Take-home message: Improvements to refractive laser surgery will continue to make procedures even more precise and accurate.
Reviewed by Michael Mrochen, PhD
Zurich—Refractive laser platforms provide outstanding results, have reliable technology with excellent predictability and outcomes, and provide a broad range of applications. Better diagnostic imaging is possible with optical coherence tomography and Scheimpflug technology, and the advances of femtosecond lasers are moving into cataract surgery, said Michael Mrochen, PhD.
“An element connecting all these components is treatment planning,” said Dr. Mrochen, founder of IROC Science, Zurich, Switzerland. “We are seeing improvement in software and customized treatment modalities.”
However, there still is room for improvement, Dr. Mrochen said.
For instance, efficacy and predictability could be improved for high myopia or myopic astigmatism, hyperopia and hyperopic astigmatism, presbyopia correction, and irregular cornea and higher-order aberration correction.
Although refractive lasers are very safe and effective, they could still be made safer to avoid dry eye issues, flap-related complications, epithelium and biomechanical considerations, and the ability to reverse treatments (such as in patients with presbyopia), Dr. Mrochen said.
There are even improvements that could be made in the realm of convenience, such as the consideration of a patient’s fear about surgery or the ability for the surgeon to make easy treatment decisions and planning.
Some technology under way is already aiming toward improvements in these areas, Dr. Mrochen said.
For example, the introduction of ray-tracing ablation profiles that consider individual eye models will help boost refractive predictability.
“There’s a huge potential with treatment planning in this area,” he said.
Another improvement that could come soon is better precision with the introduction of ultraviolet (UV) femtosecond lasers instead of infrared lasers for small-incision lenticule extraction (SMILE). Although SMILE effectively helps highly myopic patients, Dr. Mrochen said, the procedure’s use of infrared lasers causes some limitations in accuracy. In fact, the accuracy compared with UV lasers is notably lower. By experimenting with ways to use less energy, surgeons can switch to UV light application, he noted.
“This will use lower energies and get a more precise cutting element for SMILE,” Dr. Mrochen said.
In corneal collagen crosslinking for keratoconus, there are efforts under way to use noncutting treatments to correct low refractive errors, especially after cataract lens implantation.
The use of laser shaped lenticle onlays and an inlay from donor eyes for patients with hyperopia is an approach that is currently under examination, Dr. Mrochen said.
Yet, one more advance under assessment is the use of infrared lasers to modify the sclera and increase the ability of the lens to restore accommodation.
Though there is no one advancement outlined above to address all of the efficacy, safety, or convenience concerns that Dr. Mrochen outlined, they all might play a part in improving refractive surgery in future, he said.
Michael Mrochen, PhD
This article was adapted from a presentation by Dr. Mrochen during Refractive Surgery Subspecialty Day at the 2015 meeting of the American Academy of Ophthalmology. Dr. Mrochen is founder of IROC Science, Zurich, Switzerland.