Lasik

Lasik (Laser assisted in situ keratomileusis) is de meest populaire excimer laser techniek. Dit is te danken aan het snelle herstel van functionele gezichtsscherpte. De uiteindelijke resultaten verschillen niet van de oppervlakkige technieken.

Met een femtosecond laser of een microkeratoom wordt een lamellaire flap gemaakt in het hoornvlies. Dit geschiedt onder druk, waardoor zeer nauwkeurig de gewenste dikte kan worden verkregen. Een normale flapdikte is rond de 120 micrometer, voor femtosecond 110 micrometer. De flap zit aan een zijde vast, waardoor deze als een soort klepje opzij kan worden gelegd. In het onderliggende steunweefsel (stroma) wordt computer gestuurd de hoornvlies vorm geremodelleerd met excimer laser, om de gewenste brilsterkte in het hoornvlies aan te brengen. De behandeling vindt plaats onder locale verdoving met druppels.

De lange termijn resultaten zijn voorspelbaar en stabiel. Het herstel is snel: na enkele uren is doorgaans de meeste irritatie verdwenen en het zicht functioneel. Volledig herstel en stabilisatie duurt enige maanden, maar normaal functioneren en werken is doorgaans binnen 24 uur mogelijk.

Bezwaar van deze techniek is de tijdelijke (3-12 maanden) verminderde gevoeligheid van het oppervlak van het flapje. Ogen, die vooraf al droger waren kunnen hier nog droger van worden in die periode (omdat de prikkel voor de traanklier om tranen te produceren  minder is). Daarom worden kunstranen gedruppeld in die periode.  Ook zijn tegenwoordig andere maatregelen mogelijk, zoals een tijdelijk plugje in het traanafvoer buisje naar de neus.

Recente literatuur:

Resultaten van Lasik (t.o.v. contactlenzen)

Three-Year Longitudinal Survey Comparing Visual Satisfaction with LASIK and Contact Lenses

Marianne O. Price, PhD

,

David A. Price, BS

,

Frank A. Bucci Jr., MD

,

Daniel S. Durrie, MD

,

William I. Bond, MD

,

Francis W. Price Jr., MD
A.J.Ophthalmol. Volume 123, Issue 8, Pages 1659–1666

 

Purpose

To assess patient satisfaction and perceived outcomes with different methods of refractive error correction through annual surveys administered over a 3-year period.

Design

Prospective, longitudinal, parallel-group, multicenter survey.

Participants

A total of 1800 subjects, aged 18 to 60 years, who had LASIK or continued using contact lenses.

Methods

Twenty sites across the United States enrolled subjects who completed a study-specific baseline survey during a contact lens examination or while being evaluated as a candidate for LASIK. Links to follow-up surveys were emailed annually for 3 years. Between-group differences were assessed by analysis of variance, and associations were assessed by logistic multivariate regression.

Main Outcome Measures

Visual satisfaction.

Results

Of 1800 subjects, 694 (39%) comprised the control group who continued contact lens wear, 819 (45%) wore contacts at baseline and had LASIK, and 287 (16%) wore glasses at baseline and had LASIK. Most contact lens users had worn them successfully ≥5 years. The proportion expressing strong satisfaction with their current vision correction method decreased from 63% at baseline to 54% at year 3 in the contact lens control group, whereas 88% of former contact lens wearers and 77% of former glasses wearers were strongly satisfied with LASIK at year 3. Patients 40 years of age or younger when they had LASIK were somewhat more likely to be strongly satisfied than older patients. LASIK significantly reduced difficulties with night driving and nighttime visual disturbances among former contact lens users and former glasses users. The proportion with dry eye symptoms at 1, 2, or 3 years after LASIK was not significantly increased relative to baseline contact lens wear but was significantly increased relative to baseline glasses use, consistent with many glasses users having tried and abandoned contact lenses because of latent dry eye problems. Compared with continued contact lens wear, LASIK significantly reduced the self-reported rates of eye infections, ulcers, and abrasions each year.

Conclusions

Compared with contact lens wear, current LASIK technology improved ease of night driving, did not significantly increase dry eye symptoms, and resulted in higher levels of satisfaction at 1, 2, and 3 years follow-up.

 

Bronnen

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