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Up Front | Jan 2003

Will the Laser Last, or Will the Lens Win Out?

The Top 10 Reasons to Avoid Refractive Surgery at the Level of the Crystalline Lens:
1. It is traditional ocular surgery. (You actually have to enter the eye!)
2. It requires a dedicated OR.
3. Depending on your situation, it may involve hospital bureaucracy.
4. If performed in a hospital OR, it may not be financially feasible for the patient, especially compared with an ASC's fee structure.
5. Intraocular complications can occur.
6. Extraocular corneal laser vision correction has been universally accepted.
7. Corneal laser vision correction is the wave. Why fight the trend?
8. Simultaneous, same-day surgery is routine with corneal laser vision correction and likely will not be with IOL surgery, at least initially.
9. Patients believe that laser vision correction produces instantaneous results, but they think that lenticular surgery requires more healing time and more physician involvement.
10. Operating on a pristine cornea is one thing, but performing surgery on a pristine lens is over-the-top.

If there are so many reasons to avoid intraocular refractive surgery, why are so many individuals exploring every surgical option but the cornea? The answer is multifaceted. First, avoiding corneal surgery eliminates the variable of the cornea's and epithelium's healing responses, which are huge determinants of corneal refractive surgery's success and refractive stability. Second, the location of an IOL may have a more effective impact on treating presbyopia when compared with laser vision correction. Moreover, a solution for presbyopia could conceivably create an exponentially larger refractive market. The financial stakes are high for this market, and the benefit to patients is analogous to reversing the hands of time with regard to accommodation. Third, the cornea can only be used to correct a defined amount of refractive error. With all corneal refractive procedures to date, there is a point at which the results (efficacy, predictability, safety, stability, and quality of vision) are inferior to those attained with an intraocular approach. Simply stated, patients win when they receive the best procedure for their specific refractive errors.

For these reasons, Cataract & Refractive Surgery Today has contacted numerous scientists and clinicians who are working to produce the absolute best lenses out of IOL technology. Much of this research is occurring at the scientific edge of our understanding of optics, materials, biocompatibility, and bioadaptability. Stephen Brint, MD, updates us on the Acrysof Multifocal IOL. Daniel Schwartz, MD, describes his efforts with the LAL, while Paul-Rolf Preussner, MD, explains the concept of a software-designed customized IOL. Lee Nordan, MD, updates us on Vision Membrane IOL technology. Mark Packer, MD; I. Howard Fine, MD; Richard Hoffman, MD; Burkhard Dick, MD; and Michael Colvard, MD, bring us up to speed on future multifocal IOLs and the clinical results with current accommodative IOLs. Finally, our staff summarizes recent, IOL-related US patents.
I believe that the lens could provide the solution for both ametropia and the accommodative needs of the 21st century refractive patient. I hope that the information contained in this issue of CRSToday helps you to make your own decisions about the future of the refractive surgery specialty.

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