Eyeworld

EW FEATURE 48 Keratorefractive surgery August 2015 by EyeWorld staff The future of laser vision correction ablations: What's next? A s laser vision correction (LVC) has evolved, so have patient expectations. "There are increasing patient expectations— we are victims of our own success. Newer technology has significantly improved outcomes, which keep pace with the greater demands of patients for excellent results," said Steve Schallhorn, MD, San Diego. Ablations are one area in which the technology has improved. "Ev- ery LVC candidate rightly demands the safest and most accurate treat- ment available," said A. John Kanellopoulos, MD, Athens, Greece, and New York. "In our experience, wavefront-optimized is very good, and topography-guided is strongly superior even in 'normal' virgin eyes. The rule is that most corneas have some degree of asym- metry in regard to the cornea apex (the visual axis). Topo-guided offers the best option today in maximizing the effective corneal symmetry for each patient." In the 2014 ASCRS Clinical Sur- vey, ASCRS members were surveyed about their ablation preferences. When asked which types of ablations are used in their practices, more than half of U.S. respondents indicated that they preferred wave- front-customized ablations, while non-U.S. respondents typically use standard ablations or wavefront-op- timized ablations. Statistically signif- icant differences between U.S. and non-U.S. respondents are highlight- ed in green in Figure 1. Dr. Schallhorn cited the follow- ing reasons that more physicians are not using customized ablations: are the best patients to offer this to as a presbyopic solution," Dr. Kraff said. "There are no other options beyond premium IOLs and refrac- tive lens exchange or a monovision option in a corneal refractive proce- dure." Another promising technology is the Raindrop (ReVision Optics, Lake Forest, Calif.), Dr. Koch said. International data for implanta- tion of the non-dominant eye in presbyopes show excellent results in providing good reading vision with minimal change in uncorrect- ed distance acuity. It appears to be a forgiving and readily accepted option, he said. Mapping the future Another emerging technology that could prove helpful is epithelial thickness mapping in laser vision correction, according to Dr. Koch. This could be an important tool for screening for early forms of kera- toconus. Availability of epithelial thickness indices developed for OCT may provide a better way to screen for keratoconus in its early forms. Emerging technologies continued from page 47 "The other potential role could be in enhancements. When a pa- tient has regression or progression of the effect, you can look at the epithelial thickness profile and try to understand whether it was a stromal change or had something to do with the epithelium," Dr. Koch said. "With time we might learn how to create treatments that are more stable and also better un- derstand how to more accurately enhance patients who had an unex- pected refractive change." EW Editors' note: Dr. Koch has financial interests with Alcon (Fort Worth, Texas), Abbott Medical Optics (Ab- bott Park, Ill.), and ReVision Optics. Dr. Kraff has financial interests with Abbott Medical Optics. Dr. MacRae has financial interests with Bausch + Lomb (Bridgewater, N.J.). Contact information Koch: dkoch@bcm.edu Kraff: ckraff@kraffeye.com MacRae: Scott_MacRae@urmc.rochester.edu Figure 2 Source: ASCRS Wavefront-customized Wavefront-optimized Topography-customized Significant combination of wavefront-customized and topography-customized Other 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% U.S. Non-U.S. Overall U.S. Non-U.S. Overall Wavefront-customized 52.2% 21.5% 35.9% Wavefront-optimized 22.7% 29.9% 26.2% Topography-customized 0.5% 12.1% 7.4% Standard ablations 22.7% 35.5% 29.2% Other 1.9% 0.9% 1.3% Figure 1

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