BBI Contributing Editor
NEW ORLEANS, Louisiana — Attendees of the Wavefront and Emerging Refractive Technologies Symposium held during the annual meeting of the New Orleans Academy of Ophthalmology earlier this year may have walked away feeling the industry is over-hyping the imminent widespread use of wavefront technology. However, few would question the potential benefits.
"Wavefront is becoming a reality," said symposium presenter Stephen Slade, MD, an ophthalmologist in private practice in Houston, Texas, and national co-medical director for TLC/LVCI laser centers. All the study results "are better than the printed standard results accompanying the laser. This is pretty encouraging for a new technology," Slade said. However, "I believe we need to be cautious before we speculate as to just how good this technology will be. It's better than what we've had before, but in some cases only a little better. And some patients don't have any aberrations."
Slade said the concept of wavefront would inspire practitioners to evaluate a host of technologies. "We not only have this technology to drive the laser. The same technology is also diagnosing eyes. It is a new way to evaluate the effects of our own surgery," he noted. Hartmann-Shack appears to be the standard technology, but the Tracey Visual Function Analyzer from Tracey Technologies (Houston, Texas) "seems to be able to work on a wider range of eyes," Slade observed. On the other hand, "corneal topography may become more important in patients who have already had surgery." Based on expensive investment in complex and improved technology, Slade said he hopes that practitioners "will charge for wavefront what it's worth," unlike the deep discounts currently seen with LASIK surgery.
Ronald Krueger, MD, medical director of refractive surgery at the Cleveland Clinic Foundation (Cleveland, Ohio), was another symposium speaker. "The wavefront devices are practical tools that will be an adjunct to a refractive surgery practice," he said. "Just like corneal topography was questioned when first introduced, it is now an essential item. Wavefront will likely evolve to that point as well, where if you don't have one you are not practicing the standard of care." Still, Krueger acknowledges the element of hype. "I think the real hype comes from the concept that wavefront is going to provide this panacea of customized laser treatment. This hype has to be tempered slightly because we are not there yet, despite spending the majority of our time at refractive surgery meetings talking about wavefront. The results are quite good, but they are not perfect in every instance. And the results are very promising, which is why everyone is so excited," he said.
Physicians will have a more balanced view if they consider wavefront first as a diagnostic adjunct to a practice. "The best way to understand the technology is to get right in there and test patients' eyes," Krueger said. As for vying technologies, "it's too early to say that one is going to be substantially better than another. Hartmann-Shack has been shown to be very reproducible, while the accuracy of ray tracing may not be better," he added. "But with ray tracing you can selectively sample an area of greater concern. Whether that's a realistic advantage, though, has yet to be determined."
"Although there is a lot of hype about wavefront, I think ultimately clinicians will want to learn about this method and embrace it," said David Williams, PhD, the William G. Allyn professor of medical optics at the University of Rochester (Rochester, New York). "Wavefront will enhance practices because surgeons will be able to achieve ultimately — not immediately — better outcomes on average. The number of aberrations in eyes will be reduced." This is in contrast to how laser refractive surgery is practiced today, "where higher order aberrations are introduced which cannot be corrected by optics," he said.
Williams, director of the Center for Visual Sciences at the university, presented the basics of wavefront at the New Orleans symposium. "I predict that eventually wavefront technology will be standard of care for many things, including the way to refract the eye for glasses and contact lenses." His research has centered on coupling wavefront with a deformable (flexible) mirror that can be shaped to correct the specific pattern of aberrations.
According to Steven Schallhorn, MD, director of corneal and refractive surgery at the Naval Medical Center (San Diego, California), "more work is needed" on wavefront. "We need to understand much more about the optics of the eye; for example, higher order aberrations." He said more studies are needed as to how higher aberrations affect visual performance. "The only way we can quantify the optics of the eye is through standard spherical lenses and cylinder lenses," he said. "Wavefront . . . is an untapped vista of new information, especially for patients with significant aberrations." As for those patients seeking "super vision, the effect of wavefront-guided LASIK or wavefront-guided refractive surgery remains to be seen. But it is a promising thought." Schallhorn said wavefront may not generate much income for practices, "but those practices that do not have it will probably be at an economic disadvantage."