2011-2012 Basic and Clinical Science Course, Section 13: by Christopher J. Rapuano MD

By Christopher J. Rapuano MD

This up to date quantity covers a couple of issues, from the technology of refractive surgical procedure to accommodative and nonaccommodative remedy of presbyopia, from sufferer review to foreign views. It examines particular approaches in refractive surgical procedure, in addition to refractive surgical procedure in ocular and systemic sickness. significant revision 2011-2012.

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Extra resources for 2011-2012 Basic and Clinical Science Course, Section 13: Refractive Surgery (Basic & Clinical Science Course)

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Broad -beam lasers and some scanning-slit lasers require a mechanical iris diaphragm or ablatable mask to create the desired shape in the cornea, while the rest of the scanning-slit lasers and the flying spot lase rs use a pattern projected onto the surface to guide the ablation profile without masking. The majority of excimer lasers in clinical use today utilize some form of variable or flying spot ablation profile. Wavefront-optimized and wavefront-guided laser ablations Because conventional laser treatment profiles have small blend zones and create a more oblate corneal shape postoperatively, they are likely to induce some degree of higher-order aberration, especially spherical aberration and coma.

Surgeons should be wary of progressive myopia due to nuclear sclerosis. Patients with mild lens changes that are visually insignificant should be informed of these findings and advised that the changes may become more significant in the future, independent of refractive surgery. They should also be told that [OL power calculations are not as accurate when performed after keratorefractive surgery. In patients with moderate lens opacities, cataract extraction may be the best form of refractive surgery.

Some surgeons use wavefront analysis to document levels of preoperative higher-order aberrations. Refraction data from the wavefront analysis unit can also be used to refine the manifest refraction. If the manifest refraction and the wavefront analysis refraction are very dissimilar, the patient may not be a good candidate for wavefront treatment. Note that a custom wavefront ablation generally removes more tissue than a standard ablation in the same eye. Calculation of Residual Stromal Bed Thickness After LASIK A lamellar laser refractive procedure such as LASIK involves creation of a corneal flap, ablation of the stromal bed, and replacem ent of the flap.

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