Journal of Refractive Surgery

Editorial Free

The State of Refractive Surgery: 2021 and Beyond

J. Bradley Randleman, MD


J. Bradley Randleman, MD


J. Bradley Randleman, MD

What a year 2020 was. As we turn the page into 2021, many uncertainties remain worldwide. Although we hope that the acute impact of the pandemic will lessen this year, we also know that life will not be returning to pre-2020 “normalcy” anytime soon.

The pandemic has impacted health care in multiple ways, some predictable and some not. One interesting phenomenon is that in some countries, particularly the United States, interest in refractive surgery increased significantly.1 Potential reasons for this include the frustration of wearing glasses with masks, the need to avoid touching one's eyes to reduce the risk of virus transmission, and greater flexibility for some patients to come in for evaluations due to work from home schedules. Regardless, the demand for refractive surgery has not waned in these trying times. This is good for our profession, but, most importantly, for our patients. Now more than ever, we have techniques and technology to provide safe and highly effective refractive surgery to the majority of patients for most refractive errors,2–4 and increasingly effective strategies to repair unwanted outcomes when they do occur.5,6

Since initial reports of coronavirus being found in tears and potentially transmissible via the conjunctiva, the risk of coronavirus transmission through ocular surgery has been evaluated. Fortunately, the two primary approaches for refractive surgery, corneal and lens-based, do not appear to be high risk procedures based on the lack of particle aerosolization.7,8 This is also great news for our field because we can continue to offer refractive surgery options knowing that the risk of transmission through surgery appears to be extremely low.

As we (finally) leave 2020 behind, looking forward, refractive surgery remains vibrant and dynamic. The articles published in this issue highlight the expanding scope of refractive surgery today and the continued advancements in our field. With new science on lens-based approaches, corneal approaches, presbyopia correction, advances in imaging to further refine outcomes, and novel therapeutic options for ectatic diseases, the future for our field has never been brighter. So, as we see the rolling out of multiple coronavirus 2019 (COVID-19) vaccines worldwide over the coming year and the continued use of basic safety measures such as wearing masks, hand hygiene, and social distancing, let us all hope that we can see the end of this global pandemic. Until then, we can feel reassured that we have found a safe way to move forward and provide the refractive surgery our patients need and strongly desire during these unprecedented times.


  1. Refractive surgery on the rise during COVID-19 pandemic. Ocular Surgery News. October10, 2020.
  2. Schallhorn JM, Seifert S, Schallhorn SC. SMILE, topography-guided LASIK, and wavefront-guided LASIK: review of clinical outcomes in premarket approval FDA studies. J Refract Surg. 2019;35(11):690–698. doi:10.3928/1081597X-20190930-02 [CrossRef]
  3. Moshirfar M, Somani AN, Motlagh MN, et al. Comparison of FDA-reported visual and refractive outcomes of the toric ICL lens, SMILE, and topography-guided LASIK for the correction of myopia and myopic astigmatism. J Refract Surg. 2019;35(11):699–706. doi:10.3928/1081597X-20190930-01 [CrossRef]
  4. Siedlecki J, Schmelter V, Mayer WJ, et al. SMILE versus implantable collamer lens implantation for high myopia: a matched comparative study. J Refract Surg. 2020;36(3):150–159. doi:10.3928/1081597X-20200210-02 [CrossRef]
  5. Reinstein DZ, Archer TJ, Carp GI, et al. Incidence and outcomes of optical zone enlargement and recentration after previous myopic LASIK by topography-guided custom ablation. J Refract Surg. 2018;34(2):121–130. doi:10.3928/1081597X-20171215-01 [CrossRef]
  6. Wiley LA, Randleman JB. Topography-guided custom ablation photorefractive keratectomy treatment of irregular astigmatism resulting from decentered SMILE. J Refract Surg. 2020;36(11):766–771.
  7. Khamar P, Shetty R, Balakrishnan N, et al. Quantitative shadowgraphy of aerosol and droplet creation during oscillatory motion of the microkeratome amid COVID-19 and other infectious diseases. J Cataract Refract Surg. 2020;46(10):1416–1421. doi:10.1097/j.jcrs.0000000000000326 [CrossRef]
  8. Noureddin GS, Iovieno A, Eslami M, Weaver T, Meadows H, Yeung SN. Quantification of aerosol generation during cataract surgery. Accepted manuscript. Published online November 30, 2020. J Cataract Refract Surg. doi:10.1097/j.jcrs.0000000000000530 [CrossRef]

From Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, Ohio.

The author has no financial or proprietary interest in the materials presented herein.

Correspondence: J. Bradley Randleman, MD, Cleveland Clinic Foundation, Cole Eye Institute, 9500 Euclid Avenue, Cleveland, OH 44195. Email:


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