October 01, 2004
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New technologies enhance clinical acumen

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Michael D. DePaolis, OD, FAAO [photo]
Michael D. DePaolis

As you’ve probably gleaned from previous editorials, I’m pretty much in awe of technology. Whether it’s a sophisticated diagnostic instrument, a next-generation contact lens or a complex pharmaceutical agent, I often marvel at these technological feats. What is equally impressive as the final product is the journey by which each comes to fruition. Indeed, every end product is the result of a significant intellectual effort, forged by meticulous research and development and validated in clinical trials.

Wavefront enhances outcomes

In many respects, wavefront-guided laser vision correction is the quintessential example of today’s ophthalmic technology. The identification, quantification and validation of human visual system higher-order aberrations (HOAs) is quite a feat. The clinical ramifications are equally impressive. It is largely through wavefront technology that we now better understand suboptimal outcomes in laser vision correction. It is also wavefront technology that affords us the opportunity to provide enhanced visual outcomes with current procedures.

Since its inception almost 2 years ago, wavefront-guided laser vision correction has been the focus of numerous research articles, papers, posters, discourses, monographs and editorials. We’ve learned a lot. We’ve learned that a variety of HOAs exist, that each affects vision differently, that their expression is influenced by other variables (such as pupil size) and that they vary from patient to patient.

We’ve also learned that diagnostic wavefront scans provide valuable insight as to why previous-generation laser vision procedures occasionally resulted in glare, halos and starbursts. And we’ve come to appreciate the power of wavefront technology in planning for and executing the correction of HOAs for an enhanced visual outcome.

But, perhaps most importantly, we’ve learned that even wavefront technology is not a substitute for clinical acumen.

Technology vs. clinical acumen

However, this is not new, as we deal with these issues every day of our professional lives. For instance, how should one proceed when a significant disparity exists between a refractive surgery candidate’s manifest refraction and wavefront-determined refraction? On one hand, it is tempting to discount the wavefront-generated results and simply incorporate the time-honored manifest refraction. On the other hand, wavefront refractions provide a more sophisticated description of refractive error and, therefore, a potentially better visual outcome.

While this scenario has no simple answer, it does provide us an opportunity: an opportunity to consider these findings in the context of other variables (amount of ametropia, pupil size, corneal thickness, laser platform, patient expectations, etc). And an opportunity to embrace new technologies in the spirit of enhancing clinical acumen — rather than replacing it.