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Novel and resurging technologies may propel advances in refractive surgery
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CHICAGO — New technologies and the re-emergence of existing methods promise to further improve refractive surgery, a speaker said here.
“Some of these techniques become successes, and there’s a lot of unfinished business left for us to do in the field of refractive surgery,” Günther Grabner, MD, said during the Barraquer Award Lecture at the joint meeting of the American Academy of Ophthalmology and Asia-Pacific Academy of Ophthalmology.
Grabner discussed advances made during the first 30 years of refractive surgery and emphasized incisional intrastromal techniques, corneal onlays and inlays, phakic IOLs, and presbyopia correction and assessment.
Emerging techniques include femtosecond laser-assisted keratotomy, which is undergoing a series of clinical trials.
Intrastromal astigmatic keratotomy shows promise, but it is somewhat tedious and involves a steep learning curve, Grabner said.
“Astigmatic incisional procedures will be back and they will be much better,” he said.
Corneal onlays may undergo a revival, particularly with the advent of hydrogel synthetic epikeratophakia and biosynthetic epikeratophakia, he said.
Working in the anterior chamber is somewhat risky, Grabner noted. However, angle-supported and iris-supported IOLs and the iris-claw toric phakic IOL mitigate risk and optimize outcomes, he said.
Presbyopia correction is still considered the last frontier of refractive surgery, Grabner said. He noted a steady series of improvements in measuring reading visual acuity, ranging from the Jaeger scale to the Salzburg Reading Desk.
Grabner encouraged fellow surgeons to explore new methods to assess the success of presbyopia correction techniques they consider best suited for their patients.
Advances in corneal presbyopic surgery include the Kamra corneal inlay (AcuFocus), which uses the pinhole effect to sharpen near vision in the nondominant eye, he said.
Disclosure: Grabner is a consultant for AcuFocus, Abbott Medical Optics and Polytech.