Problems with wavefront aberrations applied to refractive surgery: Developing standards

Refractive surgery is evolving rapidly. A recent development uses wavefront aberration information to improve the surgical outcome. Before the wavefront information can be used effectively a number of problems must first be resolved. One of the main concerns is the presence of halos during night driving conditions. It seems clear that this problem occurs when the pupil is large enough to overlap the ablation transition zone. Several questions associated with the transition zone are examined. Shape descriptors to characterize the transition zone are discussed. Better ways of quantitatively characterizing the transition zone and predicting its properties are needed to help specify the ablation. Many of the issues associated with improving refractive surgery can be addressed by establishing a standards committee that includes basic researchers and clinicians. This committee can become a forum for developing techniques to assess visual outcomes, it can make recommendations for developing a database that would allow researchers to compare the intended outcome of ablation with the actual outcome. In order for this enterprise to be successful increased openness about surgery parameters and surgery outcome would be helpful.