Journal of refractive surgery最新文献

{"title":"Targeting Higher Order Aberrations Alone in Keratoconus: A Tissue-Saving Alternative to Established Protocols.","authors":"Shady T Awwad, Karen E Asfar, Samuel Arba-Mosquera, Noura Wahoud, Jeremiah Gendy, Jad F Assaf, Yara Bteich","doi":"10.3928/1081597X-20260512-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260512-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate cone stromal ablation depth with varying optical zones using different customized ablation strategies in keratoconus.</p><p><strong>Methods: </strong>This retrospective computational analysis assessed 59 eyes from 59 patients with mild to moderate keratoconus using three different simulation approaches. The first approach involved treating the full manifest refraction along with the corneal higher order aberrations (HOAs). The second approach, following the Athens Protocol, targeted all HOAs with up to 70% correction of the cylinder and sphere, limiting cone stromal ablation to 50 µm at an optical zone (OZ) of 5.5 mm. The third approach treated all HOAs and included only the sphere and cylinder embedded within the HOA ablation profile, as calculated by the ORK CAM software for the SCHWIND AMARIS (SCHWIND eye-tech-solutions GmbH). All models were simulated on the ORK module, with OZ ranging from 5.5 to 7 mm. The primary outcome measure was the mean stromal ablation depth over the cone and was calculated for all possible scenarios.</p><p><strong>Results: </strong>In approach #1, the mean cone stromal ablation depths and ablation volumes were 49 ± 28, 58 ± 34, 68 ± 40, and 77 ± 46 µm, and 1,074 ± 626, 1,460 ± 863, 1,906 ± 1,113, and 2,448 ± 1,451 nl for an OZ of 5.5, 6, 6.5, and 7 mm, respectively (<i>P</i> < .001). Approach #2 yielded mean depths and volumes of 33 ± 13, 38 ± 15, 44 ± 17, and 50 ± 19 μm, and 686 ± 266, 939 ± 371, 1,240 ± 489, and 1,592 ± 669 nl, respectively (<i>P</i> < .001). In approach #3, the corresponding depths and volumes were 15 ± 6, 17 ± 7, 19 ± 7, and 21 ± 8 µm and 279 ± 89, 377 ± 118, 491 ± 146, and 626 ± 205 nl, respectively, across the same OZ range (<i>P</i> < .001). There was a significant difference in mean cone stromal ablation depths and ablation volumes among the three approaches across all OZs, with approach #3 consistently demonstrating the lowest ablation depths and ablation volumes (<i>P</i> < .001). Furthermore, the rate of increase in mean stromal ablation depth over the cone with expanding OZ size was minimal in approach #3.</p><p><strong>Conclusions: </strong>Treating only the sphere and cylinder embedded into the HOA ablation treatment profile leads not only to the slimmest ablation depth over the cone and ablation volume, but, more importantly, it provides the lowest increase in ablation depth with enlargement of the OZ.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e841-e851"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ray-Tracing-Guided LASIK: Refractive and Visual Outcomes and the Role of Higher Order Aberrations in Visual Gain.","authors":"Renshen Shi, Wanghua Zhao, Liangyong Zhu","doi":"10.3928/1081597X-20260508-03","DOIUrl":"https://doi.org/10.3928/1081597X-20260508-03","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and efficacy of ray-tracing-guided laser in situ keratomileusis (LASIK) and to investigate the associations among visual line gain, higher order aberrations (HOAs), and manifest refraction spherical equivalent (MRSE).</p><p><strong>Methods: </strong>This retrospective study enrolled 285 eyes of 143 participants who underwent ray-tracing-guided LASIK, and measurements including visual acuity, manifest refraction, and whole-eye aberrations at a 6-mm diameter pupil, with examinations performed preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively.</p><p><strong>Results: </strong>At 3 months postoperatively, 93.7% of eyes achieved uncorrected distance visual acuity (UDVA) of 20/20 or better, and 62.8% of eyes gained one or more visual lines of UDVA compared with preoperative corrected distance visual acuity (CDVA) (right eye: 62.9%; left eye: 62.7%). MRSE, astigmatism, astigmatism vectors, and HOAs were effectively corrected and well controlled. As UDVA improved postoperatively, trefoil decreased significantly compared with the pre-operative level (<i>P</i> < .01); in addition, eyes gaining one or more visual lines showed greater trefoil reduction and lower residual trefoil than eyes that did not gain (both <i>P</i> < .001). Notably, trefoil metrics did not differ across baseline MRSE strata, although the proportion of eyes with visual line gain decreased with increasing baseline MRSE.