Alicante, Spain and Ankara, Turkey. Laser surgery has been used to correct vision problems since the early 1990s. There are two main types of surgery. Photorefractive Keratotomy (PRK) is often used to correct low to moderate myopia. In-situ keratomileusis (LASIK) is preferred for high myopia corrections. Although over 18 million LASIK procedures have been performed worldwide, controversy remains regarding the maximum correction possible and efficacy with this technique.

 

Researchers from Miguel Hernandez University, Medical School (Alicante, Spain) and Ankara University School of Medicine (Ankara, Turkey) report on a study of high myopia patients ten years after LASIK surgery. Researchers found the treatment was safe and effective for myopia over -10 D in the long term, with a retreatment rate of under 30 per cent. The study is published in the American Journal of Ophthalmology.  

 

196 high myopic eyes of 118 patients, preoperatively needing at least 10 diopter (10 D) corrections to achieve 20/20 vision, were evaluated ten years following surgery.

According to lead investigator Jorge L. Alió, "These results are extremely encouraging considering that this refractive correction implies the maximum limit of application of this technique. This study has allowed us to demonstrate that, in spite of the prejudices about the limits of LASIK technique, the results regarding predictability, efficacy and safety for high myopic patients are very good in the long term. The optimum limit of predictability for this technique is around 10 D of myopia. This reference study, with a long time perspective, allows us to know the safety, precision and limits of LASIK in highly myopic eyes."

 

The researchers concluded that "LASIK for myopia over -10 D is a safe procedure with myopic regression that slows down with time and a high rate of BSCVA increase in the long term."

 

Lead investigator, Jorge L. Alio, said "These results are extremely encouraging considering that this refractive correction implies the maximum limit of application of this technique."

 

"This study has allowed us to demonstrate that, in spite of the prejudices about the limits of LASIK technique, the results regarding predictability, efficacy and safety for high myopic patients are very good in the long term," he added.

 

He stressed that the optimum limit of predicatability for this type of surgery appears to be around 10 D of myopia.

 

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In an editorial in the same issue of the journal, Dr George O Waring, of Emory University and Inview in Atlanta, generally supported the findings, and said that LASIK and other vision correction procedures have improved significantly in the last ten years, with some recent studies on LASIK reporting correction to plus or minus 0.5 D in more than 90 per cent of eyes.  

 

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Ten-year Follow-up of Laser In Situ Keratomileusis for High Myopia. Jorge L. Alio, Orkun Muftuoglu , Dolores Ortiz , Juan Jose Perez-Santonja , Alberto Artola , Maria Jose Ayala , Maria Jose Garcia , Gracia Castro de Luna. American Journal of Ophthalmology, 2008 January, Vol. 145, Issue 1, Pages 55-64.e1. PII: S0002-9394(07)00781-7. doi: 10.1016/j.ajo.2007.08.035.

 

Abstract

 

Purpose. To evaluate the long-term outcomes of laser in situ keratomileusis (LASIK) for high myopia.

 

Design. A long-term (10 years) follow-up retrospective interventional case series study.

 

Methods. The study included 196 myopic eyes of 118 patients with a mean preoperative spherical equivalent of −13.95 ± 2.79 diopter (D) treated with myopic LASIK at the Instituto Oftalmológico de Alicante, Spain using the VISX 20/20 excimer laser (VISX Inc, Santa Monica, California, USA) and the Automated Corneal Shaper microkeratome (Chiron Vision, Irvine, California, USA). All patients were evaluated three months, one year, two years, five years, and 10 years postoperatively. The main outcome measures were refractive predictability and stability, mean corneal keratometry, topographical cylinder, safety, efficacy, stability of visual acuity, and postoperative complications.

 

Results. At 10 years, 82 (42%) of 196 eyes were within ±1.00 D and 119 (61%) were within ±2.00 D. Fifty-four (27.5%) eyes underwent retreatments attributable to under correction and/or regression. The myopic regression decreases with time in eyes that did not undergo retreatment with a mean rate of −0.25 ± 0.18 D per year. Eleven eyes (5%) lost more than 2 lines of best spectacle-corrected visual acuity (BSCVA) and 78 eyes (40%) showed a postoperatively uncorrected visual acuity of 20/40 or better. Two eyes (1%) with more than 15 D myopic correction developed corneal ectasia.

 

Conclusions. LASIK for myopia over −10 D is a safe procedure with myopic regression that slows down with time and a high rate of BSCVA increase in the long-term.

 

 

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