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    Toward emmetropia: More advances, more improvements

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


    The quest for emmetropia

    One ophthalmologist views the burgeoning technologies as a continued escalation to his full spectrum of kerato-lenticulo-refractive surgery from a specific vantage point.

    “With the recent approval of the new technologies for premium lens implants, crosslinking, extended application of Demtosecond lasers and presbyopic inlay options along with dry eye therapy, we seem to be seeing a much-awaited scenario that I have envisioned for the last two decades—i.e., Corneoplastique, a super specialty that involves the art of utilizing all these technologies in a holistic and symbiotic manner to custom-design each patient’s vision outcomes,” said Arun C. Gulani, MD.

    “Using this ever-expanding armamentarium of tools, we can help patients become candidates for surgery who were not candidates previously, said Dr. Gulani, founding director and chief surgeon, Gulani Vision Institute, Jacksonville, FL. “With each approval of a new technology ranging from diagnostic to interventional, there is one additional tool that has been added to my already overflowing toolbox to plan, perform, and improve each patient’s vision.”

    Dr. Gulani has used many of these technologies abroad before the FDA approval this year and was predictably impressed with the rapid adaptation of these new technologies by surgeons in the United States who were awaiting their approval.

    Notable among these advancements were the approvals of crosslinking (Avedro), two presbyopic corneal inlays (KAMRA and RainDrop), newer premium lens implants like the Symfony IOL (Tecnis, Abbott) for cataract surgery and more indications for laser cataract technologies that will be added to an already wide array of currently available advances to help achieve the best vision possible in the safest and most predictable fashion.

    Other new tools introduced in 2016 were ocular surface therapeutics, which included medications for dry eye, technologies to evaluate dry eye, diagnostic criteria, and ocular sealants like ReSure (Ocular Therapeutix, Inc.) and surface tissue, the use of which allow patients to become candidates for refractive surgery.

    Medications to improve pupillary dilation, new tools and technologies to quantify surgical procedures including intraoperative IOL calculations and also means to perform consistent capsulorrhexis, expand the iris, and stabilization of anterior chamber also were introduced.

    Dr. Gulani cited Descemet’s membrane endothelial keratoplasty as a technique that was further refined and applied to enhance surgical outcomes to achieve enhanced predictability and vision beyond correcting just the pathology, thus exuding his much beloved refractive-outcome concept to every corneal surgery.


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