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EW SHOW DAILY 4 ASCRS News Today Tuesday, April 21, 2015 by Rich Daly EyeWorld Contributing Writer or if you have had a flap complica- tion you would want to go over the surface," Dr. Luthra said. Additionally, using epithelium thickness mapping with new devices allows surgeons to plan their treat- ments in a better way. For patients who are unhappy about their night quality vision, Kumar J. Doctor, MD, Mumbai, In- dia, uses topography-guided corneal wavefront analysis to determine if they need retreatment. The tech- nology allows a surgeon to identify improvements they can make in unhappy patients who are tested as having 20/20 vision. "If the patient has a large optical zone, in this way you can make sure the patient's night quality vision improves," Dr. Doctor said. "This is when I do corneal wavefront-guided treatment." Dr. Doctor prefers to use an ocular wavefront-guided treatment in unhappy patients if the difference between a scotopic and a 4 mm pu- pil is more than 1.25 D in refractive error because it removes all possible aberrations. The ongoing challenge of complications inspired Dr. Sangit to note that although eagle-like vision remains the goal of refractive surgery, surgeons need to avoid ever promising that result. EW Editors' note: The physicians have no financial interests related to their presentations. S urgeons have a range of go-to strategies for LASIK patients who have seri- ous complaints following LASIK treatment. "There will still be some sub- optimal outcomes in some patients and unsatisfied patients, in spite of the good objective outcomes that you may see on your tests and di- agnostics," said Vishram A. Sangit, MD, Maharashtra, India. The sources of unhappiness post-LASIK can vary widely among patients, including corneal surface problems, optical issues from the treatment, surgical complications, unmet expectations, and psycho- physical causes, Dr. Sangit said. "One or all of these factors could be at play," Dr. Sangit said. A common element in the various problematic cases Dr. Sangit discussed was a need for thorough counseling and reassuring patients at all times, allowing optimal time between retreatments, and for the refractive error to stabilize. Many patients also experienced improved vision on their own after he treated the symptoms of discomfort. "Ultimately, time is the great- est healer," Dr. Sangit said. "Never forget that." Although many patients may be ready for retreatment after 3 months, Dr. Sangit has found that he usually has to wait from 6 months to 9 months to get many reluctant patients to return. "There are patients who need a little time before retreatment be- cause of their dislike of surgery; they would probably be on the backseat," Dr. Sangit said. Gaurav Luthra, MS, Dehra Dun, India, noted that the go-to response for many surgeons is to lift the flap and retreat because they are easy to lift even years postop, the correc- tion is predictable, and it is easy on patients who are nervous about the retreatment. "Some of these patients come back unhappy after 5 or 6 years be- cause they have been used to excel- lent vision and they suddenly have changes in their refractive error, so watch out for cataracts and other changes," Dr. Luthra said. However, the risks include in- sufficient residual bed thickness and risk of ectasia. Problems lifting the flap can include difficulty identify- ing the edge. Thin flaps, previously created during an era when surgeons were trying to minimize thickness to less than 90 microns, also can cause problems, including buttonholes. In patients with stable vision, Dr. Luthra opts to lift flaps within the first couple years postop if the flap is more than 90 microns, and uses an Amoils rotary brush. He also uses mitomycin-C when enhancing the surface. "For early enhancements in patients who are dissatisfied you would definitely want to lift the flap Strategies for unhappy LASIK patients Complex Cases Made Simpler: Femtosecond-Assisted Cataract Surgery in Difficult and Challenging Cases Armando Crema, MD Winner Fun with Femtosecond Lasers Nick Mamalis, MD Glaucoma Surgery Runner-Up Effect of Combined Aqueous Outflow Reconstruction and Vitreoretinal Sur- gery in Juvenile Diabetic Retinopathy: Induced Neovascular Glaucoma Miyuki Nagahara, MD, PhD Grand Prize Strange Stories, Amazing Facts: The Wavefront Omnibus Samaresh Srivastava, DNB Cataract Complications Runner-Up Management of Intraoperative Challenges During Femtosecond Laser-Assisted Cataract Surgery Surendra Basti, MD Winner Femtophaco Follies Ronald Yeoh, MD Cataract/Implant Surgery Runner-Up 2015 Film Festival winners continued on page 6 Richard S. Hoffman, MD, presents the grand prize to Samaresh Srivastava, DNB. Dr. Sangit said the sources of unhappiness post-LASIK can vary widely among patients.

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