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    Toward emmetropia: More advances, more improvements

    Refractive, corneal surgery in 2016 saw gains in therapies for keratoconus, presbyopia


    Femtosecond laser

    Femtosecond laser-assisted transplants and the ability to use the femtosecond laser to perform more dependable deep anterior lamellar keratoplasty (DALK) in keratoconus are very helpful for patients with keratoconus, Dr. Hersh said.

    In his practice, most of the keratoconic transplants are done with the femtosecond laser.

    A benefit of the femtosecond laser, he noted, is that the level of corneal astigmatism has been greatly reduced because of the good graft-host correspondences achieved.

    Dr. Hersh noted he prefers the mushroom pattern, because it facilitates making a big bubble in the DALK procedure. In addition, the suturing is done peripherally, resulting in less astigmatism postoperatively and faster visual rehabilitation. (Figure 2)


    Topography-guided LASIK was approved to treat patients with 8 D of myopia and 3 D of astigmatism. Dr. Hersh pointed out that ophthalmologists are beginning to incorporate this technology into their practices.

    The clinical trial of topography-guided LASIK in normal corneas showed excellent results, he noted, with many patients achieving vision after LASIK that was better than their best-corrected spectacle vision before LASIK. This procedure is not approved for clinical use in the US for patients with unusual or irregular corneas that ophthalmologists might want to treat.

    “This is an innovation that is one of the most exciting recent advances in LASIK,” he said. “It will be interesting to see the evolution of the procedure in clinical use in the United States as doctors become more experienced with it.”

    He uses the technology in his practice and is pleased with the results.

    The innovative VisuMax Femtosecond Laser for the small-incision lenticule extraction (SMILE) procedure (Carl Zeiss Meditec) was approved this year for treating patients with myopia.

    “When the indication expands to treatment of astigmatism, I believe that we will see more surgeons performing SMILE in the United States,” Dr. Hersh said. “This is an exciting, new kind of technique.”


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