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    Corneal biomechanics may pave way for personalized refractive surgery

    Computer simulation-based medicine an important part of treatment


    For examples, nomograms incorporate very little patient-specific information from the preoperative exam and are lacking altogether for newer, off-label, or combined refractive treatments. Corneal biomechanics may eventually help fill that gap, he said.

    “Current paradigms are more retrospective, probabilistic, and population-based,” Dr. Dupps said. “In the future, they will be more prospective, deterministic, and more personalized. The way to get there is through simulation-based medicine.”

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    In refractive surgery, simulation can help surgeons and researchers test hypotheses, simulate treatments in a pre-clinical setting without putting patients at risk, and evaluate novel treatment designs and personalized optimizations.

    “If we can predict refractive outcomes more precisely in a virtual domain, this can help us to select right procedure for a patient or optimize it appropriately,” he said. “For screening, it provides feedback on the likely structural response and may help reduce ectasia risk. It will also be a new tool for designing and refining the next generation of corneal refractive treatments.”

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    Examples of applications include evaluating how a refractive surgery candidate might fare from a structural risk standpoint with LASIK, PRK or SMILE, for example, or assessing how a patient with a particular keratoconus geometry might respond to various crosslinking patterns.

    To drive the predictive simulations, surgeons will be able to capture patient-specific information from devices they are already using, such as Scheimpflug tomography or optical coherence tomography, and then eventually include information from emerging corneal biomechanical characterization tools.

    The goal of developing a software interface that can combine this information, simulate the outcome of a procedure, and produce a report for the surgeon is becoming a reality with the help of National Institutes of Health support and a commercialization grant from the State of Ohio, Dr. Dupps said.

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    1. Wollensak GSpoerl ESeiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135:620-627.


    William J. Dupps Jr., MD, PhD

    E: [email protected]

    This article was adapted from Dr. Dupps’ keynote presentation at Refractive Surgery Subspecialty Day at the 2015 meeting of the American Academy of Ophthalmology. Dr. Dupps is founder of OptoQuest Inc. and has intellectual property through Cleveland Clinic Innovations related to computational modeling and biomechanical measurement in ophthalmology.

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