Binkhorst Medal lecture focuses on the need to understand, manage changes produced by corneal ablation
AMSTERDAM — Corneal ablation is a remarkably successful procedure, but it produces a number of changes that need to be fully understood and adequately managed.
With statement, Douglas Koch, MD, opened this year’s Binkhorst Medal lecture at the European Society of Cataract and Refractive Surgeons meeting. The lecture offered an extensive review of the progress made over the years in corneal refractive surgery, the excellent outcomes already achieved and what is still needed to further improve the entire ablation process.
“By ablating the cornea, we not only remove tissue from the anterior stromal surface, but we alter the epithelial thickness profile and induce biomechanical changes that involve both the anterior and posterior corneal surface,” Koch said.
Optical coherence tomography and other evolving tools have provided clinically useful ways of monitoring and modulating these changes, increasing predictability and stability of refractive procedures, he said.
Alterations of the anterior corneal curvature also produce optical changes. Koch emphasized that moving from standard to wavefront-guided ablation has led to substantial improvements in terms of preserving or even increasing quality of vision with refractive surgery.
“We have been able to increase optical zone sizes, reduce the induction of unwanted aberrations, predictably lower some aberrations and predictably produce some aberrations,” he said.
The last part of the lecture focused on the impact of altered optical aberrations on the outcome of IOLs that might be implanted at the time of cataract surgery.
“Changing the front and not the back with our ablative procedures makes IOL power calculation so much more difficult,” Koch said.
Better than most refractive prediction formulas, Fourier domain OCT technology with the RTVue-CAM module can assist by providing an evaluation of corneal power that incorporates anterior and posterior curvature measurements.
“The future presents an exciting challenge,” Koch concluded. “There is much to be done, and we are making great progress.”