Eyeworld

World view Advanced diagnostics and treatment modalities in corneal refractive surgery M ajor advances have been made in preop testing for refractive surgery to maximize safety and accuracy. Our goal in refractive surgery should be to advise the patient on the best surgical options, be it cornea, lens, phakic IOL, or nothing. In corneal refractive surgery we want to operate on patients who are great candidates and have eyes that have crisp image quality with op- tical devices and simply want to see well without them. Patients are not always the best historians, thus advances in objective testing can be helpful to guide our surgical decision making. In this issue of EyeWorld, we learn about advancements in quantifying image quality from Karolinne Rocha, MD, including quantifying opti- cal scatter that early pathologies like dry eye, ectasia, or early cataract can cause. We can treat certain abnormalities, such as dry eye, to optimize the surface for accurate measurements and thus accurate surgery. We do not want to perform laser vision correction on certain abnormalities, such as uncrosslinked keratoconus or in the presence of early cataract formation. We also learn from Dr. Rocha and Daniel Reinstein, MD, their opinions of using advanced technologies such as biomechanical and epithelial thickness measures to go to another level of sensitivity and specificity in ruling out keratoconus. Jennifer Loh, MD, and Preeya Gupta, MD, take us down the road of understanding how the optical and therapeutic nature of the tear film can be optimized by being proactive about finding patients with dry eye issues preoperatively through a quality exam with fluorescein staining, tear break- up time testing, topography, osmolarity testing, MMP-9 testing, and meibo- mian gland imaging. This can help uncover patients who need additional testing such as for Sjögren's disease and/or allergy. Approaching the tear film in the ways they teach us helps us make sure the patient's tear film is appropriately healthy before proceeding with any anterior segment surgery, especially refractive and cataract. Steven Wilson, MD, Daniel Durrie, MD, and John Doane, MD, teach us the finer details of how three quality corneal refractive procedures, PRK, LASIK, and SMILE, fit into a refractive surgeon's options to consider for his or her patients' desired surgical correction. J. Bradley Randleman, MD, Renato Ambrósio Jr., MD, PhD, and David Hardten, MD, provide wonderful insights on treating irregular corneas. The importance of halting progressive ectasia with crosslinking is discussed, along with the fact that crosslinking leads to a flattening that can lessen corneal curvature and refractive error but also the importance of time since this is not a predictable refractive shift. The delicate intricacies of potentially lasering these corneas, both if and when, are discussed. Michael Gordon, MD, Ronald Krueger, MD, and Karl Stonecipher, MD, share their vast experience in dealing with the finer details of how to optimize topographic laser ablations when indicated in PRK and LASIK and also the laser ablation of diseased corneas. These experts share a vast amount of knowledge in this issue about amazing advancements and insights to make us better diagnosticians and physicians. I hope you enjoy learning from them as much as I did. EW The official publication of the American Society of Cataract & Refractive Surgery A S C R S February 2018 Vol. 23 • No. 2 Publisher Donald Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer 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 Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Michelle Stephenson Roanoke, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York 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 Monica Frishman monica@eyeworld.org Classified Sales Cathy Stern cathy@eyeworld.org EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org Anne Le anne@eyeworld.org 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 2018, 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. Requests to reprint, use, or republish: Requests to reprint or use material published herein should be made in writing only to Cathy Stern, EyeWorld, 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 EyeWorld reprints: To order reprints of material published in EyeWorld, contact Cathy Stern, EyeWorld, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: cathy@eyeworld.org or your salesperson Change of address: Notice should be sent to the publisher six weeks in advance of effective date. Include old and new addresses and label from recent issue. The publisher cannot accept responsibility for undelivered copies. POSTMASTER: Send change of address to EyeWorld, 4000 Legato Road, Suite 700, Fairfax, VA 22033. Periodical postage paid at Fairfax, VA 22033 and at additional mailing offices. The ideas and opinions expressed in EyeWorld do not necessarily reflect those of the editors, publisher, or its advertisers. P U B L I S H I N G S T A F F Vance Thompson, MD, Refractive editor

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