However, with laser refractive surgery already achieving excellent clinical outcomes, it is often difficult to demonstrate that these newer procedures are superior to the established techniques. Novel refractive surgical implants have also been introduced, ranging from intracorneal to intraocular implants. Developments in femtosecond laser technology has led to the improvement of laser in situ keratomileusis (LASIK) and the birth of refractive lenticule extraction. Today, refractive surgery has evolved beyond the stereotypical ‘laser eye surgery’.
The US FDA run Patient-Reported Outcomes with laser in situ keratomileusis showed that, on average, 95% of patients were satisfied with their treatment.
Laser refractive surgery is recognized as an extremely effective and safe procedure for low to moderate levels of refractive error, with more than 99.5% achieving spectacle independence. It is now recognized that refractive surgery has signficant impact on quality of life and daily work, with benefits extending beyond spectacle independence. ‘Refractive surgery’ encompasses any procedure that corrects refractive error, one of the leading causes of reversible visual impairment in the world. In this review, we also discuss possible developments in refractive surgery beyond 2020, such as preoperative evaluation of refractive patients using machine learning and artificial intelligence, potential use of stromal lenticules harvested from SMILE for presbyopic treatments, and various advances in intraocular lens implants that may provide a closer to ‘physiological correction’ of refractive errors. With the improved safety and efficacy of refractive lens exchange, a wider variety of intraocular lens implants with advanced optics provide more options for refractive correction in carefully selected patients. Presbyopic treatment options have also expanded to include new ablation profiles, intracorneal implants, and phakic intraocular implants. New keratorefractive techniques such as small incision lenticule extraction (SMILE) avoids corneal flap creation and uses a single laser device, while advances in surface ablation techniques have seen a resurgence in its popularity. Today, refractive surgery has evolved beyond the traditional laser refractive surgery, embodied by the popular laser in situ keratomileusis or ‘LASIK’. Refractive surgery refers to any procedure that corrects or minimizes refractive errors.
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