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    Toward emmetropia: More advances, more improvements

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


    Patients with keratoconus can have surgeries planned from lasers to microsegment inserts, including intraocular manipulation including toric, phakic, and piggyback IOLs, and now include crosslinking as a permanizing end-stage surgery to move patients with keratoconus and LASIK ectasia to excellent refractive outcomes, he explained.

    In addition, patients who previously could not undergo LASIK because of thin corneas can undergo the SMILE procedure or enhanced laser PRK with improved drug modulation and have a pain-free experience and even combine this with corneal inlay surgery to address presbyopia.

    Patients with complicated presentations resulting from their pathologies and complications from previous surgeries such as radial keratotomy can have more accurate intraocular measurements using newly approved devices to measure lens implant powers resulting in emmetropia without any refractive surprises. Patients with ocular surface inadequacies can be diagnosed and treated with new modalities (chemical and visual diagnostics) to prepare the patients for a refractive procedure.

    “When we consider all the approvals, increased indications, and enhanced technologies and add them to our relentless pursuit of striving for visual acuity over 20/20 in all cases, more patients can become surgical candidates, complex cases can be simplified, and less predictable situations can become more predictable,” Dr. Gulani said.

    He expressed excitement about using more of these tools in his practice that has a worldwide referral base with a global clientele of complex and complicated cases and applying them in single or staged combinations to achieve perfect vision.

    “My dream of turning every patient into a refractive candidate is becoming a reality,” Dr. Gulani said.

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