</p><p><strong>Conclusions: </strong>Ray-tracing-guided LASIK showed favorable safety, efficacy, predictability, and accuracy. Effective trefoil correction with low residual trefoil may be associated with visual line gain, and this association appears to be unaffected by the baseline MRSE distribution.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e804-e814"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biometry-Guided IOL Formula Selection in Post-Laser Vision Correction Eyes.","authors":"David L Cooke, Jascha A Wendelstein, Kamran M Riaz","doi":"10.3928/1081597X-20260629-02","DOIUrl":"https://doi.org/10.3928/1081597X-20260629-02","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether objective biometry can guide intraocular lens formula selection in post-laser vision correction (LVC) eyes with indeterminate classification of actual LVC type (total keratometry [TK] TK_ave - keratometry [K] K_ave = 0.00 to 0.06), and to compare refractive accuracy among contemporary LVC formula strategies.</p><p><strong>Methods: </strong>A total of 507 post-LVC eyes (inclusive of both myopic [M-LVC] and hyperopic [H-LVC] eyes) with TK_ave - K_ave between 0.00 and 0.06 measured by swept-source optical coherence tomography biometry (IOLMaster 700; Carl Zeiss Meditec AG) were analyzed. Refractive prediction errors were calculated for 22 formulas, including eight H-LVC, eight M-LVC, and six non-LVC formulas. Formula performance was assessed using root mean square error rankings and heteroscedasticity testing for dependent data. The main outcome measure was refractive prediction error and proportion of eyes within ±0.50 diopters (D) of target refraction.</p><p><strong>Results: </strong>H-LVC formulas demonstrated superior refractive accuracy across all eyes, regardless of reported LVC type. Pearl DGS and Barrett True K No-History (H-LVC) achieved the highest proportion of eyes (approximately two-thirds) within ±0.50 D of target. K-based H-LVC formulas outperformed variants incorporating posterior K or TK. Standard formulas showed intermediate performance, whereas M-LVC formulas ranked lowest. Differences between top-performing formulas were statistically significant.</p><p><strong>Conclusions: </strong>In post-LVC eyes with TK_ave - K_ave between 0.00 and 0.06, H-LVC formulas provide the most accurate refractive outcomes, independent of reported treatment type. These findings challenge reliance on historical LVC classification for formula selection and support a measurement-driven approach in which biometry-guided formula selection improves outcomes when history is unreliable in ambiguous post-LVC eyes.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e815-e823"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal and Geographic Patterns of Public Interest in Refractive Surgery in the United States: A 10-Year Google Trends Analysis of LASIK, PRK, SMILE, and ICL Implantation (2015 to 2025).","authors":"Nicholas F Fazio, Mina M Sitto, David Szanto, Emily R White, Phillip C Hoopes, Majid Moshirfar","doi":"10.3928/1081597X-20260604-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260604-01","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze trends and correlations in online public interest regarding four refractive procedures: laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and Implantable Collamer Lens (ICL) (STAAR Surgical) implantation.</p><p><strong>Methods: </strong>Monthly relative search volume (RSV) from Google Trends (Alphabet Inc) for terms \"LASIK surgery,\" \"SMILE surgery,\" \"PRK surgery,\" and \"ICL surgery\" was collected in the United States from January 1, 2015 to October 1, 2025.</p><p><strong>Results: </strong>\"LASIK surgery\" showed significantly greater search interest than PRK (10.3×), SMILE (14.8×), and ICL implantation (32.3×) (<i>P</i> < .001). Over the 10-year period, LASIK and PRK showed no significant changes in public interest (<i>P</i> > .05), whereas SMILE (<i>r</i> = 0.86) and ICL implantation (<i>r</i> = 0.81) demonstrated significant upward trends (both <i>P</i> < .001). However, subanalysis of the post-coronavirus disease 2019 period (March 2020 to October 2025) revealed a significant decline in LASIK search interest (<i>r</i> = -0.55; <i>P</i> < .001), whereas SMILE (<i>r</i> = 0.74) and ICL implantation (<i>r</i> = 0.84) continued to rise. PRK remained unchanged during this period. Search interest was strongly correlated between SMILE and ICL implantation (<i>r</i> = 0.80) and between PRK and LASIK (<i>r</i> = 0.59). Regionally, LASIK showed the highest RSV across most states, particularly above the national mean in the Midwest (Wisconsin and Iowa; <i>z</i> = 1.35) and the Northeast. Higher search interest was observed for PRK in Hawaii (<i>z</i> = 3.59), SMILE in Maryland (<i>z</i> = 3.12), and ICL implantation in Utah (<i>z</i> = 5.06).