REFRACTIVE EWAP SEPTEMBER 2023 19 Contact information Ambrosio: dr.renatoambrosio@gmail.com Chu: yrchu@chuvision.com Over the last 20 years, refractive surgery has expanded beyond the cornea and to intraocular correction. There have been so many advancements on the diagnostic and procedural front that Y. Ralph Chu, MD, said refractive surgery is truly its own subspecialty. “It takes equipment commitment, mental commitment. You have to structure your practice around refractive surgery. I think that over the last 10 or more years, refractive surgery has evolved to where unless you’re fully committed to it, it’s hard to just dabble in it,” he said. “You need the right diagnostic technology. You need easy access to laser technology. There is staff education, energy, and internal expertise needed to manage the Equipment updates advancing refractive surgery by Liz Hillman Editorial Co - Director high expectations of the modern refractive surgery patient.” Some of the more recent advancements have been at the diagnostic level. Specific to LASIK, Dr. Chu said one of the biggest things to happen on the preoperative screening front is epithelial thickness mapping. This, Dr. Chu said, helps surgeons identify what might be causing asymmetry on topography as it relates to the epithelial surface. “Sometimes asymmetry on the topography can be the result of epithelial basement membrane dystrophy. It could be the result of epithelial disorders that aren’t structural anomalies, so patients can still have a refractive surgery. Epithelial mapping has helped surgeons screen in and screen out patients who are good or bad patients more effectively,” he said. Renato Ambrosio, Jr., MD, PhD, shared with EyeWorld an editorial on the concept of multimodal refractive imaging 1 and a review paper he co- authored describing the value of epithelial thickness mapping. The authors concluded that conscious application of such measurements “significantly impacts safety and efficacy of refractive surgery, and also allows for significant improvement for therapeutic procedures.” 2 Dry eye diagnostic technologies and tests have also impacted the screening of patients. “I think incorporating some type of advanced diagnostic dry eye test is important, and I think for a refractive surgeon, tear breakup time and meibomian gland imaging are helpful This article originally appeared in the July 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Figure 1. Placido disc-based corneal topography; note the irregular tear film on Placido’s reflection and irregular steepening on the axial map. Source: Renato Ambrosio, Jr., MD, PhD
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