REFRACTIVE 24 EWAP SEPTEMBER 2023 five different procedures—PRK, LASIK, SMILE, ICL, and refractive lens exchange—for treating people,” he said. “It’s gotten more exciting, more complex.” What’s next? Dr. Chu said he’d like to see continued improvement in diagnostic screening for refractive surgery candidacy. He said what he would like are pieces of equipment that integrate multiple tests into one device. He acknowledged some negatives to that (such as if the device breaks) but said it would greatly improve efficiency in the preoperative setting. Procedurally, Dr. Chu said that LASIK already works well, and other options in the market, such as SMILE and ICLs, could continue to see improvements. In his presentation, Dr. Ambrosio mentioned the convergence of “applied artificial intelligence with ancient philosophy being important for customized treatments and individualized medicine” going forward. He shared with EyeWorld examples of clinical studies on how artificial intelligence can enhance interpretation of Scheimpflug tomography, 4 and integrating it with corneal biomechanics, 4,5,6 to reduce the risk of ectasia after refractive surgery. EWAP References 1. Ambrosio R. Multimodal imaging for refractive surgery: Quo vadis? Indian J Ophthalmol. 2020;68:2647–2649. 2. Salomao MQ, et al. Role of the corneal epithelium measurements in keratorefractive surgery. Curr Opin Ophthalmol. 2017;28:326–336. 3. Ambrosio R. Therapeutic refractive surgery: why we should differentiate? Rev Bras Oftalmol. 2013;72:85 – 86. 4. Lopes BT, et al. Enhanced tomographic assessment to detect corneal ectasia based on artificial intelligence. Am J Ophthalmol. 2018;195:223–232. 5. Ambrosio R, et al. Integration of Scheimpflug-based corneal tomography and biomechanical assessments for enhancing ectasia detection. J Refract Surg. 2017;33:434 – 443. 6. Ambrosio R, et al. Optimized artificial intelligence for enhanced ectasia detection using Scheimpflug- based corneal tomography and biomechanical data. Am J Ophthalmol. 2022;251:126–142. Editors’ note: Dr. Ambrosio is Professor of Ophthalmology, Federal University of the State of Rio de Janeiro and Federal University of Sao Paulo, Rio de Janeiro, Brazil, and has interests with Alcon, Carl Zeiss Meditec, Mediphacos, and Oculus. Dr. Chu is Founder and Medical Director, Chu Vision Institute, Bloomington, Minnesota, and has interests with Carl Zeiss Meditec. Presbyopia eye drops in development • Slit lamp biomicroscopy • Central corneal thickness • Placido topography • Ocular surface imaging • 3D Scheimpflug tomography • Corneal total and internal wavefront imaging • Ocular scatter imaging • Ocular biometry • Segmental tomography • IOP/corneal biomechanic measurements • Specular/confocal microscopy • Osmolarity, molecular biology, and genetic testing Source: Renato Ambrosio Jr., MD, PhD Preop diagnostic and screening technologies for refractive surgery Equipment updates - from page 20 Dr. Chang said he would be interested to learn more on this topic through further studies. Fundamentally, clinical testing of vision is quite limited, he said. Our vision tests were not created to understand visual quality in real-world contrast and lighting conditions, which are key to understanding IOL performance. For now, he said it’s important to increase awareness that high energy light filtering is about more than just macular protection and more than just marketing hype. EWAP References 1. Chang DH, et al. Clinical evaluation of a modified light transmission short-wavelength filtering intraocular lens compared to a colorless control. Ophthalmol Ther. 2023;12:1775–1785. 2. Chang DH, et al. Violet and blue light: impact of high-energy light on vision and health. J Ophthalmic Stud. 2020;3. E - pub. 3. van der Mooren M, et al. Effect of violet light-filtering and manufacturing improvements in an extended depth - of - focus intraocular lens on visual performance. Clin Ophthalmol. 2023;17:701–709. 4. Chang DH, et al. The effect of violet light filtration and manufacturing improvements on the clinical performance of an extended depth of focus IOL. Presentation at the 2022 ASCRS Annual Meeting, Washington, D.C. 5. Chang DH, et al. Violet light-filtering IOLs: visual and non-visual benefits. Presentation at the 2020 American Academy of Ophthalmology Annual Meeting, virtual. Editors’ note: Dr. Chang is Cataract and Refractive Surgeon at Empire Eye and Laser Center, Bakersfield, California. Dr. Waring practices at Waring Vision Institute, Mt. Pleasant, South Carolina. Both have interests with Johnson & Johnson Vision.
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