Refractive surgeons must understand the arsenal of diagnostic technology available to them as well as how and when to use it for their patients, according to Renato Ambrósio Jr., MD, PhD.
Reviewed by Renato Ambrósio Jr., MD, PhD
Careful preoperative evaluation can help ophthalmologists boost patient satisfaction by improving surgical outcomes and avoiding many of the potential complications of refractive surgery. Preoperative assessment must include understanding and proper counseling of patients as well as provide a comprehensive evaluation for planning the procedure and screening for potential complications, said Renato Ambrósio Jr., MD, PhD.
“Listen to patients’ needs, motivations, and expectations to understand why they have come to refractive surgery, and what they expect from it,” said Dr. Ambrósio, adjunct professor of ophthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), and director of refractive surgery, VisareRIO, Rio de Janeiro, Brazil.
“In addition, imaging has revolutionized our ability to screen, plan, and evaluate the results of refractive procedures, gaining fundamental relevance in the preoperative workup,” he said.
The list of diagnostic technologies is long and growing, starting from classic slit lamp biomicroscopy with digital documentation, central corneal thickness, and Placido’s disk-based topography.
Scheimpflug tomography provides a three-dimensional picture of the cornea, an imaging technique distinct from front-surface topography as well as from segmental tomography by OCT. Very high-frequency ultrasound provides epithelial thickness mapping. Proper nomenclature is essential to distinguish technologies.
In addition, ocular wavefront, ocular scattering evaluation, novel ocular surface imaging with meibomiography, IOP, corneal biomechanical assessment, confocal, and specular microscopy are available. Molecular biology and genetics are moving toward practical applications for patient evaluation.
Renato Ambrósio Jr., MD, PhD
E: [email protected]
This article was adapted from Dr. Ambrósio’s presentation during Refractive Surgery Subspecialty Day at the 2018 meeting of the American Academy of Ophthalmology. He is a consultant to Alcon Laboratories, Carl Zeiss Meditec, and Oculus.
1. Ambrósio Jr., Renato. Therapeutic refractive surgery: why we should differentiate? Revista Brasileira de Oftalmologia. 2013;72:85-86. https://dx.doi. org/10.1590/S0034-72802013000200002.
2. Lopes BT, Ramos IC, Salomão MQ, Guerra FP, Schallhorn SC, Schallhorn JM, Vinciguerra R, Vinciguerra P, Price FW Jr, Price MO, Reinstein DZ, Archer TJ, Belin MW, Machado AP, Ambrósio R Jr. Enhanced tomographic assessment to detect corneal ectasia based on artificial intelligence. Am J Ophthalmol. 2018;195:223-232. doi: 10.1016/j. ajo.2018.08.005. Epub 2018 Aug 9. PubMed PMID: 30098348.
3. Ambrósio R Jr, Lopes BT, Faria-Correia F, Salomão MQ, Bühren J, Roberts CJ, Elsheikh A, Vinciguerra R, Vinciguerra P. Integration of Scheimpflug-based corneal tomography and biomechanical assessments for enhancing ectasia detection. J Refract Surg. 2017;33:434-443. doi: 10.3928/1081597X- 20170426-02. PubMed PMID: 28681902.
4. Salomão MQ, Hofling-Lima AL, Lopes BT, Canedo ALC, Dawson DG, Carneiro-Freitas R, Ambrósio R Jr. Role of the corneal epithelium measurements in keratorefractive surgery. Curr Opin Ophthalmol. 2017;28:326-336. doi: 10.1097/ ICU.0000000000000379. Review. PubMed PMID: 28399067.
5. Ambrósio R Jr, Tervo T, Wilson SE. LASIKassociated dry eye and neurotrophic epitheliopathy: pathophysiology and strategies for prevention and treatment. J Refract Surg. 2008;24:396-407. doi: 10.3928/1081597X-2008040114. Review. PubMed PMID: 18500091.