Ask any refractive surgeon about the history of this field, and he or she will undoubtedly tell you that both the treatment of refractive errors and the technologies developed for this purpose have come a long way in a relatively short time. He or she may also tell you, however, that both of these things have a long way to go.

Why is that?

For starters, a gold standard treatment for presbyopia has yet to be crowned. Presby-LASIK, corneal inlays, IOLs—these are all viable options that seem to provide patients with some level of correction—but surgeons also are focused on the promise of treatments yet to come, including lens softening with a femtosecond laser, intrastromal methods of presbyopia correction, and instillation of pharmacologic agents to restore accommodation.

Another reason surgeons will tell you that refractive surgery has room for improvement is because they suspect that a paradigm shift is upon them—a shift away from flap-based procedures and toward intrastromal treatments that promise to be even more minimally invasive than the still-popular LASIK and PRK procedures.

This cover focus explores some of the most heavily discussed topics in refractive surgery and asks surgeons to take a stand on three hard-hitting questions: What is the ideal femtosecond laser? Will intrastromal treatments be the future of refractive surgery? Will surface ablation survive? Although the jury may still be out on some or all of these subjects, it remains beneficial to brush up on your colleagues' thoughts and rationales on the practice of modern refractive surgery. n