Pumping Up Your Refractive Prowess
Wavefront technology reveals there's more to refraction than meets the phoroptor.
By Paul S. Koch, M.D., Warwick, R.I.

As ophthalmologists, we've spent our careers defining vision as nearsighted, farsighted or astigmatic. We refract patients, prescribe eyeglasses and contact lenses or recommend surgery according to these three categories. But wavefront technology has taught us there are more than these three types of optical aberrations -- probably as many as 30 or 40.

The challenge we now face is incorporating our new knowledge into our practices. We're all familiar with the role of wavefront technology in custom ablation, but how can we use this technology to improve our diagnostic skills?

For example, now we may be able to explain the syndrome of the "bag o' eyeglasses" wherein a patient arrives with a dozen pairs, none of which work. Their problem, we now know, is that eyeglasses correct only lower-order aberrations. Perhaps these people should preferentially be treated with a higher-order aberration improving laser rather than with eyeglasses.

The articles in this supplement are adapted from presentations given at the 2003 American Academy of Ophthalmology. John F. Doane, M.D., and Daniel S. Durrie, M.D., two of our most accomplished refractive surgeons discuss how wavefront technology is affecting the way we refract our patients. Now, when patients arrive in our offices wanting to know why their eyeglasses don't work, instead of shrugging our shoulders, we can use wavefront to explain exactly why their vision systems work the way they do. The advent of wavefront technology truly has been an eye-opening experience for all of us.

Dr. Koch is the chief medical editor of Ophthalmology Management magazine.