Optometry Podcast: What’s New and What’s Next in Refractive Surgery

Dr. Michael Marino

When is the last time you suggested LASIK to your patients before they brought it up to you? Today’s guest is Dr. Michael Marino, an OD practicing in Raleigh, NC who has nearly 20 years of experience in refractive surgery comanagement with past roles as a clinical director at TLC and in the refractive surgery center at UNC.  His advice for optometrists to build lifelong patient relationships is simple: be proactive.  Many patients think about LASIK in the back of their mind, but aren’t sure they are good candidates.   They will go on their own to referral centers because they have the false impression optometrists are against LASIK since they may not need prescription eyewear after surgery.  We can prevent these misconceptions and avoid our patients seeking care by bypassing our discussions and recommendations by starting the refractive surgery conversation in our own exam chairs.  A simple “Have you thought about LASIK?” as you pull away the phoropter can spark a conversation that leads to a better long term patient relationship where they seek your advice for all the newest advances in technology – from glasses and contact lenses to medical care.

So who’s a great candidate? Dr. Marino says myopes between -1 to -6 are pretty much slam dunks, with around 96% of surgeries resulting in vision of 20/20 or better. But even higher prescriptions and astigmats have refractive options to get familiar with.  Dr. Marino talks about LASIK versus PRK, comanagement strategies, and newer procedures like Topography-guided custom ablation treatments (T-CAT) LASIK that use corneal topography to improve outcomes in patients with higher and irregular astigmatism.

He also discusses the holy grail of refractive surgery: presbyopia correction.  But while new innovations like KAMRA and the Raindrop inlay have excited patients with the promise of throwing out their reading glasses, the technology is far from perfect.  Studies are showing around 25% failure rates, with complaints like glare and distortion.  Luckily new innovations are on the horizon, and we discuss a few more outside the box treatment proposals for presbyopia, including the possibility of in office electroshock treatments stimulate the ciliary muscle.  Yes, you read that right.

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