New Studies Do Not End Controversy Over Simultaneous Versus Sequential Laser Eye Surgery
27 Jul 2007
SAN FRANCISCO, Sept. 1999 - According to a press release of the American Academy of Ophthalmology we still do not know if it is best to do LASIK surgery in both eyes at the same time or on different dates.
The controversy among refractive surgeons over the benefits of simultaneous bilateral [both eyes at the same time] laser in-situ keratomileusis (LASIK) versus sequential bilateral [each eye separately, at different times] LASIK continues with the publication of two new studies in Ophthalmology, the journal of the American Academy of Ophthalmology.
In a study from the United States, authors Peter Chiang, M.D., and Peter Hersh, M.D., conclude that it may be advantageous to perform bilateral LASIK sequentially rather than simultaneously, using outcomes from the first eye to more accurately predict the correction for the second eye. They also found that "waiting approximately one week was potentially as effective as waiting longer periods of time between treatments.''
This study was based on an analysis of sequential LASIK in 196 eyes of 98 patients. The authors acknowledge that "the improved outcomes of sequential treatments are theoretical and not clinically proved,'' and that a larger "randomized, prospective study would better address the practical clinical situation.''
In a nonrandomized retrospective Canadian study of 2,142 LASIK procedures, authors Howard V. Gimbel, M.D., et al., conclude that "simultaneous bilateral LASIK is as safe and effective as sequential bilateral LASIK surgery.'' This conclusion is virtually identical to the conclusion of an earlier randomized prospective clinical study by Waring, et al. (Ophthalmology, 4/99).
The Canadian study also suggests simultaneous bilateral LASIK may offer several benefits to patients, including: less time away from work; a slightly lower rate of retreatment; less variability of surgical procedures and refractive results between the two eyes; avoidance of unequal vision during the time between surgeries; and no increase in risk of complications.
However, the authors acknowledge that the ability to predict outcomes in the second eye of sequential cases was not improved, perhaps because the procedures were done as close as four days apart.
Though the two new studies reach different conclusions about simultaneous versus sequential LASIK, they contribute to the ongoing efforts of ophthalmologists (Eye M.D.s) to provide choices and to improve treatment options for potential refractive surgery patients.
Comment on Press Release:
What neither study seems to have addressed is the logical question, "What happens if, during simultaneous eye surgery, the surgeon has a bad day?" Even though the possibility of catastrophic malpractice causing total blindness in both eyes may be extremely small should a prudent patient take the risk?
It would seem to be the ultimate tragedy for a patient to experience any simultaneous loss of vision in both eyes. If the results of sequential surgery are equally as good as simultaneous surgery the former would appear to be the safest course. In any event, the patient should be the one who weighs the risk versus the benefit of the timing of the procedures.
In Florida, where a significant number of laser procedures are performed each year, lawyers who practice in the field of medical malpractice law, are receiving some reports of injury from the procedures. It may only be a matter of time when the inevitable happens - a surgeon performing simultaneous bilateral LASIK surgery has the ultimate bad outcome.
