The Truth about Wavefront Supervision

The so-called "Holy Grail" of refractive surgery is to give patients better vision than they had with glasses or contact lenses. Many patients with complications believe that they have been used as experimental animals toward this end. In spite of the marketing hype, there are substantial barriers to achieving "wavefront supervision."

34 Challenges for Excimer Laser Technology to Achieve Super-Vision

    Ocular challenges

  • Changes in wavefront with age
  • Changes in wavefront during accommodation
  • Effect of pupil size on higher-order aberrations
  • Biomechanical differences among corneas before surgery
  • LASIK flap biomechanics
  • Changes in tear film
  • Changes in corneal thickness after laser surgery
  • Changes of wavefront during cycloplegia
  • Variation of ablation rate in the different depths of the cornea
  • Variation in corneal thickness in different meridians
    Uncontrolled optical changes during the healing process

  • Corneal epithelium wound healing
  • Corneal collagen wound healing
  • Effect of corneal biomechanics after surgery
    Technological limitations of surgical equipment

  • Eye positioning during preop measurement and laser treatment
  • Accuracy of laser ablation
  • Microkeratome accuracy and profile
  • Tracking the location of the laser beam
  • Decentration
  • Accuracy of wavefront sensors
  • Computer programs for the laser
  • Accuracy of the laser
  • Consistency of one laser
  • Chromatic aberrations not detected by aberrometers
  • Location and shape of wavefront measurement
  • Possible cortical, neural impact on vision
    Uncontrollable surgeon variables
  • Dryness of the ablation surface
  • Environmental issues during surgery
  • Retinal problems of aberration-free optics
  • Possible worsening of visual performance with inaccurate surgery
  • Effect of enhancement procedures on the wavefront
  • Positioning of the flap after ablation
  • Flap edema after ablation
  • Ill fit of curvature of flap and bed after ablation
  • Irreversible procedure
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