Sir,

Laser refractive surgery is a rapidly evolving field in ophthalmology. We carried out a national UK survey to acquire information regarding surgeon demographics, types of excimer laser utilised (phototherapeutic keratectomy (PTK), photorefractive keratectomy (PRK), laser assisted in situ keratomileusis (LASIK), laser epithelial keratomileusis (LASEK)), indications, and the complication rates within the UK by consultant ophthalmologists (accredited independent practitioners from the Royal College of Ophthalmologists (RCO)).

The UK refractive survey1 (UKRS) in 2005 reported on 61 clinics. The survey stated that 65% of practitioners who performed excimer therapy were ophthalmic consultants. This percentage has increased to 43% in 20042 from 35% in 2003.3

Postal questionnaires were sent to all 903 ophthalmology consultants registered with the RCO in the UK. The questionnaire was anonymous and single paged to encourage a high response rate (Figures 1 and 2).

Figure 1
figure 1

Questionnaire despatched to consultants.

Full size image
Figure 2
figure 2

Percentage of patients (green columns) undergoing various types of excimer laser and percentage of surgeons (blue columns) using various types of excimer laser in the previous month.

Full size image

The overall response rate was 49.1% (443 out of 903) which compares with the response rates from US surveys 11.8–18.4%.4, 5, 6, 7, 8 Five per cent of the respondents had performed excimer therapy in the previous month and all were corneal specialists.

Forty-four percent of the consultants treated patients privately alone whereas 48% treated both National Health Service (NHS) and private cases, and 8% did not respond in this regard.

Twenty-three consultants reported on their refractive practice over the previous month. When considering the case load of the surgeons, 34.8% (vs 47% in 2004 US Refractive Survey (USRS))7 performed more than 20 procedures per month and 26.1% (vs 19.6% USRS7) conducted less than five procedures per month.

Overall 13.3% (57/429) of patients underwent PTK, 1.6% (7/429) PRK, 59.7% (256/429) LASIK, and 25.4% (109/429) LASEK. Consultant activity comprised PTK 47.8% (11/23), PRK 8.7% (2/23), LASIK 95.7% (22/23), and LASEK 65.2% (15/23). In total 78.3% of surgeons (18/23) used multiple modalities of laser therapy during the previous month.

The popularity of LASIK is mirrored in the 2004 USRS;7 however in contrast to this study (65.2 vs 8.7%) PRK is still more popular than LASEK in US (PRK (71%) vs LASEK (40.8%))7 even though there is a shift towards LASEK.

Wavefront-guided ablation was used by 60.1% of our consultants (vs 71.6% USRS4) on 25.8% of patients. Mitomycin-C (MMC) treatment was used by 13.6% of consultants (vs 58.4% USRS7) on 3.5% of the patients.

In 57 patients treated with PTK, recurrent erosion syndrome (40.4%) was the most common indication followed by band keratopathy (29.8%), post graft astigmatism (21.1%), and treatment of corneal dystrophy (3.5%).

Fagerholm et al9 found that recurrent erosion syndrome was the most common indication in Sweden, in contrast Rao et al10 reported corneal scars were the most common indication in India.

Complications of excimer laser ablation over the last year were recorded. Residual refractive error requiring further treatment was described by 82.6%, diffuse lamellar keratitis (DLK) by 52.2% (vs 66.7% USRS4), microbial keratitis by 8.6% (vs 4% in LASIK, 1.1% in LASEK, and 2% in PRK from USRS7), and flap related complications by 8.6% of the surgeons (vs 5.6% USRS7).

Over the last year reported complications included 43 cases of DLK, two cases of infection and two flap-related problems. The average percentage of patients with refractive error requiring further treatment was 11%. Jabbur et al11 reported 8.7% retreatment rate after LASIK and Taneri et al12 reported a 6.7% rate after LASEK in their study group.

Our study is the first UK national survey of excimer laser use by RCO accredited ophthalmology consultants and provides novel information in the use of excimer laser for both refractive and therapeutic indications.