News Coverage
December 1999
Ophthalmic Practice Guest Editorial
LASIK is an Art and a Science
Howard Gimbel, MD
The rapidity of visual recovery and stabilization of refractive result have made LASIK a popular corneal refractive procedure. With any new procedure, there is an evolution in instrumentation and in the subtleties of the technique itself. The LASIK procedure has now reached that portion of the development curve where the curve is flattening out and the refinements are becoming more subtle and more difficult to evaluate in terms of outcome measurements. Also, patient expectations are rising as the procedure is becoming commonly performed and most patients are extremely happy with the result.
The subjective assessment of quality of vision is becoming recognized as a necessary supplement to the objective methods that we have employed. As well, refinements in objective measurements and new and newly applied objective technologies such as Scheimpflug imaging, confocal techniques, and wave-front analysis are helping us to understand the sometimes subtle changes that affect quality of vision and patient satisfaction.
The LASIK procedure is demanding of surgical expertise, attention to detail, and finesse or artistry on the part of the surgeon. Many factors such as the speed of surgery which greatly influences the degree of tissue hydration, the artistry of replacing the flap and expressing interface fluid to avoid microstriae, the management of epithelial problems intra- and postoperatively, and the avoidance of interface debris can make the difference between a very satisfied versus a somewhat dissatisfied patient.
Certainly fellowship training in refractive surgery is the most ideal preparation to beginning LASIK surgery. Sharing experiences regarding techniques and complications management through journals, books, and courses, careful outcome analysis, and controlled research studies will all help to advance the science and art of LASIK and other emerging refractive surgery techniques.