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    Keratoconus as refractive surgery: Thinking outside the ‘cone’

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

    Gloves Off with Gulani By Arun C. Gulani, MD, MS

    The first issue to address is why is there a need for such a paradigm shift in thinking for keratoconus?

    Over the past two decades of seeing patients with keratoconus from all over the world, I found many instances in which the referring surgeons have done an excellent job in helping their patients, but the patients were still referred to me since they were dissatisfied with the vision endpoint.

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    In nearly every case, I found that had the surgeon only believed (mindset) that the patients could see 20/20, they could have completed their endeavor rather than reached a mediocre visual endpoint. Most of these surgeons were true heroes but could not collect their trophies due to their presumed notions resulting in limited endeavors.

    Additionally, in many such cases, I did not have to undo the surgeons’ work but instead I picked up the “baton and took these patients to their vision end zone.”

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    These referring surgeons also send me pages and pages of topographies and abstract vision tests that had compelled them to believe that each case of keratoconus was basically destined for poor vision and I found that my explaining to them to take the next step was always met with fear of success!

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    Basic experience

    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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