Trends in Refractive Surgery and in Presbyopia Correction

The LASIK market will continue to be flat in 2015, as there is no earth-shaking development on the horizon in the world of excimer lasers. Machines may become faster and algorithms more refined, but no new innovations are expected. Additionally, although more buzz and data on ReLEx small incision lenticule extraction (SMILE) will surface, the procedure will continue to be nice to have in one’s repertoire, but not yet a must-have. I believe that LASIK will remain the go-to treatment in the majority of centers next year because of its fast visual recovery, the wide range of refractive powers it can correct, its ability to be enhanced, and its cost to patients. Another area in which there will be continued interest is presbyopia solutions. The Kamra inlay (AcuFocus) is on the brink of FDA approval; this approval will pave the way for the other corneal inlays, which will be used most often for presbyopia treatment in near-emmetropes. In patients with refractive errors, there are not enough data and experience for a combined excimer-inlay approach to be viable. Excimer-based presbyopia algorithms will continue to be refined and improved; however, the uptake will be minimal, because, just as with SMILE, these novel procedures are brand-specific. Surgeons who do not have the right laser for a proprietary treatment would be hard-pressed to justify acquiring an expensive machine if the market is not clearly going in that particular direction. In terms of presbyopia-correcting IOLs, trifocals will continue to eat into the market share of bifocal multifocal IOLs. I do not see a downside of trifocals compared with bifocal multifocals, but the potential upside of better intermediate vision will be further established next year. Presbyopia correction has traditionally been performed in three locations: on the cornea (excimer-based), in the cornea (inlays), and in the lens capsule (IOLs). But a fourth location, in the sulcus (phakic IOLs), will emerge. A phakic IOL with presbyopia-correcting abilities will excite the market. In terms of principles for presbyopia correction, the most common method—multifocality with either IOLs or excimer-based treatments—will continue to thrive in 2015. However, two new buzzwords that will be trending for presbyopia are enhanced depth of focus (EDOF) and extended range of vision (EROV). The Symfony (Abbott Medical Optics), WIOL (Medicem), and IC-8 small-aperture (AcuFocus) IOLs will champion these new concepts. While the near-vision gain may not be as strong as with multifocal options, what makes EDOF and EROV lenses attractive is that they reduce unwanted photic phenomena (glare and halos) and, to some extent, diminish the decrease in contrast sensitivity that has been a thorn in the side of multifocality. As EDOF and EROV options continue to emerge, the principle of mini-monovision will become more acceptable. So far, this is what my crystal ball is showing me. It looks like 2015 will be another exciting year. Let us keep our eyes and ears open.