</p><p><strong>Conclusions: </strong>Despite LASIK's widespread popularity, search interest in SMILE and ICL implantation has increased during the past decade. Google Trends may be an effective tool for assessing shifting interest in refractive surgery modalities.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 8","pages":"e824-e831"},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes of the Flanged Scleral Fixation Technique.","authors":"Biana Dubinsky-Pertzov, Ori S Mahler, Idan Hecht, Asaf Shemer, Michael Ostrovsky, Avner Belkin, Eran Pras, Adi Einan-Lifshitz","doi":"10.3928/1081597X-20260504-05","DOIUrl":"https://doi.org/10.3928/1081597X-20260504-05","url":null,"abstract":"<p><strong>Purpose: </strong>To report long-term safety and efficacy of the flanged scleral fixation technique.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a single tertiary medical center. Patients who underwent 7-0 polypropylene flanged scleral fixation between 2019 and 2022 and had at least 24 months of follow-up were included. The primary outcome was postoperative complication rate. Secondary outcomes included postoperative uncorrected and corrected distance visual acuity and refraction.</p><p><strong>Results: </strong>Eighty-nine eyes of 89 patients were included in the analysis. The mean age was 77.83 ± 9.33 years and 51 (57%) were male. In 45 eyes (50%) a subluxated IOL was repositioned and fixated, in 28 eyes (31%) the IOL was exchanged and a new IOL was fixated, and in 16 eyes (18%) secondary IOL implantation and fixation were performed in aphakic eyes with lack of capsular support. The mean follow-up time was 34.49 ± 10.19 months. Loss of intraocular pressure control requiring hypotensive medication and/or glaucoma intervention occurred in 12 patients (13.5%) and corneal pseudophakic bullous keratopathy occurred in 3 patients (3%) who later underwent posterior lamellar corneal transplantation. In 2 patients (2%) a second surgery was required to re-fixate the re-subluxated IOL due to intraocular slippage of one of the flanges.</p><p><strong>Conclusions: </strong>Flanged scleral fixation showed acceptable long-term anatomical and visual outcomes in this complex cohort. These findings should be interpreted cautiously given the lack of endothelial cell data and the observed postoperative intraocular pressure-related and corneal complications. Further prospective comparative studies with endothelial assessment are needed.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 7","pages":"e695-e700"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a More Rigorous Definition of Customized Corneal Cross-Linking.","authors":"Ciro Caruso, Gaetano Barbaro","doi":"10.3928/1081597X-20260618-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260618-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 7","pages":"e745"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corneal Asphericity Preservation via Spatially Selective Peripheral Stromal Volume Ablation Following Ray-tracing-Guided LASIK.","authors":"Bo Zhao, Bo Yuan, Yutong Liu, Xuzhao Guo, Jingwen Chai, Huiqin Zhang, Yanjia Li, Qian Zhang, Xuefei Yang, Tong Wang, Weijie Jiang, Fengju Zhang, Xia Hua","doi":"10.3928/1081597X-20260415-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260415-01","url":null,"abstract":"<p><strong>Purpose: </strong>To quantitatively appraise postoperative visual quality and to delineate the spatial corneal morphological changes occurring within the central and pericentral optical zones subsequent to ray-tracing-guided laser in situ keratomileusis (RTLASIK) compared to Q-value-guided LASIK (Q-LASIK).</p><p><strong>Methods: </strong>Sixty eyes from 60 patients were enrolled: 30 eyes in the RT-LASIK group and 30 eyes in the Q-LASIK group with a mean preoperative spherical equivalent of -5.029 ± 1.532 diopters (D) versus -5.279 ± 1.779 D. The cornea was partitioned into three vertex-centered concentric regions: a central 0- to 3-mm optical zone, a paracentral 3- to 5-mm annulus, and a pericentral 5- to 7-mm annulus. The corneal ablation ratio (CAR) was calculated as the quotient of the preoperative-to-postoperative reduction in either corneal thickness (tCAR) or stromal volume (vCAR) divided by the absolute value of the preoperative SE.