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    Keratoconus as refractive surgery: Thinking outside the ‘cone’

    Adapting a planned approach for taming keratoconus presentations to 20/20


    In this two-part column, I am sharing my experience of my own surprise at how well many patients with keratoconus can see and how that raised my own endeavor to always aim for unaided emmetropia in all patients unless their situation for any reason was a limitation to that end.

    In this column, I encourage you to change your mindset. In the second part, I will share with you strategies and cases of patients with keratoconus with practically every presentation and combination I have seen over more than 2 decades and review how I planned my approach to their emmetropic outcomes.

    First, let’s recap a few basics. All ocular surgeries should end with the best vision that individual patients can achieve. This concept of using brief, topical, aesthetically pleasing, least interventional, and visually promising techniques singly or in combination is what I have introduced as a super-specialty called Corneoplastique.

    Corneoplastique involves the full spectrum of kerato-lenticulo-refractive surgery to include all levels of LASIK, cataract, and corneal surgery to manipulate the optical elements of the eye singly or in a staged fashion and results in a final emmetropic outcome. The backbone of this thought process and surgical planning is based on the 5S system (I liken this system to a mental sorter).

    Success in ophthalmology does not mean merely stopping progression of the patient’s disease or execution of surgical acrobatics: If the eye has the potential for vision, then it is the surgeon’s job to retain that vision or even to achieve better vision regardless of how complex the starting point. As long as there is no ongoing disease or irreversible blindness, every eye deserves unaided emmetropia.

    Changing our mindset

    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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