REFRACTIVE SURGERY IN THE NEW MILLENNIUM

As we stand at the threshold of a new millennium, perhaps nowhere else in the field of ophthalmology is there such a feeling of excitement, enthusiasm, and anticipation as in the subspecialty of refractive surgery. What was once considered an experimental hobby, dabbled in by a few rogue physicians, has now gained a level of respect among patients and ophthalmologists that has surprised even its most vocal critics. Much of this acceptance has come from advancements in science and technology that have increased the safety, accuracy, and predictability of altering the refractive error of the human eye. This technology continues to accelerate at an almost dizzying pace, providing new tools for the ophthalmologist to improve and enhance vision for the twenty-first–century patient. Once considered a subspecialty area of corneal surgery, refractive surgery now encompasses a much broader and dynamic definition. Ametropia is now correctable by using one of a myriad of surgical techniques in a variety of anatomical locations. Just as an artist has a palette, today's refractive surgeon has an array of procedures from which to chose, each one tailored to the specific requirements of an individual patient. One can only imagine the possibilities for the refractive surgeon of tomorrow. Rather than discussing current refractive surgical procedures in depth, which can be found in any number of excellent textbooks, this article attempts to peer into the future using present knowledge as a platform for the new millennium. Where we have been will help to illuminate the path of where we are going. The discussion begins anatomically, looking at current, future, and theoretic ways of correcting refractive error in the human eye.