Corneal Biomechanics and Refractive Surgery

Refractive surgeons can now perform a highly precise workup prior to surgery—and thanks to developments such as wavefront technology, they can deliver highly precise treatment. But how can the preoperative testing and treatment be better linked?

“We aren’t able to leverage patient-specific structural features; we don’t have nomograms for new treatments, combined treatments, or retreatments; and we aren’t leveraging ‘big data,’” said William J. Dupps, MD, PhD, in his keynote speech at the Refractive Surgery Subspecialty Day on Friday.

Dr. Dupps expects continuing research on corneal biomechanics—particularly the advent of computational models—to fill in those gaps. “Simulation-based engineering science, propelled by advances in imaging and computing, enables in silico hypothesis testing, treatment simulation, novel treatment design, and personalized treatment and risk assessment,” he said. And the cornea is an “ideal target” for simulation-based medicine, he added.

Simulation-based medicine—including virtual individual trials—opens the door to a number of clinical advances that are both highly personalized and exceptionally precise, such as the ability to perform case-specific modifications of cross-linking treatment patterns for keratoconus, Dr. Dupps noted.

The eventual goal is a preoperative treatment simulation platform, Dr. Dupps said. Such a platform would 1) enhance preoperative screening by quantifying risk on a structural continuum, thus leading to safer surgery, and 2) allow virtual prediction of mechanical and optical outcomes, leading to optimized and more predictable results. Moreover, it would fill in the precision gap in keratorefractive surgery planning and provide rich data sets for screening and treatment paradigms.—Jean Shaw

Financial disclosures. Dr. Dupps—Avedro: C,S; Carl Zeiss: S; Cleveland Clinic Innovations: P; National Eye Institute: S; Ziemer: C.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.