Refractive
December 2021
by Vance Thompson, MD
Refractive Editor
As I write this introduction to the Refractive section of the December 2021 issue, I am delighted to highlight some of the wonderful clinical pearls that our contributors have gifted us with as we end a year that involved great progress in ophthalmology but also great challenges for our profession and world as we continue to deal with COVID-19. Please take the time to read the article on LASIK where Thomas Clinch, MD, Ella Faktorovich, MD, and Neda Nikpoor, MD, shared their clinical wisdom. It is like an academic primer in what I call “Advanced Refractive Surgery 909” and includes pearls for any doctor, including those wanting to take their refractive knowledge and experience to another level. The article highlights the importance of studies looking at preoperative symptoms, since many go down after LASIK, versus just analyzing post-LASIK symptoms in a clinical trial; the PROWL studies developed a wonderful questionnaire for doing exactly that. Other topics are also addressed, such as respecting the psychology of presbyopia, dealing with dryness and nighttime issues, understanding when to treat or not treat higher order aberrations, the compounding of problems by not giving the patient the time they deserve, especially when they are frustrated or afraid, minimizing refractive error with enhancements with similar vigor as we do when refracting someone to plano before prescribing glasses, the power of a surgeon handing out their mobile phone number to a patient, making consults easy with “no contact lens holiday,” when to do PRK or phakic IOLs for potential ectasia risk situations, and when to map the epithelium.
… I am delighted to highlight some of the wonderful clinical pearls that our contributors have gifted us with as we end a year that involved great progress in ophthalmology but also great challenges for our profession and world as we continue to deal with COVID-19.
I think it is of particular importance that we critically read the article featuring a case discussion from Luke Rebenitsch, MD, and Shehzad Batliwala, DO, on how to handle a patient who wants correction of their presbyopia after having hyperopic LASIK in one eye and hyperopic LASIK plus a corneal inlay in the other. In the hyperopic LASIK eye, we can quantify corneal higher order aberrations and decide whether or not adding a multifocal is a possibility. In the eye that has the corneal inlay, the patient already has enhanced depth of focus and thus a monofocal lens worked beautifully. There was wonderful advanced refractive surgery thinking in this case where the patient ended up happy and achieved his goals.
I hope you enjoy the article featuring comments from Kourtney Houser, MD, Amir Marvasti, MD, and me on the epithelial blur that can degrade the optics of any eye and can be the cause of unhappy premium implant patients if left unaddressed. The importance of the gas permeable contact lens over refraction in this situation is highlighted.
Finally, the article on myopia management, one of the hottest topics in eyecare today, consults Donald Tan, MD, and Erin Walsh, MD, and is a wonderful overview of the hazards of unchecked myopia progression, great treatment options, and the multidisciplinary world needed.
I hope you enjoy this issue of EyeWorld as much as I did. Thank you again to our great contributors from around the world, and thank you to the writers at EyeWorld for bringing it all together. I wish you and yours a wonderful holiday season.
