JAN 2016

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/618732

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Page 12 of 78

World view Irregular cornea management I n my opinion, the coming year will be the most exciting year for laser vision correction since the advent of LASIK 2 decades ago. In the past, the excimer laser was employed to reduce patient dependence on glasses and contact lenses and improve quality of life. Many patients see better following LASIK and PRK than they did with the previous vision correction. For this reason, laser vision correction is significantly more than a cosmetic surgery as it also improves function. However, the primary role of the excimer laser for the past 20 years has not been therapeutic. Now, thanks to new technology, we are at the precipice of being able reduce or eliminate vision handicaps that could not be corrected with glasses or contact lenses and that relied on rigid gas permeable contact lenses, scleral lenses, or even penetrating keratoplasty for visual rehabilitation. Topographic laser ablation has been available outside of the United States for almost 15 years and has shown dramatic improvement. In this is- sue, leading experts discuss the exciting future of novel advanced technology that is becoming available today. Alcon is launching the Contoura Vision topographic-guided laser in the United States. Kerry Solomon, MD, has been part of the U.S. FDA trials, while A. John Kanellopoulos, MD, and David Lin, MD, bring a wealth of international clinical experience with topographic laser treatments. They discuss pearls for optimizing the treatment of highly irregular eyes such as corneas following penetrating keratoplasty, trauma, decentered ablations, optical zone enlargements, patients with keratoconus, and following radial keratotomy (RK). Choosing the best candidates for topographic laser abla- tions is an important step to improve clinical results. Two more key facets to getting the most out of a topographic ablation are maximizing tear film stability and capturing high quality images. In addition, clinicians need to know when to choose a topographic laser treatment over a wavefront or optimized ablation. Karl Stonecipher, MD, Allon Barsam, MD, and Daniel Durrie, MD, discuss how to capture accurate and reproducible images to get the most out of this exciting new technology. In the beginning, refractive surgeons will want to perform topographic ablations on normal corneas. Once we gain experience we will want to take on the challenge and op- portunity of more irregular corneas. With wavefront ablations, one image is used to construct a treatment. With topo-guided treatments, a compila- tion of images is employed. Stephen A. Wexler, MD, and Raymond Stein, MD, discuss how to improve outcomes by obtaining and then selecting the best possible images to develop a treatment strategy. In addition, many topographic ablations will be performed in conjunction with riboflavin UV crosslinking. Physicians and technicians will have to work together to maximize treatment efficacy. As the saying goes, there's more than one way to skin a cat, and in a similar vein there is more than one way to treat an irregular cornea. Wavefront aberrometry captures the low order and high order abnormalities of the visual system. The next generation waveform aberrometer is the iDesign from Abbott Medical Optics. Some advantages of this aberrometer include more precise image capture, greater resolution, and more personalized treatment. The iDesign has 5 times more data points and a greater dynamic range than the previous WaveScan. The added accuracy will allow this technology to improve results in normal eyes and also allow treatment of irregular corneas. Arun C. Gulani, MD, Edward E. Manche, MD, and Steven C. Schallhorn, MD, discuss the use of advanced wavefront ablations on both normal and abnormal corneas. Advanced wavefront and topographic lasers will change our available treatment options. The ability to treat surgical, traumatic and idiopathic irregular corneas is a landmark moment in refractive corneal surgery. EW Eric Donnenfeld, MD, chief medical editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S January 2016 Volume 21 • No. 1 Publisher Donald R. Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Staff Writers Ellen Stodola ellen@eyeworld.org Liz Hillman liz@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 Bradenton, Fla. Michelle Dalton Reading, Pa. Rich Daly Arlington, Va. Lauren Lipuma Washington, D.C. Matt Young Malaysia 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 Paul Zelin paul@eyeworld.org 703-383-5729 Corey Allen corey@eyeworld.org 703-788-5745 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. Copyright 2016, ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. Letters to the editor and other unsolicited material are assumed intended for publication and are subject to editorial review and acceptance. Subscriptions: Requests should be addressed to the publisher. Annual subscription prices: Individual: 1 year, $120; 2 years, $220; 3 years, $320. Institutional: 1 year, $250; 2 years, $330; 3 years, $425. Foreign: 1 year, $240, 2 years $470, 3 years, $700. Back copies: Subject to availability. Contact the publisher. Cost per copy is $15; $30 foreign. All orders for individual or back copies must be accompanied by payment. 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