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    Aspiring for zero tolerance of residual astigmatism

    Case examples highlight tools, techniques toward quest for excellent visual endpoint


    In this case of a deep dense herpetic scar in a thin cornea in Figure 19, lamellar peeling of the scar resulted in a marked improvement of the astigmatism from 11.9 to 2.4 D.

    In a number of my “Gloves Off” series (Figure 20), I have shared the concept of outside in/inside out techniques in which the cornea can be made measureable by removing a scar and irregularity including astigmatism to then proceed with confidence with a toric IOL implant to an excellent visual endpoint.

    These cases and concepts presented in this column explain the wide array of tools and techniques to correct astigmatism as well as the zero tolerance of residual astigmatism in any case and therefore driving to a promised excellent visual endpoint for each patient.

    If you do end up with astigmatism despite your planning, it is not a crime—but to not have aspired for a “zero astigmatism” endpoint is in my mind unacceptable.

    I believe that when considering premium surgeries and high patient expectations along with our unrelenting pursuit of “super vision,” the tolerance of residual astigmatism, like a bespoke tailor, must be zero. Only then will we have the commitment, resilience and ability to reach these goals and the results from then on will speak for themselves.



    1. Gulani A. Femtosecond Lasers in Complex Cataract Surgery. Cataract and Refractive Surgery Today (2015; 92.

    2. Gulani A. Sharpen your LASIK technique. Rev Ophthalmol 002 2015: 68-69.

    3. Gulani A. Entering the Lion's Cage: 'Epidemic' of Correcting RK. Ophthalmology Times 39.21 (2014): 16-23.

    4. Gulani AC. Corneoplastique: Art of LASIK & cataract surgery. Ind J Ophthalmol 2014;62:3-11.

    5. Gulani AC. Vision à la carte: Designing vision. Ophthalmology Times 2013; 38:31-33.


    Arun C. Gulani, MD, is founding director and chief surgeon of the Gulani Vision Institute, Jacksonville, FL. Dr. Gulani has no financial interests to declare. He can be reached at [email protected].

    Arun C. Gulani, MD
    Dr. Gulani is director of refractive surgery and chief, cornea & external disease, as well as assistant professor, department of ...

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