Since the time of Charles Kelman’s inspira- tion in the dentist’s chair (while having his teeth ultrasonically cleaned), incremental ad- vances in phacoemulsification and intraocu- lar lens (IOL) technology have produced ever-increasing benefits for patients with cataract. The modern procedure simply was not possible even a few years ago, and until recently prolonged hospital stays were com- mon after cataract surgery. Advances in effi- cacy and safety have justified the current transition from cataract to refractive lens sur- gery.
A recent survey of members of the Ameri- can Society of Cataract and Refractive Surgery has revealed that 40% of respondents performed at least one refractive lens ex- change (RLE) per month during 2003, up from 15% in 1999 [1]; 2.4% said they per- formed six or more RLEs per month in 2003.
When asked about their level of interest in new technology, 100% said they were inter- ested in an accommodative IOL.
Our current ability to achieve emmetropia following refractive lens surgery rivals the re- sults of corneal refractive surgery, yet covers a much wider range of refractive errors. While phakic refractive lenses extend the range of correction for younger patients, RLE also of- fers, with new IOLs, a high probability of achieving functional binocular vision at dis- tance, intermediate and near focal lengths.
For these reasons, RLE will become the dom- inant refractive procedure for patients past the age of presbyopia. With RLE, patients can enjoy a predictable refractive procedure with rapid recovery, which addresses all types of refractive errors, including presbyopia, and never develop cataracts. Surgeons can offer these procedures without the intrusion of their party payers and establish a gratifying and mutually beneficial relationship with their patients. Government programs can en- joy the decreased financial burden from the expense of cataract surgery for the ever-in- creasing ranks of baby boomers that opt for RLE to address their refractive surgery goals, ultimately reaching the age of coverage as pseudophakes.
The competitive business environment and the wellspring of human ingenuity con- tinue to demonstrate synergy in the improve- ment of surgical technique and intraocular lens technology. Future advances will contin- ue to benefit our patients and allow even greater success for refractive lens surgery.
Reference
1. Leaming DV (2004) Practice styles and pre- ferences of ASCRS members – 2003 survey.
J Cataract Refract Surg 30:892–900
Conclusion: The Future of Refractive Lens Surgery
Mark Packer, I. Howard Fine, Richard S. Hoffman
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