New paradigm for the treatment of myopia by refractive surgery

摘要

Eventually, refractive surgery will be done not only to provide refractive correction but also to optimize the optical performance of emmetropic eyes. With the advent of adaptive optics in ophthalmology this has become a goal that is within reach although there are a number of significant hurdles (technical, procedural and theoretical) that need to be addressed before it is implemented. Until adaptive optics (or some other technology) delivers, we need to perform surgeries that reduce the number of patients with significant losses in visual functions following the surgery. This can be done with a new surgical algorithm that optimizes the post operative shape of the cornea to maintain the pre operative corneal aberrations after surgery. By maintaining this balance of aberrations, we maintain preoperative visual performance, at least for pupil sizes smaller than the zone of treatment. The best post operative shape depends on both the refractive change applied and the asphericity of the pre operative cornea (eq. 2 and 3). Furthermore, the profile based on this paradigm results in shallower ablation profiles.