Laser-based Refractive Surgery: A Review of Select Clinical Challenges and Future Directions

Advances in laser-based corneal refractive surgery have allowed for a diverse array of surgical options available to patients seeking vision correction and contact lens/glasses-free independence. The most common laser-based corneal refractive surgeries include laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE). Although advancements in technology have been made, select clinical challenges such as higher-order aberrations, postoperative ectasia, diffuse lamellar keratitis (DLK)/central toxic keratopathy (CTK), and pressure-induced interlamellar stromal keratitis (PISK) remain as postrefractive issues to be addressed in laser-based corneal refractive surgery. Recent improvements in preoperative evaluation, the development of instrumentation to measure and treat higher-order optical aberrations, and new techniques for the treatment of presbyopia all serve as unique avenues for innovation in the field. Despite its many advances, laser-based corneal refractive surgery has specific clinical limitations that may be better addressed through lens-based refractive techniques.