Not a candidate for refractive surgery? Not anymore!

Gloves Off with Gulani

Editor’s Note: Ophthalmology Times introduces this new series called “Gloves Off with Gulani” that is part of the full-spectrum concept of a “super-specialty,” in which Arun C. Gulani, MD, will present prototype case studies and accept input to show how every case-no matter how difficult-deserves a mindset of emmetropia. Look for the first “gloves-off” encounter-“Multifocal IOL nightmare: Reversed to 20/20”-in the Oct. 1 issue of Ophthalmology Times.

The "Gloves Off with Gualni" series will offer case studies similar to the patient here, who presented with scarred central cornea and a history of RK surgery (notice the RK cuts with scar in the preoperative photo, left) and legal blindness. The patient underwent laser ASA/PRK with "Corneoplastique" concepts and was immediately clear (post-operative photo, right).

In Arun C. Gulani, MD’s contemporary concept of "Corneoplastique" as a super-specialty of LASIK, custom cataract, corneal, and full-spectrum vision refractive surgery, vision becomes the accountable endpoint of all eye surgery through the intelligent manipulation and interplay of the optical components within the eye.

“In this era of raised expectations, advanced technologies, and dedicated pursuit for Super Vision, I wish to introduce this concept and holistic approach by combining all levels of anterior segment surgery that strives to attain the goal of unaided emmetropia or best vision potential in every eye,” said Dr. Gulani, an internationally renowned eye surgeon with a global clientele referred by eye surgeons worldwide, and founder and chief surgeon of the Gulani Vision Institute in Jacksonville, FL.

Envisioning the near future, Dr. Gulani believes there will be no separation or discrimination between corneal, LASIK, or cataract surgeons, because all surgeons will be called upon to use their combined abilities and technologies to manipulate either of these optical components in the eye to address the refractive errors effectively. According to Dr. Gulani, corneal, LASIK, and cataract surgeons will then all be known as “vision-corrective surgeons,” and confidently approach every case planning for unaided emmetropia toward best vision potential.

“This art of blending the full spectrum of ocular surface, corneal, and intraocular surgery in a planned approach either before (to prepare the eye) or after eye surgery (to repair the eye) is the core function of this new super-specialty that keeps focusing on unaided emmetropia in single or staged fashion, especially if you consider that these techniques are all brief/topical/aesthetically pleasing and, therefore, a fond memory for the patient,” he noted.

The envisioned goals of Dr. Gulani’s super-specialty will be as follows:

• Raise vision outcomes to beyond 20/20 in virgin eyes.

• Reverse practically any refractive complication (including LASIK, radial keratotomy [RK], multifocal implant, etc.) back to 20/20 or best vision potential.

• Turn patients who are not candidates because of corneal scars, thin corneas, ectasias, irregular astigmatism, previous refractive surgeries like RK, and so forth, into appropriate candidates.

• Apply the full spectrum of anterior corneal refractive and lenticular surgeries including multifocal lens implants along with infinite staged combinations to suit each eye individually.

‘Am I a candidate?’

Dr. Gulani“The question ‘Am I a candidate?’ then becomes redundant as we can approach practically every eye with a uniquely designed approach (single or staged) for a life free of glasses using individually designed surgeries keeping safety in mind, thus raising the bar on predictability, safety, and reversibility,” Dr. Gulani explained.

“This truly then elevates refractive surgery from ‘one-size-fits-all’ to an art,” he added.

In summary, concluded Dr. Gulani, practically any ocular situation-including virgin eyes with basic refractive errors like myopia, hyperopia, and astigmatism of all levels, as well as complex eyes like status postcataract surgery, glaucoma surgery, retinal surgery, LASIK complications, and corneal transplants, as well as traumas-can be addressed to achieve the best unaided visual capacity, provided the patient has visual potential. This, of course, should not be a frivolous advertising gimmick, but instead, a dedicated desire and commitment of every eye surgeon.

“As long as there is no intraocular pathology or disease, such as retinal, neurological pathologies, or uncontrolled glaucoma, there is no reason why we cannot aim toward a perfected visual outcome. This ability to help patients with refractive surgical complications/previous surgeries/etc. toward 20/20 vision is no longer out of reach in aspirations or outcomes, and will raise the level of comfort for surgeons as well as patients. Because when you design surgery for an individual eye, you are planning for success, not just hoping for it,” Dr. Gulani said.

Suggested reading

Gulani AC. Corneoplastique: Art of visual surgery. Video Journal of Cataract and Refractive Surgery. 2006;22(3).

Gulani AC. A new concept for refractive surgery: Corneoplastique. Ophthalmology Management. 2006;10:57-63.

Gulani AC. Principles of surgical treatment of irregular astigmatism in unstable corneas. Textbook of irregular astigmatism. Diagnosis and treatment. Thorofare, NJ: Slack Inc.; 2007:251-261. (Released at the American Academy of Ophthalmology conference, New Orleans, 2007).

Gulani AC. Corneoplastique. Techniques in Ophthalmology. 2007;5:11-20.

Gulani AC. Corneoplastique. Video Journal of Ophthalmology. 2007;22(3).

Gulani AC. Algorithm addresses corneal scarring. Ophthalmology Times eReport, Nov. 30, 2011. http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/modernmedicine/modern-medicine-news/algorithm-addresses-corneal-scarring. Accessed July 26, 2013.

Bansal J, Gulani AC. Excimer laser enhancements after multifocal IOLs. In: Hovanesian J, ed. Textbook of premium cataract surgery: A step by step guide. 1st ed. Thorofare, NJ: SLACK, Inc.; 2012:135-145.

Donnenfeld E, Gulani AC. Femtosecond laser for astigmatism correction during cataract surgery. Textbook of femtosecond laser: Technology and techniques. 1st ed. J.P. Publishers; 2012;21:155-161.

Gulani AC. Art of LASIK surgery: Raising the bar on outcomes and safety. In: Afshari N, Copeland R, eds. Textbook of cornea and refractive surgery. 1st ed. J.P. Publishers; 2012.

Gulani AC. Reversing LASIK and premium IOL woes: Taking a logical, stepwise approach and fighting for every line of visual acuity will pay dividends for you and your patients. Review of Ophthalmology. 2013;13:104-155.

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