Refractive surgery has experienced substantial advancements over the past few years, driven by innovative techniques and continuous technological progress aimed at enhancing visual outcomes and patient satisfaction. Refractive errors such as myopia, hyperopia, and astigmatism affect a significant portion of the global population, impacting quality of life and productivity. Recent advancements have been fueled by a deeper understanding of ocular biomechanics and visual optics, leading to more precise and effective treatments. Traditional methods such as LASIK and PRK have been refined, and new procedures like SMILE (Small Incision Lenticule Extraction) have been introduced, expanding the range of treatable refractive errors and improving safety and predictability. Customized treatments, such as wavefront-guided LASIK and topography-guided PRK, allow for individualized plans tailored to each patient\'s unique corneal characteristics, enhancing visual acuity and reducing higher-order aberrations. The use of femtosecond lasers in procedures like Femto-LASIK and femtosecond laser-assisted cataract surgery (FLACS) offers unparalleled precision, reducing surgical risks and improving outcomes. Implantable Collamer Lenses (ICLs) and corneal crosslinking (CXL) have emerged as effective options for specific patient groups. Advanced diagnostic tools like optical coherence tomography (OCT) and Scheimpflug imaging have improved surgical planning and complication management. As research and technology continue to evolve, these advancements promise even greater improvements in refractive surgery, addressing the visual needs of the global population.

BACKGROUND: To explore intraocular lens (IOL) preferences of United Kingdom-based (UK) refractive surgeons in cataract and refractive lens exchange (RLE) surgery.
METHODS: An online survey on IOL preferences (and reasons for their choice) in cataract and RLE surgery was distributed. It also enquired about implementing mini-monovision with extended depth of field (EDoF) IOLs, about utilising IOL mix-and-match (different IOL types in each eye), and at what level of corneal astigmatism they prefer toric lenses.
RESULTS: Following an 81.6% response rate, thirty responses were analysed; median years of refractive surgery experience was 12.5. The most popular IOL choices for cataract surgery were EDoF lenses (30%), monofocals (20%), and trifocals (20%). The most cited reason for each was better overall visual outcomes (88.9%), fewer unwanted symptoms (66.7%) and best spectacle independence (66.7%), respectively. For RLE, EDoF remained most popular (36.7%), followed by trifocals (30%), and multifocals (16.7%) with the same reasons for choice cited above. Mini-monovision with EDoF lenses was well-regarded (83% recommend for most/select patients), unlike utilising IOL mix-and-match (60% did not recommend). 40% prefer toric IOLs for astigmatism of 1 dioptre (D) or higher, whilst 30% opt for them at < 1D.
CONCLUSIONS: Experienced UK refractive surgeons prefer newer IOLs with enhanced optics; ≥50% of respondents favoured either EDoF or trifocals for a \'typical\' cataract or RLE patient. Notably, respondents have a low corneal astigmatism threshold for toric lenses. Mini-monovision with EDoF IOLs was well-regarded, whilst mix-and-match of different IOL types was less recommended.

UNASSIGNED: As one of several refractive surgeries, Implant Collamer Lens (ICL) surgery offers stable biocompatibility and consistent, high-quality visual outcomes. ICL has become an effective complement to corneal refractive surgery, gradually becoming one of the mainstream methods for correcting refractive errors. This study employs bibliometric methods to analyze research on ICL surgery to understand the progress, hotspots, and potential future trends in this field.
UNASSIGNED: This study performed a bibliometric analysis of all ICL-related articles collected from the Web of Science Core Collection database between January 1st, 1996, and December 31st, 2023. The CiteSpace 6.2.R4 tool, Excel and the Web of Science website were used to analyze data by country, institution, keywords, and clusters of keywords. Additionally, an in-depth interpretation and analysis were conducted on the field\'s high-impact articles.
UNASSIGNED: Since the first clinical application report of ICL, there have been a total of 875 studies. The number of papers published annually has shown an overall increasing trend. Studies published from China are the most numerous, accounting for 29.14% (n = 255) of the total. Among the institutions, Fudan University and Kitasato University both have published more than 50 papers, with Kitasato University having the highest H-index of 26. The journals with the top 10 publication volumes are all specialized in ophthalmology. The burst keywords since the introduction of ICL surgery have been \"intraocular lens,\" \"refractive surgery,\" and \"cataract surgery.\" The current burst keywords include \"visual quality,\" \"vector analysis,\" \"axial length,\" etc. The results of keyword clustering included ICL, pIOL, high myopia, axial length, optical quality, refractive surgery, ICL implantation, and pupil size. In the High-impact Articles, it was found that the high-impact articles predominantly focus on the safety, efficacy, and predictability of ICL surgery.
UNASSIGNED: Research on ICL has grown since its clinical introduction, with the advent of the central hole ICL sparking a surge in recent hotspots, particularly in China. Current hotpots in the field of ICL surgery are \"visual quality,\" \"ICL implantation,\" \"vector analysis,\" \"axial length,\" \"evo ICL,\" \"ICL v4c,\" and \"ICL.\" ICL surgery research trends have evolved from implantation techniques to biological parameters associated with ICL surgery and the benefits of new ICL designs.

