Viewpoint
Here's Rooting for CK

FROM THE CHIEF MEDICAL EDITOR, Paul S. Koch, M.D.

Boy, I hope conductive keratoplasty works. The initial results of the clinical trials look promising; the technique seems easy; and the demand is real.

I'm not wild about LASIK for hyperopia, so I usually work under an epithelial flap via LASEK. Even so, there are optical problems with laser ablation, and my preference is to treat most hyperopia with lens surgery. That's certainly overkill for many patients, but what's the option?

I was an early LTK user, but we quickly learned that the protocols established by the company were incorrect. The incidence of induced astigmatism was not only higher than anticipated, but a medical monitor for the company -- incredibly -- told groups of users that if they were getting astigmatism they must be doing the procedure wrong. In his monitoring, he had never, ever come across any significant induced astigmatism. Yeah, right.

LTK users also learned that the procedure was qualitative, not quantitative. It was great for inducing monovision, but not so great for targeting emmetropia. Multiple single-ring sessions were preferable to fewer double-ring sessions. Unfortunately, by the time we worked this out on our own, the company was gone. The LTKs I'm doing now are much better than what I did before, but at this point does it matter?

NOW COMES THE REAL-WORLD TEST

Refractec has the same challenge. Quite a lot of us want a nonablative treatment for hyperopia, one that is simple and safe, and we will cut them quite a bit of slack in terms of the trees if the forest is OK.

We still have a lot to learn. Will future treatments mirror the clinical trials, or will results differ? Will thin areas of corneas have relatively more effect and cause astigmatism? Is the treatment sufficiently quantifiable that it can be used for pure hyperopia, or is it more qualitative and better suited for monovision?

As conductive keratoplasty passes out of clinical trials and into general use, I persist in hoping we are gradually finding our grail. Hey Refractec, any chance I can trade my Sunrise stock for a CK box?