Eyeworld

SUMMER 2026 | EYEWORLD | 55 R Relevant disclosures Cummings: Alcon Lobanoff: Alcon, Bausch + Lomb, Lochan, Ziemer Stonecipher: Alcon, Bausch + Lomb, Johnson & Johnson Contact Cummings: abc@wellingtoneyeclinic.com Lobanoff: mlobanoff@gmail.com Stonecipher: stonenc@gmail.com Remaining limitations and ongoing platform development One caveat to the WaveLight Plus' success, ac- cording to Dr. Cummings, is that it does not yet perform hyperopic corrections, but the compa- ny is working on collecting data for this in the future. Dr. Stonecipher called the WaveLight Plus platform "pretty innovative," and noted that Alcon is already working on ways to make it better. "As Dr. Cummings noted earlier, the nice thing about the WaveLight Plus platform is consistency from surgeon to surgeon," Dr. Stonecipher said. "In two of our presentations at the 2026 ASCRS Annual Meeting, we showed excellent LASIK outcomes with all of the WaveLight platforms. However, the WaveLight Plus platform had 100% 20/20; 90% 20/16; 53% 20/12.5; and 11% 20/10." Preoperatively, 1.4% of the eyes could see 20/12.5, and after surgery, that number rose to 53%. He also said that "Bausch + Lomb continues to press on to- ward more approvals for their platform, but the FDA approvals are taking longer than before." Surgical fundamentals still matter Even with all of these updates, no matter how good the technology is, Dr. Cummings said you still need to perform perfect surgery, taking care of ocular surface issues and dryness, validating maps, making sure the patient is looking at the fixation target, etc. "You still have to stick to the basics. You can't downgrade the way you do the procedure and hope the technology is going to compensate for you," he said. From the 2026 ASCRS Annual Meeting A debate held during Refractive Day at the 2026 ASCRS Annual Meeting focused on the different LASIK planning platforms: wavefront-guided, wavefront-optimized, topography-guided, and ray tracing-guided. Here are the key messages from each debater: Wavefront-guided LASIK, Edward Manche, MD: During his presentation, Dr. Manche said the main advantage of this technology is that it treats the entire optical system. Some studies have shown better UDVA with wavefront-guided LASIK vs. wavefront-optimized. Only a few studies have compared wavefront-guided and topography-guided LASIK, but Dr. Manche said all have shown superior outcomes with wavefront-guided treatments. "We've been doing wavefront-guided for many years. It has stood the test of time, and it's still the best procedure," he said. Ray tracing- or topography-guided LASIK, Mark Lobanoff, MD: Dr. Lobanoff described these treat- ments as being based on the reality of each eye and not approximations. "Wavefront-guided LASIK is amazing … but it represents the optical state at one moment in time," he said, adding that it's dependent upon other factors within the eye as well. Wavefront-optimized LASIK, Dr. Lobanoff described as highly predictable and efficient but not customized. Ray tracing- and topogra- phy-guided LASIK create custom ablation patterns to treat higher order aberrations, improving quality of vision. Dr. Lobanoff showed data that placed ray tracing-guided (WaveLight Plus) and topography-guided (Phorcides planned Contoura) LASIK UDVA at 20/20, 20/15, and 20/10 ahead of wavefront-guided and wavefront-optimized LASIK. Wavefront-optimized LASIK, Karl Stonecipher, MD: Dr. Stonecipher said that wavefront-optimized, compared to some systems, has excellent outcomes for many patients regardless of some corneal nuances, but he acknowledged that for the majority of patients, ray tracing-guided is performing better than wavefront-optimized at the 20/16 level. "One last thing, and this is very important," Dr. Lobanoff added during the debate's discussion. "We have an embarrassment of riches in this environment. Wavefront-guided is amazing, wavefront-op- timized is amazing, and new technology is amazing. These debates are not meant to denigrate one or the other. I think we should all be so excited of where we're at and the future. There is a place for all of these technologies."

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