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Beyond LASIK: The Future of Refractive Surgery

Beyond LASIK: The Future of Refractive Surgery


Is LASIK something that you should have done now or should you wait for future technology? This is a question that almost every potential LASIK candidate asks him- or herself prior to having Laser Vision Correction. There is no question that technology will continue to improve within the realm of refractive surgery, as it has in other areas.

So what's on the horizon for refractive surgery? Below are just a few examples of what you can expect to see in the coming years.

1) Technology to Reduce Night Vision Halos and Side Effects

Most of the lasers in use at this time are incapable of treating the entire cornea. These lasers typically have a 6.5 mm optical zone with 'blend zones' or 'transition zones' that taper and feather the treatment out to 7.5 or 8 mm. In a nutshell, this means that only the central area you look through is treated. Patients who have pupils that dilate very widely under dark conditions may actually see the transition zone between the treated and untreated corneas as their pupil expands. This effect appears as a ring or halo of light in their night vision. Patients describe halos as similar to the ring that you see around a streetlight when it's misty outside.

In order to minimize the effects of halos, a large corneal treatment zone is needed. However, there is one important thing to remember about increasing the size of this zone. Even when widening the treatment zone only a small amount, the amount of tissue removed goes up dramatically. As a result, while lasers of the future will come with higher treatment zones, they may only be applicable in patients with low degrees of correction.

2) Eye Tracking to Follow Eye Movements

Most of the lasers of the future will likely have eye tracking, and in fact, many of today's lasers already have eye tracking. Eye tracking means that the laser is able to follow small eye movements while the treatment is in progress. Eye tracking can be a good thing, but it also has its downsides. For example, if the alignment of an eye tracker is not centered, the entire LASIK treatment can end up off center. Another potential problem arises when, for one reason or another, the eye tracker takes too long to engage. When this occurs the eye can begin to dry out. This can affect your outcome more than not having the eye tracking feature working. In most instances, however, using an eye tracker is quite straightforward. Eye trackers are particularly helpful in treating patients whose head and body move around too much; this group includes patients who are very nervous and those with labored breathing.

3) Laser Flap Maker

A laser flap maker that has been approved by the FDA is now in the process of being released. If all goes well, this should turn out to be a nice improvement. The laser flap maker would, theoretically, eliminate dull blade concerns. It also should be more precise in creating proper corneal flap thickness (an integral part of the LASIK procedure). This should be especially helpful on high corrections where a thin flap is needed to preserve the maximum amount of tissue possible. Also, the laser flap maker will have the capability of making the flap in any location, with whatever diameter the surgeon may deem desirable. This should decrease the possibility of having a poor quality flap or having a flap that is accidentally cut off.

4) Wavefront Technology

There is currently a lot of talk in the ophthalmology community about Wavefront Technology and the idea of it achieving "super vision." The devices that have been used in astronomy for many years to remove aberrations created by the atmosphere and obtain clearer views of the universe are now being applied to laser vision correction. Most of these technologies are just beginning FDA clinical trials and will probably not be available for about two years. However, they are worth discussing. There are several different Wavefront diagnostic devices that are being utilized and these will ultimately be coupled to the lasers via computers. Treatments will consist of the standard myopia, hyperopia, and astigmatism treatments that we presently offer followed by a brief treatment to remove whatever aberrations are detected in the eye. The interesting thing about this approach is that aberrations coming from the natural crystalline lens or elsewhere in the eye can potentially be corrected on the cornea. The expectation with this technology may be a little bit unrealistic to imply that patients can achieve "super vision" because we do not have a way to control the tissue healing following laser treatments, and we do not have a way to totally eliminate aberrations that are created at the time of the treatment. Wavefront's biggest application will be in helping patients who have already had refractive surgery and are experiencing aberrations and side effects as a result. These patients can then be helped to regain the desired 20/20 level of vision through this technology.

In the distant future, doctors who simply genetically re-engineer our eyes by altering the DNA blueprint that controls the shape of our eye may laugh at us for our "crude technology." Until that day comes, we are still very happy to have such a high level of technology to offer our patients.

Dr. John Wright is a board certified ophthalmologist and head of the Wright Eye Center in Colorado Springs.

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