e-book Cataract and Refractive Surgery. Essentials in Ophthalmology

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Bonnie An Henderson, MD. It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. Find a Doctor Request an Appointment. Image Caption. Page Content. Waltham, MA Phone: Fax: Office Contacts. Practice Coordinator: Jennifer Schneider.

OCB utilizes a secure portal called Patient Gateway for prescription refills. About OCB. In fact, it would be the only alternative before the advent of technology that enables us to perform refractive procedures therapeutic presenting unquestionably as a less invasive alternative for visual rehabilitation.


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Several procedures originally described as refractive may also be indicated for therapeutic purposes. The implant of ring segments for intra-corneal keratoconus was originally described for refractive treatments. Moreover, treatment for promoting stromal covalent bonds in collagen crosslinking emerged in research center Refractive Surgery, purely as a therapeutic procedure to stabilize the progression of ectasia.

Cataract and Refractive Surgery

For example, a patient with anterior stromal opacity associated with irregular astigmatism due to dystrophy or scarring after keratitis may benefit from surface ablation therapy. In this case, besides the application of the excimer laser on PTK mode Phototherapeutic keratectomy , the customized ablation mode PRK Photorefractive keratectomy based on total or corneal wavefront followed by application on mitomycin C is used quite similarly to elective advanced surface ablation treatments laser vision correction.

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However, the goals of advanced surface ablation in both situations are very different, as the outcome measures and success. In therapeutic procedures, the goal is to provide good corrected vision with sphere-cylindrical refraction glasses for the patient. Thus the measure of success is related with improvement of visual acuity.

In these cases, the refractive goal is secondary. In refractive surgery, the goal is to reduce ametropia to provide adequate uncorrected vision and less dependence on glasses or contact lenses.

Refractive surgery

Thus, the uncorrected visual acuity is the primary variable that represents the effectiveness and the benefit from surgery. However, the comparison of visual acuity with correction before and after surgery has always been related to the safety of any eye surgery.

Refractive surgery: LASIK laser eye surgery vs. lens surgery

While refractive surgery is essentially optional, there are special situations in which its indication has a greater need. For example, a patient with anisometropia and intolerance to contact lenses may not have satisfactory correction with glasses, and in these cases we can even consider surgery as therapeutic.

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Additionally, other situations may be related to activities that the patient has, such as athletes and military. A case with therapeutic indication may, with the evolution of the initial treatment, become refractive.

For example, a patient with keratoconus is operated with implantation of corneal ring segments with marked improvement of visual acuity with glasses to correct high myopia. In this scenario, the phakic intraocular lens implantation may be considered for the treatment of low-order aberrations - as in Bioptics Therapeutic approach R.


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  • The need and indication of such refractive treatments should be considered according to each case. Another aspect of capital importance is related to the confusion between cosmetic surgery and elective refractive surgery. In general, all cosmetic surgeries are optional. However, refractive surgical correction does not, in any way, have an esthetic nature. The procedure is functional because ametropia reduces the ability of the patient to function on simple daily tasks.

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    Therefore, it is essential to distinguish refractive surgery with the goal of refractive corrections and therapeutic surgery. While elective refractive surgery aims to reduce dependence on vision correction spectacles or contact lenses , the therapeutic aims for restoring vision, with a refractive secondary objective. The term elective could also be used to designate a non-urgent or other emergency procedure. Thereby, all surgery that can be planned without urgency is properly designated as an elective. In this context the therapy is essentially an elective surgery, with exception to special cases in which there is an associated risk of progression with sequels.

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    However, the fundamental differentiation between the refractive surgery for therapeutic purposes is related to the preoperative status in which corrected visual acuity is not suitable with glasses or contact lenses due to high levels of higher order aberrations. The implications of the distinction should be considered for clinical and medico-legal standpoints.

    Rev Bras Oftalmol. Advanced technology intraocular lasers IOLs in cataract surgery. Int Ophthalmol Clin. Rosen E.