Viewpoint
A Clear and Present Danger

FROM THE CHIEF MEDICAL EDITOR, Alan B. Aker, M.D., F.A.C.S.

It was Dr. Brian Will who taught many of today's best refractive surgeons about the excimer laser. He also has just about the most experience as anyone in the world using it to perform LASIK. So we shouldn't be surprised that in this month's issue, he explains to us what amounts to a breakthrough in protecting the epithelium during the procedure.

Beginning on page 71, he shares with us how he's discovered that increasing the pH and lowering the temperature of proparacaine has nearly eliminated epithelial damage in his practice.

This is momentous on two fronts. First, we know that an epithelial complication associated with LASIK compromises our desired outcome. Healing can be altered, and any disruption of the corneal integrity sets the stage for ingrowth, and worse, DLK. So, making sure we don't have such a complication is paramount to our patients' welfare.

IT'S A BOTTOM-LINE ISSUE, TOO

Second, epithelial complications have an economic impact on our practices. Chair time increases; more hand-holding is necessary; some patients have to return to the OR; the "wow" factor of this wonderful procedure is lost; patients lose confidence in it; we lose referrals; the price of providing LASIK goes up.

With so much at stake, epithelial complications really represent a "clear and present danger." But thanks to Dr. Will's commitment to excellence and razor-sharp powers of observation, it's a danger we can mitigate.