Surgeons discussed indications for wavefront-guided and wavefront-optimized treatments and how wavefront-guided approaches can address complications after refractive surgery.

by Erin L. Boyle

Link to Story

Excerpt: Treating refractive complications

After LASIK surgery, regardless of which wavefront treatment is used, complications can occur. If this happens, either wavefront- or topography-guided approaches can be effective in treating such issues, according to Dr. Cheng and Dr. McDonald. They discussed the best approach to treating highly aberrated eyes at the WOC.

They agreed that the best way to decrease aberrations is to assess not only the cornea, but the entire optical system. In addition, they agreed that improvements in existing technology could assist treatment.

“Too often, our most desperate patients are ‘uncapturable’ with current technology,” Dr. McDonald said. “They need evaluation of the optics of the entire eye, not just the cornea.”

Dr. McDonald said the best approach could be a combined method that takes advantage of both wavefront- and topography-guided approaches. However, topography-guided customized ablations alone do not seem as effective as high-resolution wavefront-guided ablations in both normal and complicated cases because topography-guided ablations provide good results only in eyes with aberrations limited only to the cornea. But most eyes do not have perfect internal optics, she said.

“Only a small percentage is not capturable with new technology and is therefore in need of topography-driven ablations,” she said. “Wavefront-driven ablation provides accurate correction of the eye’s entire optical vision. This is especially important for treating our highly aberrated patients, including those few who accessed refractive technology many years ago and who now have lenticular changes as well as corneal aberrations.”

She outlined the ideal wavefront device for highly aberrated eyes as having high-resolution, high-dynamic range, a wide field of view that captures at least 8.5-mm pupils, auto-centration and dependence upon Fourier algorithms for generation of the ablation pattern. This aberrometer would be combined, in one unit, with an autorefractor, a kerotometer, a pupillometer and a topographer.

The prototype for this device exists, she said. AMO has designed the iDesign aberrometer, which has higher resolution, a higher dynamic range and increased data, as well as an autorefractor, a keratometer, a pupilometer, and a topographer.

Moose's Take: Progress is being made, yet it is coming far more slowly than then experts predicted.