Laser Eye Surgery Safe As Contact Lenses

The UK Government’s advisory body on best treatments had a change of heart on eye surgery this week. New guidance from the National Institute for Health and Clinical Excellence (NICE) says that it should be considered a safe option, which “works well enough for use in the NHS”. This is important. It’s the first time that laser eye surgery has been presented officially as a viable and safe alternative to glasses and contact lenses for people with short and long-sight in the UK.

The new guidance marks a complete turnaround by NICE. The last guidance by the institute on the procedure, in 2004, advised people to stick to glasses and contact lenses. That decision made the UK the laughing stock of the ophthalmic world, according to Sheraz Daya, a consultant ophthalmologist at the Centre for Sight, Queen Victoria Hospital, East Grinstead, and one of the first to conduct laser eye surgery in the UK. NICE changed its position after a report conducted at the University of Aberdeen reviewing all the research.

NICE’s new guidance is based on a review of the three main laser eye surgery techniques: photorefractive keratectomy, laser epithelial keratomileusis and laser in situ keratomileusis. All involve a surgeon cutting and temporarily folding back the outer membrane covering the cornea (the dome-shaped window over the front of the eye) and reshaping the cornea with a laser. This changes the shape of the lens formed by the cornea and improves the way light is focused on the retina.

Because of its widespread commercialisation and safety concerns, this type of surgery, used to correct short-sightedness, or myopia, has had an image problem. Sheraz Daya says that most UK laser surgery is performed by commercial groups, sometimes using old technology. “Out of 120,000 procedures performed each year, fewer than 5,000 are done in hospitals by eye surgeons in academic environments,” he says. Patients are often evaluated by an optometrist (non-dctor who tests eyes), rather than the ophthalmologist (a doctor trained in eye care) who will perform the surgery. That is why NICE emphasises that it should be used only in “appropriately selected patients” (see below).

However, a new laser surgery technique, Intralasik, which is not covered in the NICE guidelines, seems to give better results with fewer complications. On the facing page, we give a run-down of the facts about the latest options in laser surgery and in treating short-sightedness.

INTRALASIK

A study presented to the Royal College of Ophthalmology last year showed that Intralasik had been used successfully on 800 eyes, and with none of the complications sometimes associated with Lasik eye surgery, such as problems with night vision. All patients’ vision was corrected to better than driving standard and 71 per cent were left with better than 20/20 vision.

While Lasik uses a blade to cut the corneal flap, Intralasik uses two lasers, guided by computer. “A blade is a mechanical device and prone to mechanical error,” says the consultant ophthalmologist Sheraz Daya. “A laser is 100 times more accurate and cuts the corneal flap more uniformly, so visual outcomes are better.”

Although Intralasik is becoming the “gold standard” for laser correction in the US, it is available at only a few centres in the UK. The technique may be suitable for many patients who have been previously deemed unsuitable for laser surgery; for example, those with deep-set eyes. In the NHS, it has been cleared for use only on corneal abnormalities at one hospital, the Queen Victoria Hospital Foundation Trust, in East Grinstead, and only privately.

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