EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/357599
The official publication of the American Society of Cataract & Refractive Surgery A S C R S August 2014 Volume 19 • No. 8 Publisher Donald R. Long don@eyeworld.org Editorial Editor Erin L. Boyle erin@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Staff Writer Ellen Stodola ellen@eyeworld.org Staff Writer Lauren Lipuma lauren@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Fla. Michelle Dalton Reading, Pa. Matt Young Malaysia Enette Ngoei Dublin Rich Daly Arlington, Va. Senior Contributing Writer Maxine Lipner Nyack, N.Y. Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld. org Advertising Sales Jeff Brownstein jeff@eyeworld.org 703-788-5745 Paul Zelin paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org 703-591-2220 ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. Advertising Offices: ASCRSMedia, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. 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The ideas and opinions expressed in EyeWorld do not necessarily reflect those of the editors, publisher, or its advertisers. P U B L I S H I N G S T A F F World view Laser vision correction W e are now entering the second generation of excimer laser refractive cornea surgery. The FDA trials started in the late 1980s and PRK approval came in 1995 in the U.S., almost 20 years ago. We have come a very long way during this time. PRK was the dominant refractive surgical procedure for almost 2 years and was quickly supplanted by LASIK. The original excimer laser beam profiles had small optical zones and almost no blend, leaving many patients with good Snellen visual acuity, but nighttime glare and halo were common. Flap formation with first- and second-generation mechanical microkeratomes created thicker flaps that were more prone to dislocate, resulting in micro and macro striae. Thicker flaps, less accurate diagnostic equipment, and the lack of guidelines resulted in the rare case of ectasia. Irregular flaps also occurred occasionally and were difficult to treat. Prolate and customized ablations have dramatically improved quantity and quality of vision with many patients reporting better vision after refractive surgery than they achieved with their best correction with glasses or contact lenses prior to treatment. Better flap formation with new microkeratomes, and particularly with the femtosecond laser, have resulted in significantly better and thinner flaps. The incidence of ectasia has dramatically decreased. Not surprisingly, our early laser vision correction patients are now en- tering the age group where cataract surgery is becoming increasingly com- monplace. Cataract surgery following LASIK presents 2 problems. First of all, these patients have exceptionally high refractive expectations, and second, calculating the correct IOL power is challenging due to the changes in corneal curvature. In this issue Warren Hill, MD, Douglas Koch, MD, Samuel Masket, MD, and Mark Packer, MD, present their pearls for the best ways to select IOLs after myopic LVC. LASIK and PRK have nev- er been safer or more effective. Difficult cases can now be managed more effectively. Robert Maloney, MD, A. John Kanellopoulos, MD, Raymond Stein, MD, and I discuss better ways to treat and prevent dry eye disease and the use of corneal collagen crosslinking for patients at risk for ectasia. Lou Probst, MD, Steven Schallhorn, MD, and Kerry Solomon, MD, provide details on how LASIK results have continued to improve and where we stand today. One of the most exciting aspects of refractive surgery is the continued emphasis on improving the status quo. The next generation of refractive corneal surgery will be even better. New technologies such as topographic ab- lations, better aberrometers, and intrastromal ablations are discussed by John Vukich, MD, Guillermo Rocha, MD, George O. Waring III, MD, and D. Rex Hamilton, MD, providing readers with a glimpse into the near future. There is no doubt that laser vision correction has entered the ophthal- mic mainstream and that this life-changing surgery has undergone dramatic changes over the last 20 years. We hope you enjoy this issue of EyeWorld and learn from the best how to incorporate these pearls into your practice. Eric Donnenfeld, MD, refractive surgery editor Eric Donnenfeld, MD, refractive surgery editor