the best candidates for this type of procedure?
Dr. Krueger: The candidates really are those with nearsightedness up to about eight or nine diopters with some levels of astigmatism. The ones that have any astigmatism really benefit a lot because astigmatism is different in every single person in terms of its shape and distribution, and we can map that out in great detail and custom treat it so it gets the most regular shape.
How is this procedure done?
Dr. Krueger: It can be done as Lasik surgery, that’s where the approval was done and basically we will do a laser created flap and then move it under the typical laser that reshapes the eye and the mapping of what we’ve captured; then it is downloaded into the laser with all the specifics and it treats your eye just the same; so really nothing has changed in the Lasik procedure. The actual steps are the same, it’s not like someone has to learn new steps, except for the steps beforehand which is loading in the information and getting it all properly lined up so that we have this custom treatment.
Can you talk a little bit about how the mapping works and what that means exactly?
Dr. Krueger: The outer shape of the eye is the cornea and the tear film that lies on the cornea bends the light most in the eyes. What we call the most refractive structure of the eye and all the small details of that outer surface can affect the sharpness and the clarity of the focus. If we can regularize that outer surface as much as possible, we can get a much sharper focus with the final correction. The idea is by mapping out this outer surface so we can custom treat all the unique contour shapes to make it the very idea for correction and sharp correction.
When the patient comes in to start can you explain what they go through and how many pictures you take of the eye?
Dr. Krueger: Right. We’ll do the typical evaluation and we have multiple different maps and things to really make sure they’re a good candidate. Once we’ve determined they’re a candidate for Lasik, we’ll go ahead and do the contour mappings or the topography mapping which gives us the actual shape of the eye. Then we’ll do maybe eight to ten maps per eye and find the ones that are in closest agreement; from that we make an average map. By doing all these extra maps we’re really filtering out all the noise so we can get the really true shape of the eye and correct that in order to get the true outcome; and that gets good vision.
The maps are just pictures right?
Dr. Krueger: Yeah, the maps are actually pictures that we take of the surface of the eye that gives us kind of like a topography map that would show land, you know like a mountain is higher and a valley is lower, it kind of gives you that contour shape uh- this does the same thing with the cornea and all kinds of very small detail.
What can these patients expect after surgery?
Dr. Krueger: Laser vision correction is really good, I mean Lasik surgery we get great outcomes as it is, but this takes it just a notch better. In the FDA studies that were done two years ago, about forty percent of patients actually saw better than their best pair of glasses. I think this is a really remarkable improvement and begins to put us in a place where we can actually talk about and say we could make you better than your glasses. Not a guarantee because everybody is different but a significant percentage do. Part of the reason for that is the mapping, what we can do on the surface; the small irregularities and then correct them. Also the centration is a little different than it was before; where we’re kind of treating it right at the apex or the vertex of the cornea which is the highest part; that seems to be the best place to center it. It’s all based on what the maps are showing.
Let’s talk about Nathan.
Dr. Krueger: Okay, so Nathan was a particular patient that we did a news blitz on or something and he was a young guy in his twenties that wanted to be a navy seal and he wanted to have the surgery. His brother had surgery with great success and so we talked about contour for him. He had moderate myopia with some astigmatism and like I said, astigmatism is different in every single person in terms of whether it’s a broad amount of stigmatism or a narrow amount of stigmatism; with each of the axes and magnitude we mapped it out. We treated him and we got a very nice uniform shape and he was seeing better than 20/20, 20/15 on the first postoperative day and the first postoperative week. He’s still early in his follow-up and we anticipate it’s going to keep getting a little sharper for him as it settles in.
Can you explain a little bit about Nat’s case?
Dr. Krueger: Nate was a patient who came to me and was interested in getting into the navy; the navy seal program needs high quality vision and he was a great candidate for contour. He had a moderate amount of nearsightedness, he did have astigmatism and that sort of helps to shape that very specifically based on what the maps, the topography maps show. He had his surgery done, did extremely well, 20/15 vision on the first postoperative day. Even at a one week he was still seeing 20/15 in each eye and he’s loved his vision since. We’re still going to see him and follow up to see how he keeps improving.
Anything I missed? Who is a good candidate for contour?
Dr. Krueger: Well ultimately, if you’re going in and being evaluated by somebody that’s offering this technology they’re going to make sure you’re a good candidate for the surgery in the first place. But once they do, they’ll look and see how consistent the maps are that are captured. If you don’t have dry eyes or something else that might make an inconsistent map, you know the consistency allows us to make sure there’s no noise. Then when we can really treat your true shape then you’re a good candidate and for those that have nearsightedness up to about minus eight or nine diopters and astigmatism up to about minus three.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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