Eyeworld

89 EW FEATURE February 2018 • Laser vision correction Source: Michael Gordon, MD said. "In other words, for irregular eyes, the key is to get rid of most of the aberrations. If you do that suc- cessfully, if there is a little residual myopia and astigmatism, you can always do a secondary procedure to eliminate that. I sometimes try to go for it all if it seems reasonable for me to do it, but there are a lot of factors that have to do with the change in the spherical refraction that occurs when you're treating aberrations. If I look at the profile of what I'm treating and I make my modified correction to be zero myopia and zero astigmatism and only aberrations, I can look at the Zernike terms and look at the term of C12. C12 is the spherical aber- ration term, and I can determine if that's a high value or a low value. If it's a higher value, I can click in sphere into my modified ablation. Right now, it's at zero, so I can start clicking in some minus sphere or plus sphere to see how the C4 term, which has to do with spherical correction, changes to match what the spherical aberration term says. When I match the C4 and the C12, I know that the correction of those aberrations is going to change the sphere by that much, and that's how I have to modify what I plug into the treatment so as to not overcor- rect or undercorrect." The future Dr. Gordon thinks that surgeons will realize that it doesn't take much longer to plan topographic ablations and that they do provide better results. This realization will increase their popularity. Dr. Krueger is already seeing signs of its increase in popularity. "I heard a statistic that one-third of centers that have a WaveLight laser [Alcon] have the topographic unit," he said. "It looked like of all the treatments being done in the U.S. with the WaveLight laser, more than 10% were being topographi- cally guided, and I thought that was good for something that was brand new, more expensive, and a little more complex to figure out. I think there may be further growth in the area. However, I ultimately think that the continued success with this platform will fuel a company like Alcon to go to the next step, which is to link wavefront-guided with topography-guided with biometry and create an all-in-one treatment. If you have that capability, some of the things that we have had to use additional tools to figure out can be done automatically with those three technologies combined. I think that will make the precision of custom- ized treatment much better than anything we have seen before. Then I think the acceptance will be even greater." EW Editors' note: Drs. Gordon and Krueger have financial interests with Alcon. Dr. Stonecipher has no financial interests related to his comments. Contact information Gordon: mgordon786@gmail.com Krueger: krueger@ccf.org Stonecipher: stonenc@aol.com Poll size: 127 If I were to consider refractive surgery for myself with 20/20 correction and equal safety possible with all options, I would choose: PRK LASIK SMILE I would be equally comfort- able with A, B, or C For a 30-year-old patient with early, progressive keratoconus, I think: They should immediately undergo crosslinking They should be counseled against eye rubbing Surface ablation could be an option to lessen re- fractive error and equalize topographic irregularities provided the cornea is stable A, B, and C

• Blank Page
• Blank Page (1)