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The effectiveness of the diagnostic accuracy shown by optometrists when referring patients for corneal laser vision correction and the causal factors contributing to unsuitability

Poster Details

First Author: S.Mughal UK

Co Author(s):    A. Sokwala              

Abstract Details



Purpose:

To assess the clinical outcomes in terms of suitability, safety and efficacy in patients who were referred for corneal laser vision correction and to identify the reasons for patients deemed unsuitable by the treating surgeon.

Setting:

A certified and experienced corneal laser surgeon and fully qualified optometrists practicing in Optimax Laser Eye Clinics, United Kingdom.

Methods:

In this retrospective analysis of patients who attended 5 clinics in the year 2012, 8 optometrists referred 1453 patients consecutively to the treating surgeon. Patients had corneal topography, manifest and cyclo refraction, anterior segment examination with slit lamp and dilated fundoscopy. After counselling patients the optometrists recommended either LASIK or surface ablation with or without MMC. The patients were then seen at a later date by the treating surgeon who checked the medical history, corneal topography, slit lamp based anterior segment examination and limited peripheral retinal examination through undilated pupils using a 90D Volk lens. Two laser platforms were available for ablation. The SCHWIND AMARIS 750 (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) and the NIDEK EC5000 (NIDEK, Gamagori, Japan). The laser ablation was centred on the pupillary axis and tracking employed in all cases. The intended refractive aim for all eyes was emmetropia and there were no retreatments included. All eyes had 3 months of complete pre & postoperative visual and refractive data. Uncorrected distance visual acuity (UDVA) and manifest refraction were recorded.

Results:

1720 eyes of 1374 patients (94.6%) were found to be suitable for treatment on the same day. Of the 79 patients unsuitable, the most common reasons were lenticular opacities/astigmatism (17.8%); keratoconus or suspect topographical changes (12.7%); corneal dystrophies or significant corneal opacities (11.4%); autoimmune conditions (Graves & Hashimoto's disease, active ulcerative colitis) and systemic conditions (neurosarcoidosis, multiple sclerosis, neutropenia, HIV with undeclared CD4+ count) (11.4%). The preoperative manifest spherical equivalent (SE) was -2.98 ± 2.68 dioptres (D) (range: -10.13 to +4.88 D). At 3 month the postoperative manifest SE was reduced to -0.15 ± 0.43 D (range: +2.25 to -2.75). The manifest SE was within 0.50 D and 1.00 D of emmetropia in 85% and 96% of eyes, respectively. At 3 months, the preoperative manifest sphere was reduced from -2.59 ± 2.67 D (range: -9.75 to +5.00 D) to -0.01 ± 0.42 D (range: +2.25 to -2.75 D) and the preoperative manifest astigmatism was reduced from -0.78 ± 0.78 (range: 0 to -5.00 D) to -0.28 ± 0.30 D (range: 0 to -2.50 D). UDVA of ≥20/40 and ≥20/20 was achieved in 97% and 71% respectively. Only 1% of eyes lost ≥ 2 lines of best-spectacle corrected visual acuity.

Conclusions:

Experienced in-house trained optometrists have a high degree of diagnostic accuracy when referring patients on to the treating surgeon for successful corneal laser vision correction. Patients achieve acceptable visual outcomes and it is highly unlikely that adverse events would occur from misdiagnosis at the time of the preoperative review by the surgeon. Optometrists can continue to practice with minimal supervision and intervention by the treating surgeon. The presence of lenticular opacities and suspect topographical features contribute to unsuitability for corneal laser vision correction. Ophthalmologists can continue to provide constructive feedback to optometrists in order to facilitate their diagnostic skills and reduce the risk of adverse clinical events occurring intra and postoperatively. FINANCIAL INTEREST: NONE

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