At another breakfast seminar, Johnson and Johnson Vision took the opportunity to launch SILK, a new laser refractive procedure performed using Johnson and Johnson Vision’s Elita platform.

Dr Patrick Versace kicked off with a backgrounder, explaining the pros, cons, and differences between femtosecond, LASIK, and small incision lenticule extraction (SMILE) refractive surgery. He noted refractive outcomes were the same; that tear break-up time and the ocular surface disease index were better in SMILE; but uncorrected distance visual acuity was better with LASIK at one month and three months. He noted that SMILE could be further improved with features such as auto-centration, toric alignment, easier lenticule removal, the precision of energy delivery and an enhanced re-lenticule procedure – all of which were either on the wish list, being developed, or have landed.

Johnson and Johnson’s new offering – the Elita platform which facilitates smooth incision lenticular keratomileusis (SILK) technology – is one such promising evolution of laser refractive surgery technology. It was detailed by Professor Mahipal S. Sachdev from Delhi, India, who having worked with the platform since January 2020, has performed many SILK procedures. Prof Sachdev spoke about the safety profile of the Elita platform and provided an in-depth explanation of this next generation lenticule procedure. He described how the Elita platform delivers low energy treatment via ultrashort pulse duration, ultrafast pulse frequency, small focus spot size, and sub-micron precision. This results in the creation of fast and smooth cuts for easy lenticule access and removal, with minimal stromal tissue disruption. Research demonstrates excellent accuracy of Elita, and the platform achieves consistent flap thicknesses.

Target patients are 18-years or older, with stable refraction and in the range of <-6.00DS and up to -2.00DC. People with compliant, easy-going, positive personalities are the most suitable candidates. They need to discontinue contact lenses prior to the procedure, not be pregnant or nursing, have no other contraindications, and must be able to lie flat.

Dr Pooja Khamar from Narayana, India – the youngest person to achieve a PhD in ophthalmology – covered advancements in refractive surgery. She explored the versatility of Elita and other procedures and compared theoretical versus clinical results with pre- and post-op data. She noted that SILK shows less change in corneal asphericity and less induction of higher order aberrations compared to SMILE.

In a comparative study she was involved with, Status of residual refractive error, ocular aberrations and accommodation after myopic LASIK, SMILE, and TransPRK, she concluded that the refractive and aberrometric status of LASIK eyes was closest to normal eyes and that the SMILE procedure may benefit from slight overcorrection of the preoperative refractive cylinder. She also discussed depth of field results.

Some of the main take-home points were that with SILK, the lenticule was ‘free’, requiring very little dissection with minor or no tissue adhesions, cold spots or bridges, an excellent entry cut and fast visual recovery.

A panel session with audience participation resulted in delegates and the presenters discussing a variety of issues before the meeting closed and delegates headed off to the AUSCRS plenary sessions.