Providing the Best Vision

With refractive surgery experiencing a resurgence in popularity, this issue provides the tools needed for success

As the world has begun to emerge from the unprecedented COVID-19 pandemic, we have seen a surge of renewed interest from our patients to achieve freedom from glasses and contact lenses. While ophthalmology was the hardest hit of all specialties, in terms of Medicare spending during the pandemic, refractive surgery saw a sharp rise, as patients scrambled to get out of their mask-caused fogging glasses. Specifically, patients who contemplated refractive surgery for years seized an opportune time for self-improvement, thanks to reduced work schedules and greater disposable income (from not traveling).

As with my own journey from Bascom Palmer cornea fellowship to my current position as medical director of a busy refractive practice, we are seeing the cornea surgeon meld into the refractive surgeon in the post-pandemic era. After all, the cornea remains the most powerful refractive structure in the eye. It is no longer enough to keep the cornea clear.

A Solution for Presbyopia

With evolving technology, the expectation to see with spectacle-free vision is higher than ever for patients and surgeons alike.

For the growing presbyopic population (1.8 billion people worldwide),1 this means freedom from reading glasses as well. In this issue of Corneal Physician, Dr. Cathleen M. McCabe provides a summary of the drops for presbyopia on the market and in the pipeline in “Research Spotlight” (p.35).

Reducing Corneal Irregularities

Still, it is not enough to be able to see unaided. Patients also expect to see without distortion, ghosting, or blur. Advances in corneal refractive technologies have taken laser vision correction to the next level, whereby every topographic hill and valley can be reshaped and corneal higher-order aberrations reduced, creating a nearly perfect visual system.

In “Using Topography-Guided LASIK Software” (p.18), Dr. Mark Lobanoff discusses utilizing a customized ablation profile to reduce corneal irregularities and increase the likelihood of achieving better than 20/20 visual outcomes.

Additionally, Drs. Dan Z. Reinstein and Timothy J. Archer describe how corneal epithelial mapping can be used as an adjunct to standard topography and tomography to identify (and rule out) subclinical ectasia for the purpose of facilitating and, potentially, expanding the pool of refractive surgery candidates in “Deciphering Epithelial Mapping for Refractive Surgery,” p.31. Also, Dr. Denise M. Visco discusses how premium IOL patients can achieve optimal visual outcomes in “Creating Arcuate Incisions to Reduce Astigmatism,” p.20.

Further, Dr. Audrey Talley Rostov shares her pearls on succeeding with small incision lenticule extraction, referred to as SMILE, a growing refractive procedure that has revolutionized laser vision correction, in a web exclusive!

Remembering the Ocular Surface

Of course, the outermost layer of the cornea (i.e., the tear film) continues to play a critical role in the preoperative planning of cataract surgery. In “Product Spotlight,” p.9, Dr. Dee Stephenson introduces us to a novel imaging device that uses LED technology to characterize tear film stability to guide IOL selection.

Similarly, Dr. Laura M. Periman describes the harmonious balance among dermatology, aesthetics, and, of course, ophthalmology, in “The DAO to Healthy, Beautiful Eyes,” p.25.

Finally, Drs. Arianna Tovar Vetencourt and Guillermo Amescua summarize the best strategies for managing limbal stem cell deficiency, on p.12, as beautifully depicted on this month’s cover. Enjoy the issue! CP


  1. Fricke TR, Tahhan N, Resnikoff S, Global Prevalence of Presbyopia and Vision Impairment from Uncorrected Presbyopia: Systematic Review, Meta-analysis, and Modelling. Ophthalmology. 2018; 125(10):1492-1499.