EyeWorld Asia-Pacific June 2014 Issue

46 EWAP rEfrActivE June 2014 cones out so patients could tolerate their contact lenses. He said that the worry of an already thin cornea was very prevalent in these types of procedures. With the advent of crosslinking, physicians realized Refractive - from page 45 The moment you help your patients see the whole picture. This is the moment we work for. True Living Vision becomes reality with ZEISS AT LISA ® tri and the new ZEISS AT LISA tri toric . Excellent near, far and intermediate vision. Under all light conditions. For maximized independency from spectacles. www.meditec.zeiss.com/lisa-tri-family // TRUE LIVING VISION MADE BY ZEISS ZEISS AT LISA tri and AT LISA tri toric are not available for sale in the U.S. NEW Trifocal toric IOL that they could take more tissue off with PRK, knowing that they would have the remaining corneal strength, he said. “We started doing a lot with topography- guided because that would improve the shape beyond what we could get with the standard treatment,” Dr. Holland said. Keratoconus is particularly appropriate for this technique. “This topography- guided technique allows us to improve both the shape and the power of the cornea.” But it remains a fairly controversial topic. Acceptance of the combination Dr. Holland said that for people to accept the combination of topography-guided PRK and crosslinking, it needs to be shown that more keratoconus or ectasia is not being induced by the technique. For some patients, even with crosslinking alone, they continue to progress, but as long as they can show safety, that’s the most important aspect, he said. Which patients would benefit most? Dr. Holland said it seems that the earlier a patient is treated with the combination of topography- guided PRK and crosslinking, the better the result. “I think the extreme patients don’t do that well,” he said, meaning that those with a lot of scarring or who have already progressed with keratoconus may not respond as well to treatment. Additionally, for those with very thin corneas, there may not be many options in terms of refractive treatment. “There [are] some patients who can progress quite rapidly.” Dr. Holland said that he has been surprised at the rate of progression in some patients who have had one eye treated and come back for the second. He added that it is important to look at more results, and perhaps getting patients crosslinking treatment earlier could prove beneficial. EWAP Editors’ note: Dr. Holland has no financial interests related to this article. contact information Holland: drsimonholland@gmail.com