Noninvasive in situ monitoring of viscoelastic characteristics of corneal tissue at elevated temperatures is pivotal for mechanical property-informed refractive surgery techniques, including thermokeratoplasty and photorefractive keratectomy, requiring precise thermal modifications of the corneal structure during these surgical procedures. This study harnesses Brillouin light scattering spectroscopy as a biosensing platform to noninvasively probe the viscoelastic properties of ovine corneas across a temperature range of 25-64 °C. By submerging the tissue samples in silicone oil, consistent hydration and immiscibility are maintained, allowing for their accurate sensing of temperature-dependent mechanical behaviors. We identify significant phase transitions in the corneal tissue, particularly beyond 40 °C, likely due to collagen unfolding, marking the beginning of thermal destabilization. A subsequent transition, observed beyond 60 °C, correlates with collagen denaturation. These phase transformations highlight the cornea\'s sensitivity to both physiologically reversible and irreversible viscoelastic changes induced by mild to high temperatures. Our findings underscore the potential of the Brillouin biosensing technique for real-time diagnostics of corneal biomechanics during refractive surgeries to attain optimized therapeutic outcomes.

To assess the minimal change in visual acuity perceived by patients as important in different eye-related interventions. PubMed was utilized to search articles on each of the four major interventions: cataract surgery, keratoplasty, different glaucoma treatments, and refractive eye surgery, each combined with quality of life (QoL) and visual acuity keywords. The search was narrowed to articles between 2000 and 2023. Seventy-four major articles were thus reviewed. Of these, 27 studies reviewed the results of cataract surgery, 20 studies discussed the effect of keratoplasty interventions on the vision-related QoL (VRQoL), most showing that VRQoL improved significantly after keratoplasty, 11 studies investigated the effect of different glaucoma interventions on patients\' visual acuity and the QoL, 16 studies reviewed refractive surgery, where they showed an improved QoL in most of the cases, although some of the studies showed a slight superiority of one intervention over the other in the short term. The minimally important difference (MID) perceived in visual acuity depends mainly on the type of surgical intervention (keratoplasty, glaucoma, or refractive surgery), and the impact on QoL on improved visual acuity differs depending on the intervention.

OBJECTIVE: ReLEx (Refractive Lenticule Extraction) Small Incision Lenticule Extraction (SMILE), the second generation of ReLEx Femtosecond Lenticule Extraction (FLEx), is a minimally invasive, flapless procedure designed to treat refractive errors such as myopia, hyperopia, presbyopia, and astigmatism. This review aims to provide a comprehensive overview of the methods for preserving SMILE-derived lenticules and discusses their potential future applications.
METHODS: A narrative literature review was conducted using PubMed, Scopus, and Web of Science databases, focusing on articles published up to January 2024 and available in English. The authors also evaluated the reference lists of the collected papers to identify any additional relevant research.
RESULTS: No standardized protocols currently exist for the storage or clinical application of SMILE-derived lenticules. However, these lenticules present a promising resource for therapeutic uses, particularly in addressing the shortage of donor corneal tissues. Their potential applications include inlay and overlay additive keratoplasty, as well as other ocular surface applications. Further research is needed to establish reliable protocols for their preservation and clinical use.
CONCLUSIONS: SMILE-derived lenticules offer significant potential as an alternative to donor corneal tissues. Standardizing their storage and application methods could enhance their use in clinical settings.

OBJECTIVE: To investigate the three-year visual, refractive outcomes and adverse events of the Eyecryl toric phakic IOL (pIOL) for moderate-to-high myopic astigmatism.
METHODS: This retrospective study included eligible patients who underwent refractive surgery in one or both eyes with Eyecryl toric pIOL for myopic astigmatism. The efficacy, safety, predictability, rotational stability, vector analysis, and adverse events were evaluated in patients with spherical refraction from - 4.50 to -17.00 diopters (D) and cylindrical refraction from - 0.75 to -5.50 D.
RESULTS: Fifty-two eyes of 28 patients were included in the study. The mean efficacy and safety index were 1.12 ± 0.35 and 1.38 ± 0.42, respectively. The mean manifest refraction spherical equivalent was - 10.06 ± 2.69 D and - 0.64 ± 0.61 D preoperatively and postoperatively at 36 months, respectively. The mean manifest astigmatism was - 2.06 ± 1.16 D and - 0.44 ± 0.48 D preoperatively and 36 months postoperative, respectively. During the final examination, 70% of the eyes showed an increase in CDVA of one or more lines compared to their preoperative state. There was a cumulative endothelial cell loss of 3.1% at 36 months postoperatively. One eye developed visually significant anterior subcapsular opacity, whereas another eye experienced pIOL opacification.
CONCLUSIONS: The Eyecryl toric pIOL demonstrated satisfactory visual acuity and refractive outcomes, as assessed by efficacy, safety and stability over a three-year period.

