Weighing The Advantages And Disadvantages Of RLE In Presbyopes

Surgeons have seen varying degrees of interest in RLE in presbyopic patients in current years. At a practice like that of Daniel S. Durrie, M.D., scientific teacher of ophthalmology, University of Kansas, Overland Park, the majority of presbyopic clients will have RLE carried out. His practice does not accept Medicare and is personal pay only. By contrast, Y. Ralph Chu, M.D., adjunct partner professor of ophthalmology, University of Minnesota, Minneapolis, and scientific teacher of ophthalmology, University of Utah, Salt Lake City, stated just a small percentage of his clients are RLE.

Dr. Chu said. Dr. Packer, an devoted supporter of RLE, stated the variety of RLEs he has carried out has reduced since 2007 and 2008, a pattern he thinks associates with the financial downturn. That stated, these cosmetic surgeons concur that RLE will grow in the future as technology enhances and femtosecond laser usage in cataract surgery boosts. Dr. Hovanesian stated. RLE can be carried out in younger patientsDr. In a variety of cases, laser vision correction (LVC) improvement might follow RLE to even more treat the client's refractive 20 20 lasik denver mistake.

Because improvement is needed in 10-20% of clients at Dr. Hovanesian's practice, the cost of laser improvement is included with the expense of RLE. Selecting the right patient for RLE involves a thorough diagnostic work up that consists of retinal optical coherence tomography, endothelial cell counts, and evaluation (and possible treatment) of the client's lashes, lids, and tear movie, Dr. Durrie said.

If pre-op screening finds the patient has any concomitant pathology such as epiretinal membranes or glaucoma, Dr. Packer takes a more careful method with RLE. RLE can be an ideal fit for lots of hyperopic clients, but it likewise can be an alternative for some myopes. However, the majority of cosmetic surgeons stated they don't find RLE a great suitable for high myopes. Dr. Hovanesian stated. There is also the danger for greater cystoid macular edema, Dr. Chu said. Dr. Waltz said. For this reason, he seldom will carry out RLE in high myopes.

There is higher care with high myopes and RLE, this risk is not a factor if the client has formerly had a posterior vitreous detachment, Dr. Packer stated. A pre-op peripheral fundus examination can assist look for lattice degeneration, he stated. Some studies have even shown that the association in between retinal detachment and RLE might be debatable, Dr. Packer stated. Eventually, he thinks the benefits of RLE may outweigh the risk for retinal detachment. However, he will preserve a more detailed observation of clients who are 6 or 8 D and have not formerly had a posterior vitreous detachment. Much of the decision of carrying out RLE in myopesor any patientgoes back to cautious patient selection and education, Dr. Waltz said.

Dr. Hovanesian prefers to give much of the client education himself. At Dr. Durrie's practice, he and Dr. Stahl talk about with patients their long-lasting and short-term vision objectives to pick the finest surgical choices for them. The client education process is likewise the time to bring up the possibility of post-op LVC, Dr. Waltz stated.


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Dr. Packer, an avid advocate of RLE, said the number of RLEs he has performed has actually reduced considering that 2007 and 2008, a pattern he thinks relates to the financial decline. Choosing the best patient for RLE involves a extensive diagnostic work up that consists of retinal optical coherence tomography, endothelial cell counts, and examination (and possible treatment) of the client's lashes, lids, and tear film, Dr. Durrie stated. There is greater care with high myopes and RLE, this danger is not a aspect if the patient has previously had a posterior vitreous detachment, Dr. Packer stated. Much of the choice of carrying out RLE in myopesor any patientgoes back to mindful patient selection and education, Dr. Waltz said.

At Dr. Durrie's practice, he and Dr. Stahl discuss with clients their short-term and long-lasting vision goals to select the finest surgical alternatives for them.

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