Eyeworld

49 EW FEATURE • cost • added diagnostic device • requirement to review diagnostic measurement (aberrometer or topography ablation profile) • do not appreciate the advantages of the technology Dr. Kanellopoulos practices in both Europe and the U.S. "I think I have a deep understanding of these very interesting differences in the numbers in this survey. I think they reflect the global clinical 'pulse.' In the U.S., topography-guided has been recently approved, while those outside the U.S. have almost 12 years of clinical experience. Wave- front-optimized ablations offer very good results, and it is reasonable for a large fraction of clinicians both in the U.S. and outside of the U.S. to prefer them. Wavefront-guided ablations have their share of be- lievers, mainly in the U.S., because they comprise the only available customization platform currently; in my opinion and experience, they do improve outcomes in regard to mainly reduction of spherical aberration, which is a weak point of older, broad-beam excimer technol- ogies. Customized ablations require more labor-intensive measurements, calculations, and assessment of results," he said. When asked about the type of ablations that will be used for their LVC procedures in the next 2 or 3 years, 52.3% of U.S. respondents believed wavefront-customized ab- lations will be the majority of their LVC procedures, while non-U.S. respondents believed that wave- front-optimized ablations will be the majority of their LVC procedures (34.5%). The difference in response between U.S. and non-U.S. was sta- tistically significant (Figure 2). "In my opinion, topo-guided ablations or, even better, a combina- tion of topo-guided with spherical data provided from wavefront-guid- ed calculations will be the procedure of choice. The reason is that the cornea shape is much more stable than a wavefront measurement that varies significantly from moment to moment. I am confident that once the U.S. surgeons embrace the topography-guided technology and report their initial experience, the world will follow suit. It is unfortunate that although topogra- phy-guided ablations have been FDA approved since the fall of 2013, they have not been clinically released yet," Dr. Kanellopoulos said. Dr. Schallhorn said that custom- ized wavefront-guided ablations will be most common in his practice in the next 2–3 years. EW Editors' note: Dr. Kanellopoulos has financial interests with Alcon (Fort Worth, Texas), Allergan (Dublin, Ireland), Avedro (Waltham, Mass.), Optovue (Fremont, Calif.), and Carl Zeiss Meditec (Jena, Germany). Dr. Schallhorn has financial interests with Abbott Medical Optics (Abbott Park, Ill.) and Carl Zeiss Meditec. Contact information Kanellopoulos: ajkmd@mac.com Schallhorn: scschallhorn@yahoo.com Global Trends in Ophthalmology ™ Copyright © 2015 Global Trends in Ophthalmology and the American Society of Cataract & Refractive Surgery. All rights reserved. " Newer technology has significantly improved outcomes, which keep pace with the greater demands of patients for excellent results. " –Steve Schallhorn, MD

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