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Evolving technology and outcomes in cataract and refractive surgery 8 had more than 90% of eyes achieving 20/20 UDVA with more than 80% within ±0.5 D of target refraction. Conclusion In conclusion, unlike topo-guid- ed ablations that treat only the anterior part of the cornea leading to vision that is not opti- cally clear in eyes with irregular posterior corneal surfaces, wavefront-guided ablations ensure good vision and optical clarity even in eyes with irregu- lar posterior corneal surfaces. rected distance visual acuity achieved (UDVA), following patients up to 6 months. Comparing custom LVC with conventional LVC, more than 90% of eyes in both groups had 20/20 UDVA; 14% of eyes gained two lines of vi- sion after custom LVC, achiev- ing 20/16 UDVA, compared to only 7% achieving 20/16 UDVA after conventional LVC. Meanwhile, 85% of both custom and conventional LVC groups were within ±0.5 D of target refraction. Comparing custom LVC with flapless LVC, both groups machine. For custom LVC, robust diagnostics are provid- ed by the iDesign Advanced WaveScan Studio System (Abbott Medical Optics) using a high-definition Hartman-Shack sensor. The system is custom LVC's "thinking machine" and employs Fourier reconstruc- tion algorithms using up to 1,257 micro-refractions over a 7-mm diameter wavefront. The system's diagnostics are robust because it is able to pick up much finer resolutions com- pared to other aberrometers. Custom LVC vs. other technologies Most of the outcomes evaluat- ed when comparing technolo- gies revolve around quality of vision—every single machine, every single lens must be evaluated on quality of vision. What is most important is how the patient actually sees. Initially, we compared cus- tom LVC with other technologies to evaluate efficacy, safety, and accuracy in terms of uncor- I n my refractive surgery practice, we follow certain "commandments" for good LASIK practice excellence. These commandments begin with robust diagnostics and end with skills transfer; ultimately, it comes down to these two things, and following these commandments we evaluate the custom laser vision cor- rection (LVC) technology from Abbott Medical Optics (Abbott Park, Illinois). Robust diagnostics are the heart of refractive surgery; they are what drive the laser Rohit Shetty, MD, PhD Comparing custom LVC with other technologies Rohit Shetty, MD, PhD, Narayana Nethralaya, Bangalore, India " Robust diagnostics are the heart of refractive surgery; they are what drive the laser machine. " –Rohit Shetty, MD, PhD 10. Agca A, et al. Corneal backscatter analysis by in vivo confocal micros- copy: fellow eye comparison of small incision lenticule extraction and femtosecond laser-assisted LASIK. J Ophthalmol. 2014;2014:265012. 11. Reinstein DZ, et al. Mathemat- ical model to compare the relative tensile strength of the cornea after PRK, LASIK, and small incision lenticule extraction. J Refract Surg. 2013;29:454–60. 12. Agca A, et al. Comparison of corneal hysteresis and corneal resistance factor after small incision lenticule extraction and femtosecond laser-assisted LASIK: a prospective fellow eye study. Cont Lens Anterior Eye. 2014;37:77–80. 13. Shen Y, et al. Comparison of corneal deformation parameters after SMILE, LASEK, and femtosecond laser-assisted LASIK. J Refract Surg. 2014;30:310–8. 14. Zhao J, et al. Diffuse lamellar keratitis after small-incision lenticule extraction. J Cataract Refract Surg. 2015;41:400–7. 15. Lazaridis A, et al. Topographic analysis of the centration of the treat- ment zone after SMILE for myopia and comparison to FS-LASIK: sub- jective versus objective alignment. J Refract Surg. 2014;30:680–6. 16. Wang Y, et al. Corneal ectasia 6.5 months after small-incision lenticule extraction. J Cataract Refract Surg. 2015;41:1100–6. 17. Li M, et al. Confocal comparison of corneal reinnervation after small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK). Plos One. 2013;8:e81435. 18. Xu Y, et al. Dry eye after small incision lenticule extraction and LASIK for myopia. J Refract Surg. 2014;30:186–190. continued from page 7 Copyright 2017 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, publisher, or the sponsor and in no way imply endorsement by EyeWorld, ASCRS, or APACRS.

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