March 2019


Refractive corrections

Vance Thompson, MD,

Refractive editor

There was a day when refractive surgery was thought of as a corneal procedure only. But with technology advancements, the modern day comprehensive refractive surgeon needs to have a thorough understanding of corneal, lenticular, and phakic IOL refractive surgical options. In this issue’s featured series, ophthalmic surgeons do a great job helping us understand modern day advancements in the exciting field of comprehensive refractive surgery.
In “What’s next for SMILE after new approvals,” Rex Hamilton, MD, Jon Dishler, MD, and Jason Stahl, MD, share patient selection tips and show how nicely SMILE fits into a PRK and LASIK practice. With the recent approval of toric corrections in the U.S., I expect this procedure to grow at the exciting pace the rest of the world is enjoying.
In the article “Making room in the toolbox for the toric ICL,” Lance Kugler, MD, Erik Mertens, MD, Paul Dougherty, MD, and Gregory Parkhurst, MD, teach us the importance of alignment and sizing for the newly approved toric addition to this myopic phakic IOL. Phakic IOLs help a practice to not push the cornea too much with corneal refractive surgery in high corrections. I tell patients that phakic IOLs need annual surveillance of their corneal endothelium and will someday be removed, and at the time of ICL removal cataract surgery can be performed to address clarity and refractive error including presbyopia correction.
Experts Russell Swan, MD, Michael Greenwood, MD, and Michael Gordon, MD, teach us about corneal and light adjustable premium IOLs in “Premium IOLs continue to gain popularity.” The options available to a qualified candidate, be it cataract surgery or refractive lens exchange, have made this advanced form of lens replacement the fastest growing refractive surgery in our practice. Their tips on hitting the refractive endpoint with a corneal or light adjustable optic enhancement, if necessary, are key to success in refractive cataract surgery.
In “Considerations for patients with prior corneal refractive surgery,” Brandon Baartman, MD, and Kevin Waltz, MD, discuss how this group of patients who desire less dependence on spectacles often want the same when it comes time for cataract surgery. Their comments on quantifying how multifocal a cornea is after corneal refractive surgery is one of the keys to assessing which premium IOL, if any, is best for their situation. They nicely cover how today’s diagnostics help in patient selection and education.
Topography and tomography experts Michael Belin, MD, Renato
Ambrósio Jr., MD, John Kanellopoulos, MD, and William Trattler, MD, teach us about the science and art of early keratoconus detection in “Obtaining earlier keratoconus diagnoses.” I think that topography should be a part of not only every refractive and cataract evaluation, but every eye exam to detect keratoconus as often and early as possible. All eyecare practitioners need to work diligently to not let results be confused by this disease and continue undiagnosed. We can halt keratoconus with education on stopping eye rubbing and crosslinking.
Thank you to all the doctors and writers who contributed so much to these insightful articles.

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Ophthalmology News - EyeWorld Magazine
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