For the last 20 years controlled excimer laser ablation of corneal tissue, either directly from the corneal stromal surface or from the corneal interior after creation of a superficial corneal flap, has become widely used to correct myopia, hyperopia and astigmatism. Recently, an intrastromal refractive procedure whereby a tissue lenticule is cut free in the corneal stroma by a femtosecond laser and removed through a small peripheral incision has been introduced. The procedure avoids creation of a corneal flap and the potential associated risks while avoiding the slow visual recovery of surface ablation procedures. The all-femtosecond-based flap-free intracorneal refractive procedure has been documented to be a predictable, efficient and safe procedure for correction of myopia and astigmatism. Technological developments related to further improved cutting quality, hyperopic and individualised treatments are desirable.
There is now an increased recognition by clinicians that dry eye disease (DED) is a common disorder characterised by dryness and damage of the ocular surface. It affects quality of life, including aspects of physical, social and psychological functioning, because it induces ocular discomfort, burning sensation, light sensitivity, visual disturbances or even corneal erosions and infections. DED is also known as keratoconjunctivitis sicca, dry eye syndrome and dysfunctional tear syndrome.
Dry eye disease (DED) is a clinically significant multifactorial disorder of the ocular surface and tear film as it results in ocular discomfort and visual impairment and predisposes the cornea to infections. It is important for the quality of life and tends to be a chronic disease. It is also common, as the prevalence is estimated between 5 % to 30 % and this increases with age. Therefore, it is recognised as a growing public health problem that requires correct diagnosis and appropriate treatment. There are two main categories of DED: the deficiency of tear production (hyposecretive), which includes Sjögren syndrome, idiopathic or secondary to connective tissue diseases (e.g. rheumatoid arthritis), and non-Sjögren syndrome (e.g. age-related); and the tear evaporation category, where tears evaporate from the ocular surface too rapidly due to intrinsic causes (e.g. meibomian gland disease or eyelid aperture disorders) or extrinsic causes (e.g. vitamin A deficiency, contact lenses wear, ocular allergies). Management of the disease aims to enhance the corneal healing and reduce patient’s discomfort. This is based on improving the balance of tear production and evaporation by increasing the tear film volume (lubrication drops) and improving quality of tear film (ex omega-3 supplements, lid hygiene, tetracyclines), reducing the tear film evaporation (paraffin ointments, therapeutic contact lenses), reducing tear’s drainage (punctal plugs, cautery) and finally by settling down the ocular surface inflammation (steroids, cyclosporine, autologous serous), as appropriate. In this article we will review the clinical presentation, differential diagnosis and treatment options for DED.
Patient demand for spectacle independence is growing. The advances in laser and non-laser technology have allowed ophthalmologists to offer their patients the freedom to choose between depending on their glasses, or to go spectacle free. Presbyopia, defined as the age-related loss of the ability to clearly accommodate onto near objects, has become the last frontier for refractive vision correction.
Presbyopia remains the last frontier for refractive surgeons. With increased demand for spectacle independence at all ages, ophthalmologists are exploring different approaches for presbyopia correction. The idea of adding synthetic material to the cornea for the management of presbyopia has come a long way since its inception. The Raindrop® (ReVision Optics®), KAMRA™ Inlays (AcuFocus™) and the Flexivue Microlens™ (Presbia™) are three very different inlays that attempt to reverse presbyopia through different mechanisms. The Raindrop changes the curvature of the anterior cornea in the plane of the pupil, the Kamra uses the principle of the pinhole to increase depth of focus, while the Flexivue is a refractive annular add lenticule that creates a paracentral zone for near vision. The decreased incidence of complications, ease of insertion, reversibility and potential applicability to patients with various refractive statuses make inlays a powerful addition to the armamentarium in the management of presbyopia.
Since the introduction of ultrasound phacoemulsification in 1967, cataract surgery has become the most commonly performed outpatient operation in the US. While phacoemulsification has been shown safe and effective, application of ultrasound power within the eye does carry some risk of ocular injury, such as endothelial cell loss.