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ASCRS•ASOA SYMPOSIUM & CONGRESS, BOSTON 2014 "There was a similar trend if we looked at only those eyes that had a pressure increase of more than 10 mm Hg." The greatest percentage of responders was at month 1, but the incidence of steroid response was "only slightly higher" in the long taper group, although the differ- ences were greatest at months 2 and 3, Dr. Caldwell said. Noting that the U.S. Army "does not specially endorse any product or procedure," Scott D. Barnes, MD, North Carolina, said the military has "heavily favored" PRK—with 96% of all cases performed between 2000 and 2011 being PRK (and only 2,500 cases in the same timeframe were LASIK). "For our active personnel, they're in remote locations," and so PRK just seemed to have a better safety profile. "It was never about quality and never about dry eye," he said. "But it was always about trauma and flap dislocation." After 12 soldiers reported issues post- LASIK (and two were deployed in Iraq), "it colored our opinion," Dr. Barnes said. "The military combined have done close to 500,000 cases. So if one in 250 has an issue, that's a lot." But then things changed. LASIK now accounts for 45% of all military refractive corrections after a paper published by Michael Knorz, MD, Germany, showed incredible tensile strength of the LASIK-created flap. "We do 120 degree, temporal hinge—the least protected area of the eye," Dr. Barnes said. "Results have been very good—there are excellent visual results, achieved much sooner with LASIK." Wind tunnel tests confirmed post-LASIK soldiers can jump, dive, and fly without restrictions as the flap remained securely in place. "It will take time to change perceptions that the military is still anti-LASIK," he said. "LASIK is not the disqualifier it used to be in the military." LASIK compares "pretty favor- ably" to contact lens (CL) or ortho- K, said Steve C. Schallhorn, MD, California. "Some studies have shown a higher quality of life and better safety outcomes in the long run with LASIK." In fact, he said, the chance of having a loss of vision is greater with daily wear CLs than LASIK, especially when patients are non-compliant and sleep in their CLs. A retrospective analysis of patients between 18 and 29 years of age compared long-term results (each group had about 1,000 pa- tients). "LASIK has better visual out- comes, and there was no difference in glare or dry eye" between the two groups, he said. A 20-year cost analysis showed LASIK "is cheaper in the long run as well. CL patients report a wide variety of CL-related comfort and vision problems," Dr. Schallhorn said. Treating hyperopia The hyperopic population is substantially outnumbered by the myopic population, but surgeons should embrace treating them, said Mark F. Torres, MD, Washington. "They're not mirror images of the myope; you can't just reverse the 'plus' and the 'minus,'" he said. "There's no 'wow' factor for these patients." But these patients are much easier to treat, he said. "They have lower expectations; they just want you to make them better, not necessarily perfect," he said. "If you leave a little residual myopia in a myope, they're un- happy and their vision is blurry. Hyperopes tolerate a little bit of residual hyperopia." In a retrospective study of 347 patients (283 of whom had more than +3 D in any meridian), there were only two enhancements necessary, Dr. Torres said. "The average residual refractive error was +0.75 D and average VA was 20/25. By myopic standards, these would not be acceptable outcomes," he said. Among his pearls: When using the WaveLight Allegretto (Alcon, Fort Worth, Texas), use the plus cylinder profile as "it's more tissue-sparing." EW EW SHOW DAILY 19

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