PDF Report (2.4Mb)
View other formats
A discussion paper
Laser corneal sculpting is a technique for reshaping the cornea of the eye with an excimer laser, by the precise removal of ultra-thin layers of tissue.
The technique is being applied to the treatment of myopia (shortsightedness), hyperopia (long sightedness),and astigmatism, with the aim of enabling people with these conditions to dispense with glasses or contact lenses.
On a conservative estimate, it could potentially be applied to 15 per cent of the population.
Treatment of myopia is already being provided commercially in Australia and Europe, although the technique is still regarded as investigational.
In the USA its use is restricted to clinical trials. Very few patients have been followed up for more than a year and few published data are available on outcomes.
The procedure is not free of complications. For all patients a haze forms within the cornea after the procedure, and requires treatment with steroid drops for up to six months. The steroid medication has side effects and patients should be monitored carefully.
Limited published data indicate that there is a two to three per cent risk of corneal scarring in the zone of vision.
Costs for the procedure are heavily dependent on throughput. Very approximate estimates suggest a range of $Al200-2400 per eye. In Australia a charge of $2,000 per eye is being applied. No medical benefits are available or are being sought.
Acceptance of the technique may be limited unless results to emerge from current clinical trials show high success rates, long term stability, and very law risks of scarring.
If these results are obtained and if costs fall, usage may accelerate to the point that ophthalmological clinical practices and the optometry profession are significantly affected.
Currently the treatment does not appear to be effective for severe myopia. Further development will be required for this application. Techniques for the treatment of hyperopia and astigmatism are also still under development.
Laser corneal sculpting can also be applied to the removal of corneal scars, erosions, and irregularities. The work is still at the clinical trial stage but results are promising.
The introduction of this procedure raises questions on appropriate mechanisms for dealing with unproven technology in Australia. One possibility which might be explored is a requirement for data collection by those using new devices or procedures.
We'd love to know any feedback that you have about the AIHW website, its contents or reports.