Options abound in refractive surgery spectrum

In the past decade we have seen the convergence of refractive surgery with cataract surgery, which makes sense because the most commonly performed refractive procedure is phacoemulsification with IOL implantation. Corneal-based refractive surgery has evolved, with precise treatments with excellent outcomes. We are also learning more about phakic IOLs and newer devices such as intracorneal inlays. The key to success is to select the best refractive surgical procedure for each patient.LASIK and PRK have a long track record for success with excellent visual outcomes and very low risk as long as the patient is a strong candidate. The newer femtosecond lasers are able to create LASIK flaps that are far more accurate and predictable than using a bladed microkeratome. There are, however, the rare patients in whom a microkeratome may be preferred, such as those with corneal scars and perhaps some patients with prior radial keratotomy. Femtosecond lasers have improved considerably in both speed and quality of the flaps created, with complete treatments under 30 seconds with minimal issues with opaque bubble layers. Patients who meet topographic, tomographic and pachymetric criteria can do well with femtosecond laser-created LASIK flaps.