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Up Front | Apr 2003

Everything Old Is New Again

It is not so much that what goes around comes around, but rather, if you stay around long enough, then ideas, concepts, and inventions initially percieved as unique will actually be reinvented or revisited—old ideas presented with new zeal. For example, Lans' heat technique (and, much later, Fyodorov's hot wire radial thermokeratoplasty technique) for steepening the cornea to correct hyperopia came and went. Both have now been reinvented as collagen shrinkage techniques courtesy of Sunrise Technologies International, Inc. (Fremont, CA), and Refractec, Inc. (Irvine, CA). At its inception, Barraquer's lamellar technique (keratophakia) for the treatment of post-cataract extraction aphakia took a distant back seat to Ridley's IOL idea, but it has returned with a vengeance as LASIK. PRK faced extinction, but it has resurfaced in the past 12 to 18 months in the forms of the refined PRK of 2002 and LASEK.

The focus of this issue of Cataract & Refractive Surgery Today is our renewed interest in refractive lens exchange (or clear lens replacement). Is this a new concept? Absolutely not. In fact, Fukala reported two peer-reviewed manuscripts on the topic in 1890 and 1896, respectively! As reasons for revisiting the technique, proponents cite its refractive accuracy, familiarity, excellent optics, and importantly, its potential for curing presbyopia. Opponents of refractive lens exchange, meanwhile, cite their three top reasons: retinal detachment, retinal detachment, retinal detachment (in myopes). Hyperopic patients, while not at risk for a retinal detachment, may suffer endophthalmitis, cystoid macular edema, and intraoperative complications. For those of you interested in the debate over refractive lens exchange, I recommend reading Chapter 44 of Principles and Practice of Refractive Surgery. The chapter, entitled ?Clear Lens/Cataract Extraction for Refractive Purposes: A New Future for Refractive Surgery,? by Theodore P. Werblin, MD,1 masterfully discusses both sides of the debate over intraocular refractive surgery and is one of the best refractive chapters I have ever read.

In this month's issue, R. Bruce Wallace, MD, attempts to make sense of the terminology for refractive lens exchange. Douglas Katsev, MD, provides insight on selecting the best patients for intraocular refractive surgery. Mark Packer, MD, describes the industry's excitement for all the lenses nearing availability. I. Howard Fine, MD, shares his thoughts on monovision versus multifocality and which patients to steer toward which option. Because economic issues surrounding the procedure will affect surgeons, ASCs, patients, and third-party payers, Richard Hoffman, MD, analyzes this important topic. L. Andrew Watkins, MD, clearly defines the risks involved in refractive lens exchange and explains why they may well be worth taking. Lastly, Erik Mertens, MD, details his experience with accommodative lenses in refractive lens exchange operations.

Let the debate begin! Please enjoy this issue of CRSToday.
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