Fulfilling the promise of laser refractive surgery.
OBJECTIVE
To review the characteristics required to perform accurate and precise laser refractive surgery relative to the current state of the art and the technology improvements needed in the future.


METHODS
The general characteristics for laser refractive surgery are identified and their relative contributions to a successful result considered. For each characteristic, the degree to which improvements in technology are likely to improve results is discussed.


RESULTS
The environment (surgeon, site), technology (laser, aberrometer), and patient are identified as key factors affecting results. Although aberrometers appear to be clinically sufficient, improvements in laser beam characteristics and delivery should improve system consistency. Current registration technology may be a factor in variability from patient to patient, but the greatest contribution in this regard would appear to be patient biomechanical and healing response factors.


CONCLUSIONS
Wavefront-guided laser refractive surgery has demonstrated an ability to be better than conventional surgery. Improvements in laser technology, registration technology, and biomechanical diagnostics are expected to further improve results. These potential improvements are expected to reduce variability and suggest that the final potential of this technology has not yet been realized.
Lawless
Michael A
MA
The Eye Institute, Chatswood, NSW, Northern Sydney Area Health Service, Australia. mlawless@theeyeinstitute.com.au
Potvin
Richard J
RJ
D003315:Cornea / Q000503:physiopathology; D048988:Corneal Surgery, Laser; D004777:Environment; D006801:Humans; D011379:Prognosis; D012030:Refractive Errors / Q000503:physiopathology; D054140:Refractive Surgical Procedures; D015203:Reproducibility of Results; D014792:Visual Acuity / Q000502:physiology