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Dr Nicholas Caro on Refractive Surgery Updates

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Nicholas Caro MD, a leader in the field of Ophthalmology is the proud father of Dimitri Caro, Spiro Caro and husband of Peggy Caro

About Dr. Nicholas Caro

 

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PRK (Photorefractive Keratectomy) is a procedure similar to RK except that a laser is used to reshape the cornea instead of a diamond blade.

Small bits of tissue from the cornea are removed enabling the reshaped cornea to better focus light into the eye for clearer vision. PRK can be performed on nearsighted and farsighted individuals.

 



The Laser Method

An alternative to radial keratotomy is photorefractive keratectomy, or PRK. "In countries where PRK has been available for some time, the procedure has largely replaced RK as the procedure of choice," says FDA's Knight, adding that "with FDA approval of the excimer laser, this trend is expected to follow in the United States."


In this procedure, the surgeon operates an excimer laser programmed to deliver bursts of ultraviolet light that vaporize precisely targeted corneal tissue. The effect, as in RK, is to flatten the cornea. Also like RK, PRK takes about 15 minutes and is done under topical anesthesia.


In October 1994, FDA's ophthalmic devices advisory panel recommended conditional approval of one manufacturer's excimer laser for refractive surgery, pending reformatting and reanalysis of some of the data.


"This was the first time the agency critically assessed safety and effectiveness data of any device for refractive surgery," says Knight, "and the meeting was long and full of debate."


Approval in October 1995 was based on PRK results in about 1,600 healthy myopic eyes. In most eyes, the corneal surface healed in three days, and vision took at least three months to stabilize. Most patients studied were corrected to 20/20 vision or better with glasses or contact lenses before surgery. Best corrected vision was worse in 6 percent of patients after surgery but, of those, only 1 percent had less than 20/25 acuity and fewer than 0.2 percent were worse than 20/40.


In 95 percent of eyes, vision without glasses was corrected to 20/40 or better; 65 percent achieved 20/20 or better. About 5 percent of patients continued to need glasses all the time for distance, and up to 15 percent needed glasses occasionally, such as for driving. Results were best in younger patients with lower degrees of myopia.


Some 63 percent of patients had mild corneal haze after surgery, and 10 percent experienced mild glare and halos around lights. These conditions diminished or disappeared in most patients in six months.


According to the American Academy of Ophthalmology, RK results are best in patients with low to moderate nearsightedness and generally is not recommended for people with a correction higher than -5 diopters. PRK is effective for patients with higher myopia as well, and is approved for treatment of up to -7 diopters.


With approval of the laser, FDA also reviewed and approved a physician training program and a patient information booklet. The training program for surgeons covers operation and calibration of the laser, plus extensive clinical, didactic and practical sessions. The patient booklet is provided to physicians, who in turn are required to give it to patients and discuss it with them before surgery.

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Nicholas Caro MD, a leader in the field of Ophthalmology is the proud father of Dimitri Caro, Spiro Caro and husband of Peggy Caro

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