- •Contents
- •General Introduction
- •Objectives
- •Introduction
- •1 The Science of Refractive Surgery
- •Corneal Optics
- •Refractive Error: Optical Principles and Wavefront Analysis
- •Measurement of Wavefront Aberrations and Graphical Representations
- •Lower-Order Aberrations
- •Higher-Order Aberrations
- •Corneal Biomechanics
- •Corneal Imaging for Keratorefractive Surgery
- •Corneal Topography
- •Corneal Tomography
- •Indications for Corneal Imaging in Refractive Surgery
- •The Role of Corneal Topography in Refractive Surgery
- •Corneal Effects of Keratorefractive Surgery
- •Incisional Techniques
- •Tissue Addition or Subtraction Techniques
- •Alloplastic Material Addition Techniques
- •Collagen Shrinkage Techniques
- •Laser Biophysics
- •Laser–Tissue Interactions
- •Fundamentals of Excimer Laser Photoablation
- •Types of Photoablating Lasers
- •Corneal Wound Healing
- •2 Patient Evaluation
- •Patient History
- •Patient Expectations
- •Social History
- •Medical History
- •Pertinent Ocular History
- •Patient Age, Presbyopia, and Monovision
- •Examination
- •Uncorrected Visual Acuity and Manifest and Cycloplegic Refraction
- •Pupillary Examination
- •Ocular Motility, Confrontation Fields, and Ocular Anatomy
- •Intraocular Pressure
- •Slit-Lamp Examination
- •Dilated Fundus Examination
- •Ancillary Tests
- •Corneal Topography
- •Pachymetry
- •Wavefront Analysis
- •Calculation of Residual Stromal Bed Thickness After LASIK
- •Discussion of Findings and Informed Consent
- •3 Incisional Corneal Surgery
- •Incisional Correction of Myopia
- •Radial Keratotomy in the United States
- •Incisional Correction of Astigmatism
- •Coupling
- •Arcuate Keratotomy and Limbal Relaxing Incisions
- •Instrumentation
- •Surgical Techniques
- •Outcomes
- •Complications
- •Ocular Surgery After Arcuate Keratotomy and Limbal Relaxing Incisions
- •4 Onlays and Inlays
- •Keratophakia
- •Homoplastic Corneal Inlays
- •Alloplastic Corneal Inlays
- •Epikeratoplasty
- •Intrastromal Corneal Ring Segments
- •Background
- •Instrumentation
- •Technique
- •Outcomes
- •Intacs and Keratoconus
- •One or Two Intacs Segments?
- •Complications
- •Ectasia After LASIK
- •Uses for Intrastromal Corneal Ring Segments After LASIK
- •Orthokeratology
- •5 Photoablation: Techniques and Outcomes
- •Excimer Laser
- •Background
- •Surface Ablation
- •LASIK
- •Wavefront-Optimized and Wavefront-Guided Ablations
- •Patient Selection for Photoablation
- •Special Considerations for Surface Ablation
- •Special Considerations for LASIK
- •Surgical Technique for Photoablation
- •Calibration of the Excimer Laser
- •Preoperative Planning and Laser Programming
- •Preoperative Preparation of the Patient
- •Preparation of the Bowman Layer or Stromal Bed for Excimer Ablation
- •Application of Laser Treatment
- •Immediate Postablation Measures
- •Postoperative Care
- •Refractive Outcomes
- •Outcomes for Myopia
- •Outcomes for Hyperopia
- •Wavefront-Guided and Wavefront-Optimized Treatment Outcomes for Myopia and Hyperopia
- •Re-treatment (Enhancements)
- •6 Photoablation: Complications and Adverse Effects
- •General Complications Related to Laser Ablation
- •Overcorrection
- •Undercorrection
- •Optical Aberrations
- •Central Islands
- •Decentered Ablations
- •Corticosteroid-Induced Complications
- •Central Toxic Keratopathy
- •Infectious Keratitis
- •Complications Unique to Surface Ablation
- •Persistent Epithelial Defects
- •Sterile Infiltrates
- •Corneal Haze
- •Complications Unique to LASIK
- •Microkeratome Complications
- •Epithelial Sloughing or Defects
- •Flap Striae
- •Traumatic Flap Dislocation
- •LASIK-Interface Complications
