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    Corneal biomechanics may pave way for personalized refractive surgery

    Computer simulation-based medicine an important part of treatment

    Take-home message: Developments in the field of corneal biomechanics will enable refractive surgeons to perform more precise surgery in the future.

     Reviewed by William J. Dupps Jr., MD, PhD

    Cleveland—Advances in corneal biomechanics will continue to lead to better and more personalized results in refractive surgery, said William J. Dupps Jr., MD, PhD.

    “The corneal biomechanical link between the structure and optical function of the cornea is exquisite,” said Dr. Dupps, staff, ophthalmology, biomedical engineering and transplant, Cole Eye Institute, Cleveland Clinic, Cleveland, and founder, OptoQuest Inc.

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    “Small changes in elevation or curvature make an enormous difference in optical properties,” Dr. Dupps said. “It’s important not to ignore it.”

    The relationship between corneal biomechanics and the practice of refractive surgery continues to evolve, Dr. Dupps said.

    He reviewed its early central role in incisional refractive surgery, then its less well-recognized effects in photoablative surgery in the 1980s, then a resurgence in awareness of the importance of biomechanics with the recognition of postoperative ectasia in the 1990s.

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    “Then in the early 2000s, we saw the first publication1 demonstrating the ability of corneal stiffening treatments to alter the course of keratoconus,” he said. “A few years later, the first commercially available tool for measuring corneal biomechanical properties was introduced.”

    More recently, computer-based biomechanical models are helping leverage the potential of existing tools to transform diagnosis and surgery, Dr. Dupps said.

    Although refractive surgeons have a number of precise, sophisticated tools for corneal measurement and treatment delivery at their fingertips, tools for leveraging this precision in treatment planning have not kept pace.

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