By Christopher J. Rapuano, MD
This part underwent significant revision for the 2008-2009 edition.Reviews the underlying options in refractive surgical procedure, together with its clinical foundation, the position of the FDA, and sufferer review. particular strategies are mentioned intimately, and using refractive surgical procedure to regard presbyopia is tested. a brand new bankruptcy discusses overseas views.
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Extra resources for 2008-2009 Basic and Clinical Science Course: Section 13: Refractive Surgery
A point on the retina acts as a point source, and the reflected light is then propagated back through the optics of the eye. In a perfect eye, all the rays would emerge in parallel and the wavefront would be a flat plane. In reality, the wavefront is not flat. An array of lenses samples parts of the wavefront and focuses light on a detector (Fig 1-6). The wavefront shape can be determined from the position of the focus on each detector. CHAPTER 1: The Science of Refractive Surgery. 15 Retinal pointsource Reflected wavefront t Lenslet array Laser Figure '-6 Schematic of a Hartmann-Shack wavefront sensor.
Our understanding of corneal wound healing has advanced tremendously with recognition of the multiple factors involved in the cascade of events initiated by corneal wounding. The cascade is somewhat dependent on the nature of the injury. Injury to the epithelium can lead to loss of underlying keratocytes from apoptosis. The remaining keratocytes respond by generating new glycosaminoglycans and collagen, to a degree dependent on the duration of the epithelial defect and the depth of the stromal injury.
It,- Figure '-8 Laboratories) Representation of astigmatism using Zernike polynomials. (Used with permission. Alcon CHAPTER 1: The Science of Refractive z Surgery. 17 H V - PE ZR V H M I .. Figure 1-9 Representation - U H of vertical P HUM V D V . I 1 prism using Zernike polynomials. (Used with permission, Alcon Laboratories.! Higher-Order Aberrations Wavefront aberration is a function of pupil size, with increased higher-order aberrations seen as the pupil dilates. Higher-order aberrations also increase with age, although the clinical effect is thought to be balanced by the increasing miosis of the pupil with age.