Eyeworld

45 EW FEATURE July 2018 • Challenging cases ic or wavefront-guided laser refrac- tive surgery. "None of these treatments were in the United States a couple of years ago," Dr. Donnenfeld said, noting FDA approval of crosslinking in 2016 and approval of the first topo- graphic laser in 2013 and wavefront lasers starting in 2003. "Now I can take these irregular corneas, smooth them out, improve quality of vision, and many times take these patients out of gas permeable contact lenses and put them in soft contact lenses, very commonly glasses, or some- times they can see without glasses completely. "This takes refractive surgery to the next generation. Before we were doing refractive surgery to remove the need for glasses, but now we can do refractive surgery to remove the need for corneal transplantation or gas permeable contact lenses," he said. Another example is patients who have irregular corneas from scars, which might be due to trauma or viral infection. In some cases, these scars can be removed with a laser through phototherapeutic keratectomy (PTK) 2 or a lamellar flap, created with a femtosecond laser. From there, the refractive error could be treated. There are also cases of corneal dystrophies, Dr. Donnen- feld said, that can be treated with PTK 3 or lamellar keratectomies. "Not only are we doing rehabili- tation with excimer lasers, we're do- ing rehabilitation with femtosecond lasers as well," Dr. Donnenfeld said. On the horizon is the ability to do stromal ablations to remove stromal scars using the SMILE tech- nique; registration systems to more accurately map the cornea and treat irregularities; lamellar inlays with human corneal tissue that won't be rejected; use of corneal inlays, such as KAMRA (CorneaGen, Seattle), to treat higher order aberrations in irregular corneas; and using lasers to treat irregular corneas prior to cata- ract surgery or, conversely, IOLs to improve the contour of the lenses to suit an irregular cornea to improve refractive outcomes, Dr. Donnenfeld said. "The goal of refractive surgery is to be able to rehabilitate patients with normal corneas and abnormal corneas as well," Dr. Donnenfeld said. "There are many new technolo- gies on the horizon." EW References 1. Eydelman M, et al. Symptoms and satis- faction of patients in the Patient-Reported Outcomes With Laser In Situ Keratomile- usis (PROWL) studies. JAMA Ophthalmol. 2017;135:13–22. 2. Alevi D, et al. Photorefractive keratectomy with mitomycin-C for the combined treatment of myopia and subepithelial infiltrates after epidemic keratoconjunctivitis. J Cataract Refract Surg. 2012;38:1028–33. 3. Miller A, et al. Prevention of recurrent Reis-Bucklers dystrophy following excimer laser phototherapeutic keratectomy with topi- cal mitomycin C. Cornea. 2004;23:732–5. Editors' note: Dr. Desai has financial interests with Johnson & Johnson Vi- sion, Alcon (Fort Worth, Texas), Novar- tis (Basel, Switzerland), and Bio-Tissue. Dr. Donnenfeld has financial interests with Johnson & Johnson Vision, Alcon, Bausch + Lomb (Bridgewater, New Jersey), TLC Laser Eye Centers (Mis- sissauga, Canada), and Carl Zeiss Meditec (Jena, Germany). Dr. Durrie has financial interests with Johnson & Johnson Vision and Alcon. Contact information Desai: desaivision@hotmail.com Donnenfeld: ericdonnenfeld@gmail.com Durrie: ddurrie@durrievision.com OCTOBER 25, 2018 CHICAGO, IL CELEBRATING 10 YEARS OF INNOVATION UNITING OVER 1000 LEADERS In the development of ground-breaking ophthalmic technologies WWW.OIS.NET /OIS.NET @OISTWEETS /OPHTALMOLOGYSUMMIT MARRIOTT MARQUIS CHICAGO

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