Another new technique has arrived accompanied by enormous marketing hype. The subject of wavefront-guided laser ablation has drained more ink and filled more podium time than any other refractive surgery topic in the last 3 years. The procedure's true worth will be understood only once the rank-and-file ophthalmic surgeons test it in the field. To win our favor outright, it simply must deliver the results.
Looking back, we can see similar trends in the life cycles of several refractive procedures. RK came to the US from Russia with much love and promotion. It fell in our estimation due to a list of shortcomings that included a limited range of correction, unwanted nighttime symptoms, fluctuating vision, and a progressive effect. Next, marketers touted PRK as a near miracle, and the procedure had my support. The early haze formation, irregular astigmatism, and physical discomfort of the first 48 to 96 hours were problematic, however. Happily, concurrent antimetabolite usage is reviving this technique.
LASIK, the king of the refractive jungle for the past 7 years, received mainstream media hype that exceeded all of ophthalmology's wildest imaginings. Then, as you would expect, the media unleashed a backlash of negative press on LASIK. In my opinion, these tactics are par for the course; pump up the general public (thereby selling a lot of copy) and then strike with negative press (thereby selling a lot more copy). After the dust settled, the LASIK phenomenon had been scarred by reports of irregular astigmatism, ectasia in form fruste keratoconic patients, and DLK. Where are we headed now with this newly emerging, ?improved? LASIK procedure, wavefront-guided ablations?
The wavefront-treatment media blitz has used ?20/10 by 2010? as its tagline and trumpeted the possibility of ?supervision,? better acuity than the patient has ever had in his life. When expectations are set this high, surgeons must achieve optical perfection or face condemnation by the patient and public. As a field, it seems as though we have already stood at the edge of this precipice and witnessed the failure of several technologies that were dubbed the next breakthrough in refractive surgery. My point is that we need to ask questions about wavefront-guided corrections.
Is wavefront for real? The data presented so far by all the major players report markedly improved visual results compared with conventional symmetric laser ablations.
What are the limits to wavefront?
I am thoroughly convinced that the technology can accomplish every-thing we want it to. Unfortunately, the target medium (corneal tissue) for these amazing effects is a biological system. Containing epithelial remodeling forces will be the biggest biological hurdle for customized treatments to overcome. Were the front of the eye made of glass, plastic, or diamond instead of corneal tissue, we would have a much easier task ahead of us.
Inside this issue of Cataract & Refractive Surgery Today, our contributors have given us their latest insights on customized ablation. The verdict in this debate may be found in the same place as in any other controversy—somewhere between storyline A and storyline B, at a place we call TRUTH. Enjoy this issue of CRST.
