What are the greatest honors you have had in the past few years? The first honor involves the doctors who have entrusted me to operate on their own eyes. The second honor concerns the doctors who have entrusted their careers to me, specifically Steve Updegraff and John Doane, and all of the surgeons who have taken refractive surgery courses over the years. Lastly, respect from peers is extremely important to me. I have been honored to give several named lectures such as the Wilmer Dow Michaels lecture and the LANS lecture. Receiving ASCRS film festival awards has also been a rewarding experience.
Can you tell us about the keratophakia trials that you'll be working on soon? I will be working with Anamed, Inc. (Lake Forest, CA) on these trials. The type of lens we will be dealing with is a synthetic keratophakic lens composed of hydrogel-like material which is finely made with a 10-mm edge. This thin edge means that there is less dead space associated with it, so there will be less of a chance for material deposits at the edge as there was with Intacs.
What types of technology will shape the future of phakic IOLs? At present, we have to perform the procedure in a cataract surgery suite and the technology could have a much bigger impact if it can transition to an office-based procedure. Right now, you are not going to be able to go into a surgery center and be competitive with laser vision correction. Phakic refractive lenses are more expensive as far as overhead cost because most surgeons will have to work in a standard ophthalmic operating room. Hopefully, with time, it will be something that will cost less for us to provide. Presently, it is not covered by insurance, so therefore it's a bigger out-of-pocket expense to the patient. Ideally, a refractive IOL that is positioned in the anterior chamber would be optimal. Up to this time, the best experience I have had with phakic refractive lenses is with the STAAR intraocular contact lens which is a posterior chamber lens.
Which new technique will have the greatest impact on vision? LASIK custom ablations have the biggest short-term audience. Custom ablations will definitely have the biggest impact. Beyond that, a good fix for presbyopia is certainly needed. We've worked with the CrystaLens, the accommodating IOL, and the results are very promising. As with all refractive procedures, we like to have them removable, adjustable, and potentially even reversible—if at all possible. Most importantly, the reason that custom ablations will be so valuable is that it would be a way to address patients who have had less than spectacular outcomes after initial refractive surgery.
Parting thoughts? Any suggestions for young refractive surgeons? Go where you want to live, be thankful that you are in this profession, find the right balance of medicine to business that suits you the best personally. Work to earn the respect of your peers; the older you get, the more important it will be.