The term bioptics was suggested by Zaldivar in the late 1990s. It is used to describe the combination of 2 refractive procedures—1 intraocular and 1 corneal—to treat patients with refractive errors that are suboptimally treated with a single procedure. Examples include extreme myopia, high myopia or hyperopia with significant astigmatism, and MFIOL implantation in patients with significant astigmatism. In these cases, the intraocular procedure is performed first, with keratorefractive surgery performed after both anatomical and refractive stability are achieved, usually 1–3 months after the initial surgery.
Bioptics with LASIK or surface ablation are reasonable alternatives, depending on patient parameters. As new treatment options are developed, the possibilities for other combinations of refractive surgery will increase.
The ability to successfully combine refractive procedures further expands the limits of refractive surgery. The predictability, stability, and safety of LASIK increase when smaller refractive errors are treated. In addition, there is usually sufficient corneal tissue to maximize the treatment zone diameter without exceeding the limits of ablation depth. The LASIK procedure provides the feature of adjustability in the overall refractive operation. These benefits must be balanced against the combined risks of performing 2 surgical procedures rather than 1.
Alfonso JF, Fernández-Vega L, Montés-Micó R, Valcárcel B. Femtosecond laser for residual refractive error correction after refractive lens exchange with multifocal intraocular lens implantation. Am J Ophthalmol. 2008;146(2):244–250.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.