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8 | EYEWORLD DAILY NEWS | JULY 24, 2021 ASCRS ANNUAL MEETING DAILY NEWS T he second session of ASCRS Refractive Day focused on corneal re- fractive surgery. It began with several case presentations from Steven Dell, MD, and Eric Donnenfeld, MD, followed by a discussion on how to grow your laser vision correction practice by Blake Williamson, MD. Dr. Williamson said he grew his laser vision practice 78% between 2018–2020. He listed eight tips: 1) Use social media, 2) advertise, 3) hire a marketing professional, 4) engage in text campaigns, 5) conduct virtual consults, 6) find an influencer in your area to share their surgical success story, 7) collaborate with ODs, and 8) remember your most valuable resource: happy patients. "We're so successful with LASIK surgery and refractive cataract surgery that we have be- come numb to our successes," Dr. Williamson said, urging surgeons to document these successes. "It's amazing some of the stories, and it's great to share this." Audrey Talley Rostov, MD, gave an update on SMILE, which was approved in the U.S. in Sep- tember 2016, with the first cases being performed in March 2017. Most recently, the FDA approved SMILE to treat astigmatism in October 2018. Dr. Talley Rostov gave several comparisons among SMILE, topography-guided LASIK, and wavefront-guided LASIK. The advantage of SMILE is it results in less postop dry eye, offers greater tensile strength of the cornea, and there is less tissue removed when treating higher levels of myopia. Jonathan Rubenstein, MD, covered the topic of prevention and management of several corneal refractive surgery com- plications. Here's some of Dr. Rubenstein's advice for com- plications that can occur with astigmatic keratotomy, PRK, and LASIK. • Astigmatic keratotomy: Over correction can result from nomogram error, too long of incisions, or too central of inci- sions. Don't correct by adding incisions 90 degrees away; correct by suturing gaping inci- sions. Under correction occurs due to technique error (too short, not perpendicular, too shallow). If perforation occurs, stop and suture. Corneal infec- tions, while unusual, can occur; these should be treated with proper lid hygiene and postop antibiotic drops. Keeping inci- sions peripheral can help avoid glare, and irregular astigma- tism can be avoided if you use paired, symmetric incisions. • PRK: Under or over correction of PRK occurs more frequently with high refractive errors and at older ages; wait 6 months for refractive stability and retreat with PRK/MMC. Postop steroids can affect correction, with longer duration of use creating situations of under correction and shorter durations over corrections. PRK can also have delayed epithelial heal- ing, which is more common in cases with dry eye, other ocular surface disease, patients who are smokers, and those with connective tissue disease. Treat the ocular surface preop, Dr. Rubenstein said. Stromal haze/ scar is more common in high refractive corrections and eyes with UV exposure; it peaks at 1–3 months and regresses within 12 months. If it persists, remove the haze with MMC. • LASIK: The treatment for under or over corrections is the same as for PRK. There are several potential flap complications, and unrecognized EBMD can re- sult in delayed surface healing, epithelial defects, and increased risk of DLK. If DLK occurs, Dr. Rubenstein said to treat with topical steroids or lift and irrigate. Other complications in- clude central toxic keratopathy (which can result in a hyperopic shift), epithelial ingrowth, infec- tion, dry eye, and ectasia. Editors' note: Dr. Dell, Dr. Donnen- feld, and Dr. Talley Rostov have financial interests with various ophthalmic companies. Dr. Ruben- stein and Dr. Williamson have no relevant financial interests. Corneal refractive surgery topics take center stage Dr. Rubenstein discusses complications that can occur with corneal refractive surgery. Source: ASCRS

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