The excimer laser in ophthalmology: A state-of-knowledge update

In may 199, the Conseil d’évaluation des technologies de la santé du Québec (CETS) published a report dealing specifically with excimer laser photorefractive keratectomy (PRK). Since then, the ophthalmological applications of the excimer laser have continued to evolve at a rapid pace. Furthermore, these applications, which are available essentially in the private sector, given that they are services paid for directly by patients, have been diffused very rapidly. Question must therefore be asked about the efficacy and safety of this technology.

The purpose of this report is to update the assessment of the benefits and disadvantages of PRK ans to examine more specifically LAZIK (laser in situ keratomileusis). It also provide an overview of the alternative and future developments and research in this field. The indications, contraindications and choice of procedure (PRK or LAZIK) are discussed as well.

From its analysis, CETS concludes that for mild and moderate myopia, PRK and LAZIK can now be considered accepted technologies, although there is a lack of long-term follow-up. For the correction of serve myopia and moderate and serve hyperopia, LAZIK is still an innovative technology. The reason for this status is uncertainty as to various aspect of its use or even to its indications, uncertainly which would need to be eliminate by gathering and systematically analyzing data on the use of this techbique.

CETS still believe that steps should be taken to better regulate the introduction and diffusion of this technology in Québec and Canada. Furthermore, since these interventions rarely constitute a medical necessity, the overall obligation to inform the patient should be met with utmost rigour, with the patient being informed of the rare and even extremely rare risk.