Insider's Perspective
Exciting New Ways to Measure And Treat Visual Symptoms
By Ann L. Laurenzi, O.D., Cleveland

Wavefront is exciting because it enables us to assess and treat previously untreatable aberrations. It's an invaluable diagnostic tool for patients who have subjective complaints that we previously couldn't measure. And the technology is an excellent fit for optometrists because it's based on optical science.

We have a busy clinic with a high volume of wavefront-guided LASIK procedures. At our clinic, anyone who qualifies for custom LASIK receives it; about half of our LASIK patients get custom ablation.

I see two types of LASIK patients. First, there are those who want me to make the decision. ("You're the expert.") Then there are patients who have followed the subject on the Internet and know that custom LASIK is available. They've been waiting for LASIK technology to reach a level where they're comfortable, and now they want wavefront-guided LASIK.

Of course, some patients want the procedure but don't qualify. I look at pupil size and the amount of correction needed. We also examine patients with wavefront, and if they don't have higher-order abberations, we'll give them traditional LASIK.

Because our clinic is large, the comanagement process involves technicians. They do the initial pre-op workup, and the surgeon and I share patient discussions about risks and benefits. We both get a chance to talk with the patient, making sure that the patient qualifies for custom LASIK.

Today, the LADARVision 4000 Excimer Laser System is approved for primary eyes. As LADARVision is approved for new applications, we'll see benefits for people with glare, halos and monocular double vision. We can finally measure and identify these symptoms and treat them. Wavefront is especially promising for people with symptoms from previous LASIK surgery.

For example, we had a patient with 20/20 vision who had problems with night driving. We treated her and reduced the problem. It's those patients who really are going to benefit as their quality of vision improves.

Dr. Laurenzi practices at the Cleveland Clinic Foundation, Cole Eye Institute in Cleveland.