Dr David R Hardten MD
Refractive surgery has advanced greatly over the last 100 years. This allows patients at most stages of life to take advantage of surgical options to reduce their dependence on glasses and contact lenses. Major advancements have been made in the last 30 years in corneal refractive surgery, with technologies like PRK and LASIK. Major advancements in corneal refractive surgery are customized treatments using either wavefront or topographic guidance to allow treatments based on individual characteristics of a patient’s optical system. As the number of patients with prior corneal refractive surgery grows, the ability to manage changes in their optical system over time is increasingly important. Determination of refractive stability to decide if an enhancement procedure will have long-lasting results is important. We know that lenticular changes with age will eventually create an unstable refractive status the few years before the need for cataract surgery. Fortunately, in the last 20 years, there have been significant improvement in technology for cataract extraction and lens implantation including presbyopic IOLs and improved ability to manage astigmatism. Additionally, improvements in presbyopic technology such as a better understanding of monovision, corneal inlays, and presbyopic IOLs add to our ability to help patients in the presbyopic age group. Foremost, we should work to have a long term plan for our patient to meet their changing needs and goals.