Refractive surgery will disappear to be replaced by RLE

Dr Howard I. Fine told delegates that he was the best ophthalmic surgeon because none of his patients used glasses. He then showed the audience a video of 'patients', all wearing spectacles, drinking directly from bottles of wine. It was a lighted finish in keeping to the session's theme, "I am the best because. . .".

At the same time, Dr Fine did map out important and developing areas in refractive lens exchange (RLE), which he believes will mean that the procedure becomes the refractive intervention of choice.

"Cataract or lens extraction is incredibly safe and efficacious," he said. "It improves outcomes with lower energy, smaller incisions, adjunctive refractive techniques and increased accuracy and safety. It's evolved into a refractive surgery."

He noted there are limitations in LASIK, particularly for high hyperopes, high myopes and presbyopes and, and age-induced changes in the spherical aberration of patients' crystalline lens will mean further treatment will be necessary.

RLE, on the other hand, just keeps expanding, with many developing multifocal and accommodative options, like the Tecnis Multifocal (AMO), the Synchrony (Visiogen) and NuLens (NuLens) accommodative lenses, the Smart IOL (Medennium Inc.) and the Calhoun light adjustable lens (LAL) (Calhoun Vision). Other interesting technologies are just beginning to emerge, like the LiquiLens (Vision Solutions Technologies) or pixelate optics.

In the future, he said, RLE will be the dominant procedure because it addresses all components of patients' refractive errors including presbyopia. Refractive surgery will disappear to be replaced by RLE, to the benefit of doctors, industry and the public.

"But, we've got to move from the high-volume, efficient, low-cost practice model, and move to high-quality, personalised, patient-paid care," he said.