- •Visual Disturbances Related to Femtosecond Laser LASIK Flaps
- •Ectasia
- •Rare Complications
- •7 Collagen Shrinkage and Crosslinking Procedures
- •Collagen Shrinkage
- •History
- •Laser Thermokeratoplasty
- •Conductive Keratoplasty
- •Collagen Crosslinking
- •8 Intraocular Refractive Surgery
- •Phakic Intraocular Lenses
- •Background
- •Advantages
- •Disadvantages
- •Patient Selection
- •Surgical Technique
- •Outcomes
- •Complications
- •Refractive Lens Exchange
- •Patient Selection
- •Surgical Planning and Technique
- •IOL Power Calculations in Refractive Lens Exchange
- •Complications
- •Advantages
- •Disadvantages
- •Monofocal Intraocular Lenses
- •Toric Intraocular Lenses
- •Patient Selection
- •Planning and Surgical Technique
- •Outcomes
- •Complications Specific to Toric IOLs
- •Light-Adjustable Intraocular Lenses
- •Accommodating Intraocular Lenses
- •Multifocal Intraocular Lenses
- •Patient Selection
- •Surgical Technique
- •Outcomes
- •Adverse Effects, Complications, and Patient Dissatisfaction with Multifocal IOLs
- •Bioptics
- •Introduction
- •Theories of Accommodation
- •Nonaccommodative Treatment of Presbyopia
- •Monovision
- •Conductive Keratoplasty
- •Multifocal IOL Implants
- •Custom or Multifocal Ablations
- •Corneal Intrastromal Femtosecond Laser Treatment
- •Corneal Inlays
- •Accommodative Treatment of Presbyopia
- •Scleral Surgery
- •Femtosecond Lens Relaxation
- •Accommodating IOLs
- •Other IOL Innovations on the Horizon
- •10 Refractive Surgery in Ocular and Systemic Disease
- •Introduction
- •Ocular Conditions
- •Ocular Surface Disease
- •Herpesvirus Infection
- •Keratoconus
- •Post–Penetrating Keratoplasty
- •Ocular Hypertension and Glaucoma
- •Retinal Disease
- •Amblyopia and Strabismus in Adults and Children
- •Systemic Conditions
- •Human Immunodeficiency Virus Infection
- •Diabetes Mellitus
- •Connective Tissue and Autoimmune Diseases
- •11 Considerations After Refractive Surgery
- •IOL Calculations After Refractive Surgery
- •Eyes With No Preoperative Information
- •The ASCRS Online Post-Refractive IOL Power Calculator
- •Retinal Detachment Repair After LASIK
- •Corneal Transplantation After Refractive Surgery
- •Contact Lens Use After Refractive Surgery
- •Indications
- •General Principles
- •Contact Lenses After Radial Keratotomy
- •Contact Lenses After Surface Ablation
- •Contact Lenses After LASIK
- •Glaucoma After Refractive Surgery
- •12 International Perspectives in Refractive Surgery
- •Introduction
- •Global Estimates of Refractive Surgery
- •International Trends in Refractive Surgery
- •Basic Texts
- •Related Academy Materials
- •Requesting Continuing Medical Education Credit
Basic Texts
Refractive Surgery
Azar DT, Gatinel D, Hoang-Xuan T, eds. Refractive Surgery. 2nd ed. Philadelphia: Elsevier/Mosby; 2007.
Boyd BF, Agarwal S, Agarwal A, Agarwal A, eds. LASIK and Beyond LASIK: Wavefront Analysis and Customized Ablations. Thorofare, NJ: Slack; 2001.
Feder R. The LASIK Handbook: A Case-Based Approach. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2013.
Garg A, Rosen E, Lin JT, et al, eds. Mastering the Techniques of Customized LASIK. New Delhi: Jaypee Brothers; 2007.
Hardten DR, Lindstrom RL, Davis EA, eds. Phakic Intraocular Lenses: Principles and Practice. Thorofare, NJ: Slack; 2003.
Probst LE, ed. LASIK: Advances, Controversies, and Custom. Thorofare, NJ: Slack; 2003. Troutman RC, Buzard KA. Corneal Astigmatism: Etiology, Prevention, and Management. St Louis:
Mosby; 1992.
Related Academy Materials
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Requesting Continuing Medical Education Credit
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