LASIK For Patients with Cardiac Devices

The letter titled “Safety of the Excimer Laser in LASIK and PRK for Patients with Implantable Cardiac Devices: Our Clinical Experience in the Past Two Decades,” published in the Journal of Ophthalmic and Vision Research in 2019, offers critical insights into the safety of performing LASIK and PRK on patients with implantable cardiac devices (CIEDs).

Key Findings:

1. Objective: The letter aims to address the safety concerns related to the use of excimer lasers during LASIK and PRK in patients with CIEDs, providing insights based on clinical experiences over two decades.
2. Methods: The study retrospectively analyzed data from 1997 to 2014, involving patients who underwent LASIK/PRK and had CIEDs. The analysis included patients with various indications for CIEDs, such as atrial fibrillation, ventricular tachycardia, atrioventricular block, and Wolf-Parkinson-White syndrome. The study also reviewed potential electromagnetic interference (EMI) and its effects on CIEDs during the procedures.
3. Results: Out of 13 documented patients with CIEDs, none experienced clinically significant EMI-related complications during surgery. One patient developed ventricular tachycardia two weeks postoperatively, attributed to an uncontrolled underlying condition rather than EMI from the laser. There were no detectable changes in heart rate or rhythm, and the programmed parameters of the pacemakers and ICDs remained unchanged postoperatively.
4. Conclusions: The study concluded that LASIK and PRK can be safely performed on patients with CIEDs, provided appropriate precautions are taken. Shielding the CIED with a magnet and closely monitoring the heart rate during the procedure are recommended. Recent advancements in leadless pacemakers, which are immune to high levels of EMI, further enhance the safety of these procedures for patients with CIEDs.

Implications for Practice: At LCA Vision, we continuously strive to provide safe and effective treatments for all patients. This study’s findings reassure us that LASIK and PRK can be safely performed on patients with implantable cardiac devices, given the proper precautions and adherence to manufacturer guidelines. We will continue to implement these best practices, ensuring that our patients with CIEDs receive the highest standard of care without compromising their cardiac health.

In conclusion, LASIK and PRK are viable options for patients with CIEDs, with minimal risk of EMI-related complications. As technology advances, these procedures will likely become even safer, expanding access to life-changing vision correction for more patients.

Safety of the Excimer Laser in LASIK and PRK for Patients with Implantable Cardiac Devices: Our Clinical Experience in the Past Two Decades

Authors: Tirth J. Shah, MD; Majid Moshirfar, MD, FACS; Phillip C. Hoopes, Sr, MD.

Published in: Journal of Ophthalmic and Vision Research, 2019, Volume 14, Issue 4, p 530-531. DOI: 10.18502/jovr.v14i4.5473.

Letter Summary: Continued high prevalence in cardiac morbidity in the US has led to more refractive surgical candidates with cardiac implantable electronic devices (CIED). Historically, FDA studies have excluded such populations during LASIK or PRK evaluations, and major manufacturers have discouraged laser eye surgery in these patients until recently. Medtronic and St. Jude now approve LASIK surgery with precautions, such as shielding the CIED with a magnet and closely monitoring the heart rate during the surgery.

The excimer laser can potentially interfere electromagnetically with CIEDs, causing adverse effects. Factors affecting EMI include the frequency of the emitting device, distance between devices, and the amount of shielding. Studies have shown that the energy emitted by the excimer laser may not significantly interfere with CIEDs. A retrospective analysis from 1997 to 2014 found that none of the patients experienced CIED-related complications during surgery, except one case attributed to an uncontrolled condition.

Conclusions: The current body of evidence suggests a low risk of complications for patients with CIEDs during refractive surgery. Following manufacturer recommendations and advancements in leadless pacemakers enhance the safety of these procedures.