OBJECTIVE: Compare refractive results between mechanical PRK (mPRK) and transepithelial PRK (tPRK) with WaveLight Allegretto EX500 excimer laser system (Alcon Laboratories, Fort Worth, TX, USA).
METHODS: Department of Ophthalmology of the Federal University of Sao Paulo, Brazil.
METHODS: Prospective and randomized study.
METHODS: In 151 eyes of 73 patients with astigmatism and myopia, both eyes had similar refraction before surgery, with a maximum of 15-µm difference in ablation who underwent mPRK in one eye and tPRK in the contralateral eye. The mean age of the patients in this study was 31.45 ± 6.97 years (range, 22 to 54 years).
RESULTS: A comparison was made with all variables between the two groups, and we found that UDVA and SE were worse in the tPRK group at six months than in the mPRK group. In the mPRK group, there was a higher frequency in the +/- 0.50 range and a lower frequency in the +/- 1.50 range. In the tPRK group, however, there was a lower frequency in the +/- 0.50 range and a higher frequency in the +/- 1.50 range. Concerning gain or loss of lines of sight, there was no association between the two groups (chi-square test, p = 0.887).
CONCLUSIONS: Both mPRK and tPRK appear to have similar safety. However, mPRK was associated with significantly better UDVA and SE six months post-operatively.

OBJECTIVE: Children with autism spectrum disorder (ASD) and intellectual disability (ID) often cannot tolerate wearing spectacles or contact lenses, which are the standard of care for treating ametropia.1,2. We aimed to assess the impact of refractive surgery on social functioning and vision-specific quality of life in this population.
METHODS: Prospective, before-and-after case series.
METHODS: SETTING: Single, academic tertiary care center.
METHODS: 18 children with ASD and/or ID, ametropia, and spectacle non-adherence were included in the analysis.
METHODS: Participants underwent refractive surgery with either intraocular lens implantation or keratectomy. Parents completed the Social Responsiveness Scale (SRS-2) and Pediatric Eye Questionnaire (PedEyeQ) at baseline and 1, 6, and 12 months post-surgery.3,4 MAIN OUTCOME MEASURES: Median change in SRS-2 T-scores and PedEyeQ scores 12 months after surgery, compared to baseline. The minimum clinically important difference (MCID) was set at 5 points for the SRS-2 and 10 points for the PedEyeQ.
RESULTS: At 12 months after surgery, statistically significant improvements were observed in the SRS-2 domains of Social Awareness (8 points, 95% CI 2 to 13, p = .03) and Social Motivation (7 points, 95% CI 2 to 15, p = .03). Total SRS-2 T-score improved in a clinically important manner for 56% (10/18) of patients, but the median change was not statistically significant (5 points, 95% CI -1 to 9, p = .10). Vision-specific quality of life showed statistically significant improvements in the domains of Functional Vision (40 points, 95% CI 7 to 73, p = .02) and Bothered by Eyes/Vision (23 points, 95% CI 3 to 45, p = .02).
CONCLUSIONS: Refractive surgery led to clinically and statistically significant improvements in domains of social functioning and vision-specific quality of life at 12 months after surgery. A narrow majority of patients demonstrated a clinically important improvement in overall social functioning, but these changes were not statistically significant. The results suggest that refractive surgery in children with neurodevelopmental disorders, ametropia, and spectacle non-adherence may provide developmental and quality of life benefits. Larger, controlled studies are required to validate these findings.

Background/Objectives: This retrospective case series analyzed visual outcomes in patients with a prior history of implantable collamer lens (ICL) implantation who underwent cataract extraction (CE). A secondary aim was to investigate the relationship between vault height and the rate of cataract development. Methods: Visual acuity and refraction measurements were collected after CE at one week, one month and six months. Vault height measurements were correlated to the time until symptomatic cataracts were removed. Results: A total of 44 eyes were analyzed at six months after CE with efficacy and safety indexes of 1.20 ± 1.11 and 1.50 ± 1.06, respectively. In addition, 70% of eyes had a post-operative uncorrected distance visual acuity (UDVA) within one line of pre-operative corrected distance visual acuity (CDVA). Refractive predictability at six months demonstrated that 43% and 69% of eyes were within ±0.25 D and ±0.50 D of SEQ target, respectively. Astigmatism measured by refractive cylinder was ≤0.25 D in 17% and ≤0.50 D in 34% of eyes pre-operatively compared to 40% and 60% of eyes, respectively, at six months post-operatively. Vault heights one week after ICL (p < 0.0081) and one week before CE (p < 0.0154) demonstrated a positive linear regression with the time until CE. Conclusions: This sample population achieved favorable visual outcomes six months after CE, similar to six months after ICL implantation. Patients with a history of ICL implantation will similarly have a good visual prognosis after CE.