A Cautionary Tale of Innovation in Refractive Surgery

Hyperopia is difficult to treat surgically. Nearly a dozen techniques strive toward safe, effective outcomes. All techniques are bedeviled by 3 challenges: (1) the need for accurate centration over the pupil of a steeper central optical zone approximately 5 mm in diameter, (2) the potential decreased visual acuity caused by image minification, 1,2 and (3) the creation of corneal contours with physiologic characteristics able to minimize optical aberrations and regression of initial refractive effect.