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2014 brought improvements in refractive accuracy with technologic evolutions


Taking a look at the improvements made this past year in refractive accuracy through several new technologic evolutions.

Take Home

Taking a look at the improvements made this past year in refractive accuracy through several new technologic evolutions.


By Lynda Charters; Reviewed by Peter S. Hersh, MD, and Eric D. Donnenfeld, MD

A highlight of 2014 is the increasingly widespread acceptance in Europe of the Small Incision Lenticular Extraction (SMILE) technique (Carl Zeiss Meditec) in LASIK.

The advantages are correction of refractive errors through a small incision with minimal pain, less induced dry eye, and a more rapid recovery, said Eric D. Donnenfeld, MD.

“The SMILE technique is gaining traction in Europe and we look forward to its coming to the United States. It may offer improved corneal refractive outcomes with reduced risks because of the small incision,” said Dr. Donnenfeld, clinical professor of ophthalmology, New York University Medical Center; trustee, Dartmouth Medical School, and founding partner, Ophthalmic Consultants of Long Island, Rockville Centre, NY.

Topography-Guided Refractive Surgery

Clinicians in the United States also are eagerly awaiting topography-guided PRK and LASIK, Peter Hersh, MD, noted. Thus far, Alcon has received an FDA approval for this technology.



“Use of this technology has the potential to improve LASIK outcomes and would be helpful for any postoperative problems,” said Dr. Hersh, professor of ophthalmology at the Rutgers Medical School, Newark, and Director, Cornea and Laser Eye Institute, Teaneck, NJ.

The iDesign (Abbott) aberrometer is now available in Europe and will hopefully be available shortly in the United States.

“The iDesign is the next generation aberrometer that will allow clinicians to measure and treat irregular corneas and optical systems that cannot now be treated with custom LASIK.  I believe this technology will allow us to treat previously untreatable eyes and will work synergistically with topographic ablations,” he said, adding that the accuracy of the iDesign will also improve the efficacy of current treatments with the excimer laser or normal eyes.


The KAMRA corneal inlays for presbyopia (AcuFocus) are very close to receiving FDA approval. The inlay is 3.8 mm in diameter and 5 µm thick, with a central hole of 1.6 mm.

Rather that changing the corneal optical shape as other refractive inlays do, the KAMRA inlay works on the principle of pinhole optics. This enhances the eye’s depth of field and improves the near vision function while leaving the distance refraction unchanged.  This mechanism contrasts with other methods that improve near vision by inducing corneal multifocality.


“The AcuFocus inlay has the potential advantage of improving presbyopia but not decreasing the distance vision via the use of pinhole optics rather than multifocal optics,” Dr. Hersh said. 

Femtosecond Laser

Dr. Donnenfeld is now creating most of his astigmatic incisions intrastromally using the femtosecond laser.

“The ability to perform intrastromal relaxing incisions is an added tool in the treatment of cylinder. When incisions are not made in the cornea, there are no need for antibiotics, less concern about wound gaping and cylinder drift, and fewer changes to the cornea,” he said.

Ericc D. Donnenfeld, M

E: ericdonnenfeld@gmail.com

Dr. Donnenfeld is a consultant to Abbott, Alcon, and Acufocus.


Peter S. Hersh, MD

E: phersh@vision-institute.com

Dr. Hersh has no financial interest in any aspect of this report.


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