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    Refractive year characterized by expanding array of treatment choices



    Combination of technologies

    Dr. Gulani uses a full spectrum of what he refers to as kerato-lenticulo-refractive techniques and technologies. He implements numerous combination or staged examples, such as Intacs and phakic implants (Visian ICL, STAAR Surgical) together in patients with keratoconus to achieve 20/20 vision, and laser corneal scar correction using Corneoplastique techniques to be followed by premium lens implant cataract surgery resulting in 20/20 outcomes that could not have been reached with the use of these products independently.

    With a referral base of previously operated patients seeking correction, he has corrected a range of complications: SMILE (Carl Zeiss Meditec) using laser Corneoplastique, previous corrective vision laser procedures with laser PRK, and patients who had undergone a previous RK procedure with laser Corneoplastique and toric lens implant combinations. He also has modified Descemet membrane endothelial keratoplasty or Descemet stripping automated endothelial keratoplasty procedures to a refractively predictable outcome combined with toric lens implants to achieve emmetropia.

    “Surgeons can treat patients that were previously not refractive candidates and bring these patients to the desired refractive endpoint, achieving good vision without the need for spectacle or contact lens correction,” Dr. Gulani said.

    New technologies are serving patients in ways that did not exist just a few years previously.

    When considering the femtosecond laser in cataract surgery, for example, use of the technology in normal cases can be debated but it does offer a benefit for complicated cases with subluxated cataracts or white mature cataracts.

    Newer devices, such as the miLOOP (Iantech) and the Zepto (Mynosys), are providing evolution toward a more robotic cataract surgery with greater abilities to predict and plan the outcomes not only preoperatively, but also intraoperatively with systems such as the ORA System (Alcon Laboratories) and the Callisto eye (Carl Zeiss Meditec), according to Dr. Gulani.

    Instrumentation, such as the Pentacam along with the Pentacam AXL scan (Oculus) and the potential acuity meter (NJRetina), has taken diagnosis to the next level. They may help to identify patients with early keratoconus or those who were not previously considered to be suitable candidates for a refractive or premium cataract surgery procedure, including those who had undergone a previous refractive surgery, such as RK, LASIK, and PRK.

    Patients who were implanted with a premium IOL and are unhappy can now be identified for the causative factor using the OPD III (Marco) and Tracey systems (Tracey Technologies). They can now undergo an additional refractive procedure to achieve an excellent level of visual acuity rather than offering lens exchange as the only option.

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