January-February 2020

REFRACTIVE

Research Highlight
Studying refractive surgery at polar ends of the spectrum


by Maxine Lipner Senior Contributing Writer

The demographic of those who may be walking in the door for refractive surgery is changing, according to Idan Hecht, MD. In a recent study,1 investigators considered older individuals and adolescents who had LASIK or PRK. The investigators determined that when pushing the bounds of refractive surgery for older patients, more retreatments occurred and patient satisfaction was lower. When patients younger than 18 were considered, they fared comparably to patients in age groups that more traditionally receive refractive surgery, Dr. Hecht reported.
The study included 143 patients older than 60 years, as well as 608 patients younger than 18. Both groups were compared to a control group of 2,313 patients whose ages ranged from 20–40, treated at a single center during a 10-year period.

Considering outcomes

Outcomes were different for the two ends of the age spectrum. “We found that in older patients the results were less satisfactory,” Dr. Hecht said. Many in the older age group returned to their baseline refractions, which meant that there were more retreatments; 6.2% of older adults who had hyperopic treatments needed retreatment vs. 2.5% of controls, and 11% undergoing myopic treatment needed retreatment vs. 1.1% of controls, he continued.
There were also some safety issues in the older population. “Some people lost vision in the sense that they could not correct this even with glasses after the operation,” Dr. Hecht said, adding that it was particularly true for hyperopic treatments in this age group.
Hyperopic treatments, Dr. Hecht said, are generally more problematic. He also thinks it’s possible that the nomograms currently used are not suited to older patients. In the future, calculations and techniques may be adjusted for older patients, he noted.
Another factor could be that older patients have less effective healing, and/or cataracts could develop and interfere with results.
For younger patients—a group that is not FDA approved for refractive treatment—results were good. “Most surgeons wouldn’t operate, but we couldn’t find any basis for those concerns,” he said. “That was definitely a surprising result, given the wide consensus about concerns of surgery in that age group,” he said. Namely, these concerns are refractive instability and immaturity of the cornea.

Clinical takeaways

Dr. Hecht hopes that ophthalmologists come away from the study with the recognition that refractive surgery in patients of more advanced age was safe and effective, but careful consideration is needed. “The results to be expected are much more limited than in younger patients, especially in terms of retreatments that would be necessary in the older patients,” he said. Also, while there are some slight concerns in this older population, mostly around the issue of retreatments, the bottom line is that refractive surgery is safe and effective for this particular age group.
When opting for refractive treatment in older patients, however, practitioners should make sure that there are no comorbidities, such as AMD or any other retinal pathology. Also, myopic cases should be considered before hyperopic ones, Dr. Hecht said.
When it comes to younger patients, refractive surgery is similar to that in the typical age cohort, he continued. “But it should be noted that our group of children was mostly 17-year-old patients, which isn’t that young,” Dr. Hecht said. He recognizes that treating these patients remains controversial. “In the U.S., I would avoid treating patients under the age of 18 still, despite the results we had,” he said. “There is not enough evidence yet.”
Overall, Dr. Hecht thinks that the population interested in refractive surgery is changing. “We as ophthalmologists need to change as well regarding our methods and our expectations of this surgery and the different populations that will be having these surgeries in the future,” he concluded.

About the doctor

Idan Hecht, MD
Department of Ophthalmology Shamir Medical Center
Tel Aviv, Israel

Reference

1. Hecht I, et al. Refractive surgery in the late adulthood and adolescent age groups. Graefes Arch Clin Exp Ophthalmol. 2019;257:2057–63.

Relevant disclosures

Hecht
: None

Contact

Hecht: idanhe@gmail.com

Studying refractive surgery at polar ends of the spectrum Studying refractive surgery at polar ends of the spectrum
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