Ординатура / Офтальмология / Английские материалы / Refractive Lens Surgery_Fine, Packer, Hoffman_2005

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Editor: Marion Philipp, Heidelberg

Desk editor: Martina Himberger, Heidelberg Production: ProEdit GmbH, Elke Beul-Göhringer, Heidelberg

Cover design: Estudio Calamar, F. Steinen-Broo, Pau/Girona, Spain

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Printed on acid-free paper

The editors respectfully dedicate this book to the many pioneers of refractive surgery who had the courage to operate on healthy eyes in order to enhance the quality of life of their patients. They were right all along

and those of us who were doubters have learned that lesson and as a result have enhanced the satisfaction we derive from our own careers.

The first recorded time a human lens was removed for the purpose of addressing a refractive error was by an ophthalmologist named Fukala in 1890. We do not know what type of criticism he experienced, but we know that today he is a forgotten man in ophthalmology. The introduction of this as a concept in the late 1980s by both Drs. Paul Koch and Robert Osher’s manuscripts, resulted in considerable disdain and some condemnation by some of their colleagues and peers. At the time,refractive surgery in the United States was limited to radial keratotomy. With the development of excimer lasers came a very marked change in the attitude of eye surgeons internationally regarding the concept of invading “healthy” tissue for refractive purposes and within a relatively short period of time, LASIK was a firmly established procedure as were other modalities of corneal refractive surgery.

However,we have come to recognize that corneal refractive surgery, and especially LASIK, has limitations. We have also learned much in the recent past about functional vision through the use of contrast sensitivity and an analysis of higher order optical aberrations. We have also learned that the cornea has constant spherical aberration but the lens has changing spherical aberrations. In the young,the human lens compensates for the cornea’s positive spherical aberration, but as we age the changing spherical aberration within the lens exacerbates corneal spherical aberra-

tion. Because of the changing spherical aberration in the lens, no matter what is done to the cornea as a refractive surgery modality, including the most sophisticated custom corneal shaping, functional vision is going to be degraded by changing spherical aberration in the lens over time. This coupled with the fact that higher myopes and hyperopes, patients with early cataracts, and presbyopes are not necessarily good candidates for LASIK has resulted in a fresh look at lens-based refractive surgery. We have seen recent improvements in phakic IOL technology and utilization and we ourselves have been increasingly motivated to work with lens related refractive surgery modalities.

Our own work with power modulations, the IOL Master, and wavefront technology IOLs has convinced us that lens-related refractive surgery can give superior results. Stephen Klyce, MD, the developer of corneal topography has demonstrated, using topographical and wavefront analysis methods, that IOL intraocular optics are far superior to the optics of the most sophisticated, customized wavefront treated cornea. We have also seen the development of new lens technologies including improved multifocal IOLs, improved accommodative IOLs, light adjustable IOLs, injectable IOLs, and a variety of other investigational IOL technologies that suggest unimaginable possibilities. Our own results with the Array and Crystalens have

been very encouraging as has our work with bimanual micro-incision phacoemulsification, which I believe has allowed us to develop a refractive lens exchange technique that sets a new standard for safety and efficacy. It is our belief that refractive lens exchange is indeed not only the future of refractive surgery, but in many ways the procedure that will become a mainstay of ophthalmology within the coming decades.

A major task for any editor is delegation, and this book represents the ultimate in

delegation. My reliance on my two partners is evident throughout the book in the authorship of the chapters we have produced. It is my belief that just as refractive lens exchange represents the future of refractive surgery that my partners, Drs. Richard S. Hoffman and Mark Packer, represent the new generation of leadership in anterior segment ophthalmic surgery.

I. Howard Fine