Richard S. Hoffman, MD

We often hear how cataract surgery is becoming refractive surgery. In fact, cataract surgery became refractive surgery when Sir Harold Ridley implanted the first IOL. While cataract extraction provides an immediate benefit by clearing the optical media, the patient must rely on the refractive power of the IOL for the rest of his or her life. Getting that refractive power right falls within the purview of refractive surgery, and it involves more than inserting the IOL into the capsular bag.

The pupil that dilates poorly is frequently associated with both glaucoma and complications during combined surgery. With newer endolenticular techniques, especially with nucleofractis procedures and chop techniques, pupils do not need to be as large as previously required.1-4 However, there still are numerous instances in which the pupil is inadequate to allow the surgeon to proceed, and some form of manipulation or surgery is required.

Columbus, OH-Age-adjusted approaches are needed for the evaluation and management of suspected orbital fracture in pediatric patients because children are different from adults, according to JDespite the introduction of more accurate IOL formulas and biometry instrumentation, cataract and refractive lens surgery have yet to achieve the ophthalmologist's ideal of perfect emmetropia in all cases.1-5 This limitation stems from occasional inaccuracies in keratometry and axial length measurements, an inability to assess the final position of the pseudophakic implant accurately in a fibrosing capsular bag, and the difficulty of completely eliminating pre-existing astigmatism despite the use of limbal relaxing incisions and toric IOLs.6,7 A new lens technology offers the hope of taking ophthalmologists one step closer to achieving emmetropia in all cases and also perhaps further improving the final result by addressing higher-order optical aberrations.