In this first of a two-part series, Arun C. Gulani, MD, MS, explains how approaching keratoconus as a refractive surgery will change the way both ophthalmologists and patients will approach this condition to bring in a new era of not only relieving but also enhancing the lifestyle of this patient population. In Part 2, Dr. Gulani will share strategies and cases of patients with keratoconus with different case scenarios in action.
A U.S. patent was granted to Gholam A. Peyman, MD, in June 1989 for a method of modifying the corneal curvature of the eye. The surgical procedure involved cutting a flap in the cornea, pulling the flap back to expose the corneal bed, ablating the exposed surface and then replacing the flap. The current procedure of laser assisted in-situ keratomileusis (LASIK) was not FDA approved until 1999.
The femtosecond laser has brought many significant advances to eye surgery. For more than a decade, it has been used to create lamellar corneal flaps for laser in situ keratomileusis (LASIK), and more recently this laser is used to precisely perform several steps in cataract surgery.
After much anticipation and a long wait for both clinicians and patients in need, the U.S. Food and Drug Administration (FDA) approved corneal cross-linking (CXL) in mid April. This procedure is globally considered the only method of halting the progressive family of diseases called corneal ectasias, including keratoconus.
In a recent wave of drug price increases that can only be explained by pharmaceutical manufacturers’ desire for profit maximization and which doctors and patients may call price gouging, the drug price war has been brought to the doorsteps of many eyecare providers. As optometrists are increasing their practice of medical optometry, patients are now calling their doctors about prior authorizations and unaffordable drug copays.
Cataract surgery is one of the most successful surgeries performed in the United States. By 2020, it is estimated the number of people having cataract surgery will double, and by 2030 it will triple. The optometrist’s role in comanaging these patients will be of critical importance. Developing and maintaining your post-operative clinical care skills is imperative.