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What's the difference between LASIK enhancement and refinement?


Understanding the difference between a LASIK enhancement and a refinement in the age of customized wavefront technology will go a long way toward patient satisfaction and modifying the public perception of LASIK, according to Roy Scott Rubinfeld, MD, who spoke during the AAO's refractive surgery subspecialty day meeting.

Although some LASIK surgery cases may fall into a "gray zone," it is important to provide some guidelines to differentiate these two terms for the patient and the physician, noted Dr. Rubinfeld.

Essentially, an enhancement can be defined as an aspect of the original refractive procedure, and as part of the global fee structure, there should be no additional charge to the patient. For this enhancement, the physician may use conventional or new technology, he continued.

One such example is a patient with high myopia who has been corrected to ­2 D and has a stable refraction. "To get this patient where he wants to go, conventional technology will work," Dr. Rubinfeld said. "And in a global fee structure, there should be no charge for that."

In the case of a refinement, the patient understands that new technology is now available or the patient has now elected to use new technology for a quality "upgrade." Both the patient and the physician understand this and the patient expects an additional charge.

Dr. Rubinfeld offered the example of a weekend golfer who wants to improve his golf game and underwent LASIK 3 years earlier. His uncorrected visual acuity is 20/30.

Not ever patient case will be so clear cut, Dr. Rubinfeld said. To ease this burden, he suggested providing patients with informed consent in the form of patient education materials and of course, one-on-one communication.

"It is the physicians' responsibility to listen carefully to patients and make decisions on a case-by-case basis," he said. "Incorporating custom enhancement and refinements will require us to rely on our flexibility, our sense of medical ethics, our professionalism, and fairness."

Recent results of clinical trials of the anti-VEGF aptamer Macugen (pegaptanib sodium are extremely promising for patients with choroidal neovascularization, said Carmen Puliafito, MD, MBNA, chairman of the Bascom Palmer Eye Institute, Miami.

Quality of vision is now measured by standards beyond simple visual acuity. Contrast sensitivity testing has gained recognition as a valuable tool because of its sensitive and comprehensive measurement of visual performance.

In an evening CME symposium held Saturday at the Hyatt Regency Orange County/Garden Grove, Stephen A. Obstbaum, MD, Lenox Hill Hospital and New York University School of Medicine, New York, led a panel of experts in a discussion of contrast sensitivity testing and ways in which ophthalmologists can apply advances in this field to benefit their cataract and refractive surgery patients.

Induction of less higher-order aberrations with wavefront-guided LASIK appears to translate into improved quality of vision, said Steve C. Schallhorn, MD, director, cornea and refractive surgery, Naval Medical Center, San Diego.

Members of the American Academy of Ophthalmology (AAO) and the American Academy of Ophthalmology Executives (AAOE) are eligible to join a special purchasing program offered through the organizations' partnership with health-care product distributor Henry Schein Inc.

Typical optic neuritis, which presents with unilateral painful loss of vision, is the most common optic neuropathy in young predominantly female patients. What is being recognized increasingly is that optic neuritis may be the first indication of multiple sclerosis (MS). David Kaufmann, DO, of East Lansing, MI, noted that magnetic resonance imaging is the most important diagnostic tool and ophthalmologists are on the frontline of diagnosis of MS. Research indicates that the 10-year risk of developing MS in all patients is 38%; the risk in the presence of a normal MRI is 22%; in patients with one or more baseline lesions, the risk of MS is 56%.


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