Hyperopia and Presbyopia PDF

Preface

With the explosion of refractive surgical technologies and techniques we have witnessed increased success in the treatment of hyperopia, but we still stand restrained in our ability to free our patients from presbyopic spectacles. We eagerly await the moment of overcoming the seemingly insurmountable obstacles of presbyopic correction to echo Bru¨nhilde's greetings of the sun and of the light in the third act of Wagner's opera Siegfried.

Siegfried forged "Nothung," the famous sword that could be forged only by a man who did not know fear, and used it to slay the dragon Fafner (and recover the magical Ring and Tarnhelm). He defied the gods and entered Loge's impenetrable circle of flames to rescue the sleeping Bru¨nhilde.

We are on the verge of facing a similar success story in refractive surgery. Many unsung heroes are paving the way for the next discovery that will change the way we treat hyperopia and revolutionize the surgical correction of presbyopia. The wide range of investigations covered in this book indicates that it will not be long before we will be able to fulfill our quest to conquer these two frontiers in refractive surgery.

This book is the second of a series of books dedicated to refractive surgery published by Marcel Dekker, Inc. The focus of the first volume in this series was LASIK fundamentals, surgical techniques, and complications, a topic that has received a lot of coverage in both the peer- and non-peer-reviewed literature. For this book, we asked Drs. Tsubota and Boxer Wachler to edit the manuscripts, and they have worked diligently with the contributors to ensure maximal coverage and minimal redundancy.

It may come as no surprise to the reader that the methods of treatment of hyperopia and presbyopia are grouped in a single refractive surgical textbook. The classical teachings of physiological optics separate these two areas, but many of the surgical techniques employed for the correction of hyperopia may have applications for presbyopia.

The introductory section is written by experts in the fields of basic optics, mechanisms of accommodation, aging of the lens, and contact lens basics. Among topics discussed in the section on hyperopia are LASIK and PRK for hyperopia and hyperopic astigmatism, laser thermokeratoplasty, conductive keratoplasty, hyperopic intracorneal segments, phakic IOLs. The section on presbyopia includes discussions of monovision refractive surgery, multifocal corneal approach, scleral relaxation, scleral expansion bands, multifocal IOLs, refractive lens exchange with a multifocal intraocular lens, Phaco-Erstaz, and accommodating and adjustable IOLs. The topographical changes, corneal surface profiles, wavefront contrast sensitivity changes, and wound healing after hyperopic surgery are discussed in a separate section with special emphasis on clinical applications. The contributors draw on first-hand experiences with the aim of providing an engaging book covering these important topics.

We are indebted to the coeditors, students, residents, and colleagues who have made valuable contributions to this book. We are grateful for their effort in integrating the sometimes limited information in peer-reviewed literature with the knowledge derived from their clinical experiences and interactions with colleagues. We hope that this provides a text that is both clinically relevant and as evidence-based as possible.

We thank Dr. Geoffrey Greenwood and Elizabeth Curione of Marcel Dekker, Inc., for their commitment to this project. Special thanks go to Leona Greenhill, for her editorial assistance, and to Rhonda Harris, who managed this project with care and precision. Her attention to detail and her dedication have enabled us to work coherently in the face of adversity.

We take the opportunity to acknowledge the pioneering surgeons and researchers in the field of refractive surgery. Their work and vision have provided the basis not only for current advances in hyperopia and presbyopia that we can offer to our patients, but also for future advances to be made by the next generation of thoughtful contributors to this important field.