The synergy of cornea, cataract, and refractive surgery through the decades: insights from George O. Waring IV, MD

As part of the celebration of Ophthalmology Times’ 50th Anniversary, George O. Waring IV, MD, FACS, medical director of the Waring Vision Institute in Mount Pleasant, South Carolina, highlights 5 decades of advancements in cornea, cataract, and refractive surgery, emphasizing the evolving concept of “vision for a lifetime.” This approach ensures that vision correction procedures are available for every stage of ocular maturity, integrating corneal and lens-based refractive strategies.

Technological progress has significantly improved diagnostics, with high-resolution imaging, posterior corneal measurements, wavefront sensors, and visual simulators enhancing precision in refractive decision-making. Software now synthesizes diagnostic data, optimizing safety and outcomes.

In corneal and refractive surgery, high-speed lasers with advanced trackers enable rapid, precise treatments, enhancing visual quality and nighttime vision. FDA-approved corneal cross-linking has revolutionized keratoconus management, reducing the need for penetrating keratoplasties. Combining cross-linking with corneal reshaping techniques has further improved outcomes.

Lens-based refractive surgery has also seen substantial innovation. The EVO phakic IOL eliminates the need for laser peripheral iridotomies and offers toric correction, making it a viable alternative to LASIK for a broader patient population. For presbyopia, the concept of dysfunctional lens syndrome has led to a shift toward custom lens replacement, addressing both distance and near vision by targeting the root cause.

Refractive cataract surgery has been transformed by advanced IOL technology, including extended and full-range vision lenses, modular and exchangeable IOLs, and upcoming accommodative IOLs. Laser-assisted cataract surgery has also improved precision, safety, and astigmatism correction.

Looking ahead, emerging technologies such as transepithelial treatments, ray tracing, and hybrid laser techniques promise to refine refractive surgery further. The future also holds potential for presbyopia-correcting phakic IOLs and early intervention with lens-based solutions, ensuring continued advancements in achieving optimal lifelong vision.