Small incision lenticule extraction (SMILE), which has not yet been approved for refractive correction in the United States, may be less accurate and produce more irregular astigmatism than LASIK or PRK because of the imprecision resulting from the two incisions needed to create the lenticule. In addition, the technique for potential enhancements needs improvement. However, the treatment is promising and may stand the test of time as the technology advances.
Techniques for performing corneal collagen crosslink (CXL) are being evaluated and adapted, and at the same time, new applications are being developed.
The back layer of the cornea is made up of endothelial cells that keep the cornea clear. All cataract surgery does some damage to these cells, although due to the number of extra cells available in most corneas this damage doesn’t cause any problems. However, occasionally, post-cataract surgery endothelial cells don’t function well enough to keep the cornea clear, which can commonly cause corneal oedema. Here, Prof. Feinbaum describes a new treatment modality that has been designed to reduce and in most cases stop the oedema in 24–48 hours.
The FDA has approved AcuFocus’ corneal inlay product (KAMRA inlay.) The device is indicated to improve near vision by extending depth of focus in patients with presbyopia who have emmetropic refractions (+0.50 to –0.75 D).
Contrast sensitivity is a more valuable metric than many ophthalmologists realize, with applications in preoperative and postoperative management of corneal and refractive surgery patients and routine screening of patients’ quality of vision.
Early experience with a new intrastromal corneal ring segment arc length appears to be a valuable addition to the keratoconus treatment armamentarium for one surgeon.
Immunomodulatory therapy for ocular inflammatory disease can be potent and effective, but physicians should be patient while awaiting results—and watch carefully for complications.
Endothelial keratoplasty makes it easier to follow patients with glaucoma and lowers the risk of ocular surface disease.
Keratoneuralgia, also known as “pain without stain” is primarily a clinical diagnosis made for patients with corneal pain symptoms with minimal-to-no clinical signs and minimally, if at all, relieved by conventional dry eye treatments.
The rationale for epithelium-on crosslinking procedures is strong, and may ultimately make customized treatment of topographic abnormalities more attractive for therapeutic and refractive indications.