Refractive surgery refers to any procedure that corrects or minimizes refractive errors. Today, refractive surgery has evolved beyond the traditional laser refractive surgery, embodied by the popular laser in situ keratomileusis or 'LASIK'. New keratorefractive techniques such as small incision lenticule extraction (SMILE) avoids corneal flap creation and uses a single laser device, while advances in surface ablation techniques have seen a resurgence in its popularity. Presbyopic treatment options have also expanded to include new ablation profiles, intracorneal implants, and phakic intraocular implants. With the improved safety and efficacy of refractive lens exchange, a wider variety of intraocular lens implants with advanced optics provide more options for refractive correction in carefully selected patients. In this review, we also discuss possible developments in refractive surgery beyond 2020, such as preoperative evaluation of refractive patients using machine learning and artificial intelligence, potential use of stromal lenticules harvested from SMILE for presbyopic treatments, and various advances in intraocular lens implants that may provide a closer to 'physiological correction' of refractive errors.

Intracameral combination of 2 mydriatics and 1 anesthetic is an alternative to topical mydriatics for cataract surgery. The prompt onset of pupil dilation and the stable mydriasis induced by this drug combination improved the intraoperative conditions during crucial steps, such as intraocular lens implantation.

Purpose:The purpose of this study was to assess predictability, efficacy, safety and stability in patients who received a toric implantable collamer lens to correct moderate to high myopic astigmatism.Methods:Forty-three eyes of 23 patients underwent implantation of a toric implantable collamer lens (STAAR Surgical Inc) for astigmatism correction. Mean spherical refraction was −4. 98 ± 3.49 diopters (D) (range: 0 to −13 D), and mean cylinder was −2.62 ± 0.97 D (range: −1.00 to −5.00 D). Main outcomes measures evaluated during a 12-month follow-up included uncorrected visual acuity (UCVA), refraction, best-corrected visual acuity (BCVA), vault, and adverse events.Results:At 12 months the mean Snellen decimal UCVA was 0.87 ± 0.27 and mean BCVA was 0.94 ± 0.21, with an efficacy index of 1.05. More than 60% of the eyes gained ≥1 line of BCVA (17 eyes, safety index of 1.14). The treatment was highly predictable for spherical equivalent (r2 = 0.99) and astigmatic components: J0 (r2 = 0.99) and J45 (r2 = 0.90). The mean spherical equivalent dropped from −7.29 ± 3.4 D to −0.17 ± 0.40 D at 12 months. Of the attempted spherical equivalent, 76.7% of the eyes were within ±0.50 D and 97.7% eyes were within ±1.00 D, respectively. For J0 and J45, 97.7% and 83.7% were within ±0.50 D, respectively.Conclusion:The results of the present study support the safety, efficacy, and predictability of toric implantable collamer lens implantation to treat moderate to high myopic astigmatism.

The LASSO sizing formulas are easy to implement into clinical practice and can significantly improve the predictability of postoperative vault after ICL implantation.

<H4>PURPOSE</H4> <P>To analyze the results of a custom-designed posterior chamber toric phakic intraocular lens (PIOL).</P> <H4>METHODS</H4> <P>A 40-year-old woman with high astigmatism and thin corneas underwent bilateral PIOL implantation with the toric Implantable Collamer Lens (ICL) custom-designed and manufactured by STAAR Surgical. The appropriate toric ICL power was calculated to be –8.00 +8.00 x 96° for the right eye and –8.50 +7.50 x 86° for the left eye. Optical zone was 5.5 mm and 6.875 mm at the corneal plane.</P> <H4>RESULTS</H4> <P>At 3 and 6 months postoperatively, uncorrected visual acuity (UCVA) and best-spectacle corrected visual acuity (BSCVA) of both eyes had improved to 20/20 and 20/16, respectively. At 19 months, UCVA was 20/20 and 20/16 in the right and left eyes, respectively, and BSCVA had improved to 20/16 and 20/10, respectively. The subjective refraction was stable, with a change of –0.37±0.17 D from preoperative to 19 months postoperatively. Throughout the postoperative period, iridotomies remained patent and the corneas were clear.</P> <H4>CONCLUSIONS</H4> <P>Bilateral implantation of the custom-designed toric ICL successfully corrected the patient’s high astigmatism. Preoperative subjective refractive cylinder of –5.25 x 6° in the right eye and –5 x 176° in the left eye changed to –0.5 x 77° and –0.5 x 115°, respectively, after toric IOL implantation. There was almost no change in corneal astigmatism. This customized approach led to UCVA of 20/20 in the right eye and 20/16 in the left eye, and BSCVA of 20/16 in the right eye and 20/10 in the left eye. This is the first report of a toric PIOL being specifically manufactured to meet the refractive cylinder requirements of a specific patient. [<CITE>J Refract Surg.</CITE> 2008;24:501-506.]</P> <H4>ABOUT THE AUTHORS</H4> <P>From the Antwerp Eye Center, Antwerp, Belgium (Mertens); the University of Illinois, College of Medicine, Chicago, Ill (Sanders); and the Center for Clinical Research, Elmhurst, Ill (Vitale).</P> <P>Drs Mertens and Sanders are research and regulatory consultants to STAAR Surgical. The remaining author has no financial interest in the materials presented herein.</P> <P>Correspondence: Erik L. Mertens, MD, FEBO, Antwerp Eye Center, Kapelstraat 8, B-2660 Antwerp, Belgium. Tel: 32 3 8282949; Fax: 32 3 8208891; E-mail: <A HREF="mailto:e.mertens@zien.be">e.mertens@zien.be</A></P> <P>Received: November 19, 2006</P> <P>Accepted: May 1, 2007</P> <P><B>Posted online: July 16, 2007</B></P>