Lans lecture. Lamellar refractive surgery: where have we been and where are we going?

In summary, the greatest challenge for lamellar refractive surgery is in the treatment of myopia. There are and always will be patients who are satisfied with a partial correction of myopia. Many of these patients can be served quite adequately by currently available refractive techniques, but a technique in which level of accuracy is adequate for the treatment of myopia in general is not yet available. Lamellar refractive surgery--where have we been and where are we going? We have seen the evolution of the epikeratoplasty procedure for almost a decade and continue to see procedural changes which may increase the accuracy and stability of the procedure, such as alternative modalities for tissue preservation and alternative methods for surgical attachment. It remains potentially useful in several areas of refractive surgery, but its inaccuracy in the treatment of myopia remains a significant problem. Will the epithelial healing problems and postoperative care be too cumbersome for the general ophthalmologist? Will the excimer laser fill the needs of myopic refractive surgery? Personally, I do not feel that any biological lens, be it a cornea which has had incisions as with radial keratotomy, or a cornea which is remolded in one way or another as with the excimer laser, will produce predictable refractive results to the extent that is required to satisfy the general needs of the myopic population. Hydrogel keratophakia is in its infancy, but it holds the potential of being a far more accurate procedure because of the ability to interchange lenses to further refine the refractive result. Refractive surgery will in the next decade achieve a level of sophistication far greater than what we have seen to date. Lans could not have dreamed of the remarkable evolution in refractive surgical innovation in the past century. It is hoped that we will not have to wait that long to create a readily available solution to the problem of refractive surgery for myopia.