As surgeons, we often find that adopting new technology comes at the expense of practice flow and efficiency. However, in my practice, the move to high-definition wavefront aberrometry has actually streamlined our laser vision correction flow.
Rather than starting with a general exam and then bringing patients back for wavefront measurements at a second visit, we now route laser vision correction candidates directly to all-digital eye analysis (wavefront, tomography and biomechanical analysis) and then back to the exam lane for a dry manifest refraction, cycloplegic refraction and dilated eye exam. If the patient is a good candidate, he or she can be counseled and scheduled for surgery all in that same visit.
This works in part because the iDesign (Johnson & Johnson Vision) provides highly accurate, whole-eye refractive astigmatism data, which means that the wavefront refraction can augment autorefraction and serve as a more precise starting point for the manifest astigmatic refraction. There is still a requirement to manually fine-tune the spherical component — mainly to make sure we are fully accounting for accommodation — but in many cases we are treating off the wavefront astigmatic data.We will select the astigmatic wavefront treatment that most closely matches the manifest astigmatic refraction.
The device provides five different types of measurements in a single capture. In addition to autorefraction, we also get accurate pupillometry, wavefront aberrometry, keratometry data that are transferred into the planning screen, and integrated topography. The topographical information is already qualitatively useful in treatment planning. In the future, it may be able to provide more precise compensation for surface irregularities and even hybrid treatments that combine the advantages of both topography- and wavefront-guided treatments.
With any new refractive technology, it is worth considering what impact it will have on practice efficiency during the learning curve and over the longer term.
Disclosure: Waring reports he is a consultant for Johnson & Johnson Vision.
Editor's Note: This article has been updated to include more detail on wavefront treatment selection.