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Today's Practice | Jul 2012

5 Questions With Maria Clara Arbelaez, MD

1. What do you enjoy most about being an ophthalmic surgeon?

I enjoy performing surgery and working with people and technology. I derive great satisfaction from witnessing my patients’ happiness with their results and the benefits of their surgery.

2. What do you consider to be the most exciting surgical development that you have been a part of?

I have been performing excimer laser refractive surgery with many platforms since 1993. My involvement with the Amaris excimer laser (Schwind eye-tech-solutions) clinical trials has been the most exciting surgical development I have been a part of so far. The Amaris offers extreme accuracy and predictability and a broad spectrum of treatment options due the laser’s variety of features. These include centration tools, online pachymetry, static and dynamic cyclotorsion, and a six-dimensional eye tracker. The pulse rate (750 Hz) makes it possible to perform aspherical, corneal, and ocular wavefront treatments with confidence. The Amaris’ software helps the surgeon decide which aberrations to treat. The laser can also be used to perform pachymetry-assisted laser keratoplasty and customized treatments based on pachymetric maps in special cases.

3. How do you envision that refractive surgery will change over the next 5 years?

Presbyopia is the next frontier in refractive surgery, but certainly not the last. Presbyopia will not be cured in the near future, but major advances will be made in techniques specifically designed to restore true accommodation. Methods based on pseudoaccommodation and extended depth of focus will continue to improve and eventually reach a maturity in which the compromise in distance and near vision will be minimized and simultaneous vision at multiple distances will be achieved. This field has already been established with the PresbyMAX technique introduced by Schwind eye-tech-solutions.

With the help of better aberrometers, surgeons will be able to more fully understand exactly what patients need and to determine, based upon solid scientific findings, whether we can offer them a solution to meet those needs.

Concerning pseudoaccommodation and multifocality, in the future it will be possible to reduce patients’ spectacle dependence by providing controlled extended depth of focus. As presbyopia progresses, these treatments will be able to be repeated as necessary with minimal risk.

The range of repetition rates of laser systems for refractive surgery currently available runs from about 10 to about 1,000 Hz (median, 300 Hz), with spot size diameters ranging from 6.5 to about 0.3 mm (median, 0.9 mm), corresponding to treatment velocities from about 9.0 to 1.3 seconds per diopter (s/D; mean, 4.5 s/D). To forecast the future trends, four driving forces must be considered: (1) the technologic progress of the past 10 years, indicating an exponential improvement of the technology; (2) the nonlinear cost-to-benefit ratio for developments, indicating a continued improvement of the technology at a slower rate; (3) the clinical need for faster or more precise systems, indicating a slowdown in improvements as the technology achieves maturity and stability; and (4) the limitations imposed by the biologic tissue response to the laser interaction (eg, thermal issues, haze development). Considering these effects, we can hypothesize future refractive surgery laser systems with repetition rates ranging from about 300 to 1,500 Hz, with spot size diameters ranging from 1.5 to about 0.2 mm, corresponding to treatment velocities from about 4 s/D to about 1 s/D.

In the coming years, femtosecond and nanosecond lasers will be used not only for creating corneal flaps and sub-Bowman keratomileusis, but also for therapeutic corneal solutions. These technologies will be used for intrastromal refractive treatments, which we have already seen with the ReLEx flex and smile techniques using the VisuMax femtosecond laser (Carl Zeiss Meditec).

We will also see the introduction of additive technologies and techniques (perhaps combined with subtractive techniques) and therapeutic corneal solutions, enabling us to tailor refractive treatments for our patients basically free of risk due to their reversibility.

4. What is your advice to the next generation of refractive surgeons?

Practicing medicine ethically and in the interest of our patients’ well being is the goal we must strive for. To achieve this goal, we must continuously update our knowledge and surgical skills and learn how to choose and properly use technology.

5. How do you spend your leisure time?

I like to spend free time enjoying the simple things in life with my husband and my two precious kids Sami and Sara. I am also trying hard to improve my golf skills.