Refractive
September 2021

by Vance Thompson, MD
Refractive Editor

It is with great excitement and enthusiasm for our wonderful profession that I write this introduction for the Refractive section in the 25th anniversary issue of EyeWorld. The growth in understanding in refractive surgery over that time has been mind boggling. Twenty-five years ago, in 1996, we were doing a lot of research in PRK, LASIK, and phakic IOLs. Presbyopia-correcting IOLs were hardly used, and myopia control was simply not talked about. To see where corneal refractive surgery has come with PRK, LASIK, and SMILE, along with our understanding of how phakic IOLs fit, coupled with the progress in multifocal and EDOF IOLs, makes me feel like EyeWorld’s 25-year journey has spanned the most important 25 years in the history of refractive surgery.

Our understanding in patient selection, along with the progress in diagnostic and treatment technology, has made us so much better. We now understand that just because a patient can see the 20/20 line on the Snellen chart with their correction doesn’t necessarily mean they are a great candidate for laser vision correction. We have learned we need to ask them about their image quality. If their low-light image quality is great with their best spectacle or contact lens correction, there is a good chance we can help them with a well-performed laser vision correction procedure. But if they have reduced low-light image quality, even if they can see the 20/20 line with their correction, we now have diagnostics that can help us localize the cause of blur to early lenticular, reduced tear film, or other changes that we need to address. This respect for patient history and advanced diagnostics guides our treatment decision making tremendously.

We have also learned that a premium multifocal or EDOF implant can bring tremendous patient satisfaction if the surgeon performs a refractive enhancement when the patient is not seeing a quality 20/20 uncorrected image. Eric Donnenfeld, MD, Elizabeth Yeu, MD, and Blake Williamson, MD, provide great insights on how to utilize modern day improvements in presbyopia-correcting IOLs to optimize patient satisfaction. Shamik Bafna, MD, and George Waring IV, MD, discuss various surgical and non-surgical presbyopia treatment options that are available now and those on the horizon. Sarah Nehls, MD, and Dr. Williamson give us a great summary of why refractive lens exchange has become such a respected refractive surgical procedure for certain situations.

Thank you to the contributors in this special issue, and congratulations to EyeWorld on 25 years of educating us in such a quality way. I am excited to see what the next 25 years brings to refractive surgery.