From Biomedical Engineering, Ophthalmology and Surgery, The Ohio
State University, Columbus, Ohio.
The author acknowledges her former student and
William Joseph Dupps, MD, PhD, who made major contributions to
biomechanical model; Mr. Ashraf ahmoud for invaluable work in generating
software for topographic analysis, as well as for figure generation;
refractive surgeons for intraoperative LASIK
flap topography, Dr. David Castellano of The Ohio State University and
Dr. Francesco Carones of the University of Milan; and finally, Summit
Technologies for research funding.
The author is a consultant to Bausch and Lomb, and has a research
agreement with Summit Technologies.
Correspondence: Cynthia Roberts, PhD, Biomedical Engineering,
Ophthalmology and Surgery, The Ohio State University, 270 Bevis Hall,
1080 Carmack Road, Columbus, OH 43210. Tel: 614.292.1831;
614.292.7301; E-mail L Roberts.firstname.lastname@example.org
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The future of laser refractive surgery is exciting
with the potential for ever-improved postoperative
visual performance. In the past, the
operative goal has been 20/20 uncorrected visual
acuity with zero residual refractive error.
for a successful procedure are no longer 20/40 or better
with ±1.00 diopter (D) of residual refractive
error, because neither surgeons nor patients are satisfied
with such gross measurements of visual performance.
Hence, considerable research effort is
being devoted to develop customized procedures for
each patient. The new goal is 20/10 uncorrected
visual acuity with aberration-free postoperative
vision. How can these lofty goals be accomplished?
First, lasers have been improved with the development
of scanning, small spot systems, as opposed to
broad-beam systems. Scanning systems have
brought customized procedures into the realm of
Second, more comprehensive and sophisticated
input data can be used to guide the laser
based on individual patient measurements, as
opposed to the simple refractive sphere and cylinder.
Two types of approaches are currently being
pursued—wavefront-guided and topography-guided
procedures. Early results are promising, yet neither
approach has demonstrated consistently superior
results to non-guided procedures in controlled, scientific
studies. Is a piece of the perfect vision puzzle...