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Refractive surgery
  1. Birmingham and Midland Eye Centre, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QU

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    Refractive surgery, par excellence, isthe ophthalmic surgery of the end of the millennium. This type of surgery is performed mostly for non-sight threatening conditions; it frequently involves high technology such as lasers and computers; the great majority of this type of surgery is done in the developed world; patients have very high expectations of the surgery and want very detailed explanations about results and complications; and there is a burgeoning medicolegal industry linked to the outcome of refractive surgery.

    All these aspects of refractive surgery are starting to be echoed to a greater or lesser extent in many other areas of ophthalmic surgery. To give an example, the concept of detailed informed consent, and linked with it, the use of very lengthy and explicit consent forms, information leaflets, and educational videos are ideas which first appeared extensively in refractive surgery, but are now spreading to other areas of ophthalmology. So if we want to have a feel for the way ophthalmology is going to be going in the next millennium then we need look no further than refractive surgery today.


    Refractive surgery encompasses a range of surgical modalities which have the aim of changing the refractive state of the eye. The techniques effect this change through action on the cornea and/or crystalline lens, as these are the principal refracting components of the eye. The refractive problems that may be addressed by such surgery are myopia, hypermetropia, astigmatism, and presbyopia; sometimes a combination of these may need to be corrected. There is a very wide range of surgical modalities and this range is expanding all the time. The modalities include corneal incisions, corneal sutures, corneal laser ablation, corneal lamellar surgery combined with various ablation techniques, corneal thermal laser, corneal inlays, phakic intraocular implants (IOLs), and lens surgery usually combined with …

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