Eyeworld

42 | EYEWORLD | SUMMER 2024 R EFRACTIVE I n this issue full of wishes for innovation and dis- cussions about the com- ing years in refractive surgery, it's important to acknowledge where we are today and what trends are at work for the future. In "Corneal refractive surgery: the future wish list," Y. Ralph Chu, MD, Edward Manche, MD, and Jod Mehta, MD, dive into the tech- nologies currently in clinical trials, including the Technolas Teneo laser platform (Bausch + Lomb). While it was approved for the treatment of myopia in 2024, I'm particularly interested in its use for treating hyperopia, for which it's currently under investigation in the U.S. and in practice outside of the U.S. I also look forward to seeing the data once published on the innova- tions in femtosecond laser lenticule extraction, which has the possibility to improve the visual outcomes of this procedure. Also in this section is the YES Connect column, "Tips for IOL exchange." In it, Allison Chen, MD, and Yvonne Wang, MD, outline various scenarios for why patients may not be happy with their current lens and how to meet their needs moving forward. Finally, in "A decline in LASIK procedures: what this means for refractive surgery as a whole," Lance Kugler, MD, Luke Rebenitsch, MD, Vance Thompson, MD, and Blake William- son, MD, discuss the practical implications of this trend. In my practice, we have experienced a decline in LASIK candidates. But it's important to acknowledge all of the trends at work here, among them: opting for lens surgery earlier; phakic IOL options spurred, at least in part, by newer technologies; and direct patient educa- tion about these products. Also among the trends at play are rapidly increasing levels of myopia and screen time. By one estimate, 1 half of the world's population will have myopia by 2050. A 2023 study 2 of children ages 6 and 7 in Ireland found increased screen time (>2 hours/day) was associated with myopic shift and higher degrees of astigmatism, among other things. These statistics represent a patient population who will need refractive correction in the future in order to realize their best visual outcomes. In the short term, consider recommending alternatives to contact lens use to patients. A 3-year longitudinal study by Price et al. 3 found that LASIK not only reduced the number of infections, ulcers, and abrasions (per self-re- porting) annually, but it improved ease of night driving and resulted in higher satisfaction over 3 years of follow-up, as compared with contin- ued contact lens wear. In some cases, the risks are lower having surgery, and it's worth the discussion. What trends are you seeing in your prac- tice? What can we learn from this data? And what does it tell you about how you can better serve refractive surgery patients in the future? Let's talk about trends by Karolinne Rocha, MD, PhD Refractive Editor References 1. Holden BA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123:1036– 1042. 2. Harrington S, O'Dwyer V. The association between time spent on screens and reading with myopia, premyopia and ocular biometric and anthropometric measures in 6- to 7-year-old schoolchildren in Ireland. Ophthalmic Physiol Opt. 2023;43:505–516. 3. Price MO, et al. Three-year longitudinal survey comparing visual satisfaction with LASIK and contact lenses. Ophthalmology. 2016;123:1659– 1666. William Trattler, MD, Refractive Editorial Board member, shared what he wishes he had: I wish for presbyopia eye drops that last all day and have a very low incidence of serious side effects. Vuity (pilocarpine, AbbVie) worked great for me, and I am super excited for the next generation of presbyopia-correcting eye drops to become available. Jeff Pettey, MD, Cataract Editorial Board member, shared what he wishes he had: I wish we had refractive index shaping to allow permanent refractive correction to any patient who has had cataract surgery. I WISH I HAD ...

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