Adaptive Optics for Vision Science

Chapter 12 - Customized Corneal Ablation

12.1   INTRODUCTION

Laser refractive surgery has evolved rapidly from the first treatments, which
were done in blind eyes by Seiler in 1985 [1] and then on sighted eyes in 1987
using photorefractive keratectomy, or PRK [2]. In 1990, Pallikaris combined
the lamellar splitting of the corneal stroma with the treatment of an excimer
laser, which formed the basis of modern-day laser in situ keratomileusis
(LASIK) surgery [3]. Since then, the field of refractive surgery has advanced
quickly and millions of patients worldwide have benefited from its use.

The incorporation of scanning spot lasers to create smoother and more
subtle ablations and the use of eye trackers to compensate precisely for eye
movements when delivering treatment have contributed to the refinement of
laser refractive surgery. These refinements have improved the delivery system
of excimer ablations, but the basic diagnostic and treatment inputs driving the
ablation process have remained relatively unchanged. The treatment patterns
were driven by the manifest and cycloplegic refractions, which are subjective
measurements that rely on the patient’s subjective assessment. The incorporation
of wavefront technology into refractive surgery has signaled an important
transition from the use of subjective methods of measuring and treating
refractive error to objective methods of vision correction. This chapter will
give a brief practical overview of refractive surgical ablation and wave-front
-guided treatments.

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