The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on photorefractive (laser) surgery for the correction of refractive error.
It replaces the previous guidance on laser in situ keratomileusis for the treatment of refractive errors (Interventional Procedures Guidance no. 102, December 2004), following consideration of a systematic review of LASIK and LASEK.
Refractive error includes myopia, hyperopia, astigmatism and presbyopia; these are usually corrected by wearing spectacles or contact lenses. Modifying the shape of the cornea can reduce myopia, hyperopia and astigmatism. Corneal reshaping is achieved in photorefractive surgery using excimer laser ablation and is indicated in the range of refractive error from +6 dioptres (D) of hyperopia to –10 D of myopia, with up to 4 cylinders of astigmatism. Excimer laser refractive surgery techniques in current use include photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK) and laser in-situ keratomileusis (LASIK).
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.