EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/618732
EW FEATURE 44 Management of the irregular cornea • January 2016 by EyeWorld staff ASCRS members weigh in N ew advances in wavefront technology and topogra- phy have improved the management of irregular corneas in laser vision correction patients. "While we still do not have a laser ablation technology that will completely treat highly irregular cor- neas, it is exciting to see the incre- mental improvements in technology that are being approved," said John Hovanesian, MD, Laguna Hills, Calif. "Particularly, the approval of the first topography-guided laser ablation in the United States is great progress. There can be a disconnect, though, between correcting topog- raphy and correcting vision. How often have we seen patients with keratoconus and maybe 8 D of fairly regular astigmatism undergoing cataract surgery? We can correct at best 4 D with current toric IOLs, but for many of these patients, that un- dercorrection still provides excellent uncorrected acuity. Fully correcting all corneal aberrations in all pa- tients may not be necessary or even desirable. That means even if they were available, we should be careful not to apply laser correction to all measured corneal aberrations. Just because we can correct an aberration doesn't mean we should." In the 2015 ASCRS Clinical Sur- vey, ASCRS members were surveyed about their use of new technology in these patients. Here are the results. Ablations Ophthalmologists were asked, "What category of ablations are the majority of your corneal refractive procedures currently and in the next 2–3 years?" Currently, 81% of U.S. respon- dents use wavefront-guided abla- tions, with 52% using customized ablations and 29% using optimized ablations. Non-U.S. surgeons' responses were evenly split, with 26% using customized wavefront ablations, 27% using optimized wavefront ablations, and 27% using standard ablations. Laser vision correction in patients with irregular corneas Wavefront-customized Wavefront-optimized Topography-customized Femtosecond intrastromal lenticule extraction Standard ablations Other 0% 10% 20% 30% 40% 50% 60% Currently All U.S. Non U.S. 0% 10% 20% 30% 40% 50% In 2 to 3 years Mechanical microkeratome LASIK Femtosecond flap LASIK Surface ablation Femtosecond intrastromal lenticule extraction No clinically significant differences between these treatment options 0% 10% 20% 30% 40% 50% 60% 70% 80% continued on page 46 Figure 1 Figure 2 ASCRS Clinical Survey Wavefront-customized Wavefront-optimized Topography-customized Femtosecond intrastromal lenticule extraction Standard ablations Other All U.S. Non U.S. All U.S. Non U.S.