</p><p><strong>Results: </strong>Relative to the Q-LASIK group, the RT-LASIK group exhibited significantly superior uncorrected distance visual acuity, spherical equivalent, and 3-mm Strehl ratio 3 months postoperatively. The vCAR within the same 3- to 5-mm zone was significantly elevated in the RT-LASIK group, whereas the tCAR did not differ between groups. Furthermore, RTLASIK was associated with a significantly attenuated postoperative change in Q-value within the 5-mm zone, a more pronounced reduction in spherical aberration across all of the optical zones.</p><p><strong>Conclusions: </strong>RT-LASIK conferred superior postoperative visual performance by conserving native corneal asphericity and effecting a significant reduction in spherical aberration across the entire optical zone. This optical advantage was mediated by a proportionally greater ablation of stromal volume within the paracentral 3- to 5-mm annulus.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 7","pages":"e635-e643"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: Toward a More Rigorous Definition of Customized Corneal Cross-Linking.","authors":"Jui-Hung Hsu, Tsung-Hsien Tsai, Tsai-Wei Lin","doi":"10.3928/1081597X-20260624-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260624-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 7","pages":"e746"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity-Graded Repeatability of AS-OCT Including Epithelial and Stromal Metrics in Patients With Keratoconus Versus Healthy Individuals.","authors":"Ramin Khoramnia, Tadas Naujokaitis, Maximilian Friedrich, Hyeck-Soo Son, Gerd U Auffarth, Victor A Augustin","doi":"10.3928/1081597X-20260504-03","DOIUrl":"https://doi.org/10.3928/1081597X-20260504-03","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the repeatability of corneal parameters measured by anterior segment optical coherence tomography (AS-OCT) in patients with keratoconus and healthy individuals.</p><p><strong>Methods: </strong>This monocentric cross-sectional study included 136 individuals in total: 95 patients with keratoconus and 41 healthy individuals. Three AS-OCT measurements were performed on the same day using the Anterion (Heidelberg Engineering). One eye per patient was randomly selected and repeatability coefficients (RCs) with two-sided 95% CIs were calculated for anterior and posterior keratometry, as well as corneal pachymetric, epithelial, and stromal parameters. The repeatability of measured parameters was compared between patients with keratoconus and healthy individuals and in different keratoconus severity groups using intra-subject variance.</p><p><strong>Results: </strong>The RC of maximum keratometry (Kmax) (two-sided 95% CI) was 0.33 diopters (D) (range: 0.29 to 0.39 D) in healthy eyes and 0.68 D (range: 0.62 to 0.76 D) in eyes with keratoconus. The RC of anterior Kmean was 0.19 D (range: 0.17 to 0.23 D) and 0.37 D (range: 0.33 to 0.41 D), the RC of anterior corneal astigmatism was 0.28 D (range: 0.24 to 0.33 D) and 0.43 D (range: 0.39 to 0.48 D), and the RC of minimum corneal thickness was 1.98 µm (range: 1.72 to 2.34 µm) and 2.15 µm (range: 1.96 to 2.39 µm) in healthy eyes and eyes with keratoconus, respectively. Patients with keratoconus had a lower measurement repeatability for most measured parameters, including Kmax (<i>P</i> < .001, Mann-Whitney <i>U</i> test, two-tailed) compared to the healthy individuals. Repeatability tended to worsen with increasing keratoconus severity.</p><p><strong>Conclusions: </strong>Although the AS-OCT demonstrated a high measurement repeatability in both healthy eyes and eyes with keratoconus, the repeatability of most evaluated parameters was slightly lower in patients with keratoconus and tended to worsen with increasing keratoconus severity.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 7","pages":"e677-e686"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fragile XXVI.","authors":"Rosana Martos Sitcha","doi":"10.3928/1081597X-20260611-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260611-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 7","pages":"e628"},"PeriodicalIF":2.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}