FILLING A VOID

PUBLICATION

Limbal Relaxing Incisions

EDITORS

Louis D Nichamin

PUBLISHED BY Slack

It is a question that is often asked of me as an ophthalmologist-in-training: “Doctor, why do you still wear glasses? Shouldn’t an eye doctor be able to see perfectly?”

Considering the success of refractive surgery and many patients’ misconceptions that lasers can cure all eye diseases, it’s an understandable question. And it sheds light on the notion that the success of modern eye surgery, and in particular cataract surgery, is increasingly judged by the refractive and astigmatic outcome.

Of course, much has been done to address refractive error at the time of cataract surgery. Significantly, toric lenses have provided ophthalmologists with a way to reliably correct the astigmatic error. A great deal of information exists regarding toric IOLs. However, little has been written about limbal relaxing incisions, an alternative method of astigmatic correction that can be performed at the time of cataract surgery. This need has perhaps become more urgent with the introduction of the femtosecond laser.

Limbal Relaxing Incisions: A Practical Guide, (Slack Incorporated), edited by Louis D Nichamin fills this void. A 100-page book, it is a concise but detailed introduction to the technique that covers the history of surgical correction of corneal astigmatism, the procedure’s indications, its technical aspects and management of potential complications.

Particularly useful is the chapter entitled, “This is How I Do It.” Here, six contributing authors offer their own techniques, including imaging, surgical plan and clinical pearls, such as the oft-repeated suggestion to plan conservatively for a slight undercorrection, as this is simpler to enhance, and more acceptable to most patients, than a slight overcorrection of the corneal astigmatism.

Limbal Relaxing Incisions is intended for novice refractive implant surgeons looking to incorporate incisional astigmatism surgery into their repertoire.

A BROADER VIEW

For those surgeons seeking a broader view of refractive surgery, “Refractive Surgery: An Interactive, Case-Based Approach” (Slack) might be a good choice.

Written by J Bradley Randleman, this 330-page book consists of a 75-page summary of the fundamentals of refractive surgery, followed by 36 fully-fledged case studies. The first half of the case studies cover the preoperative evaluation: the second half deals with the postoperative patient. Questions are posed, to which the reader can respond before proceeding to the answers. The answers are supplemented by detailed information, including corneal topography and analysis, making this book ideal not only for ophthalmologists-in-training but also for resident and fellowship educators charged with teaching the next generation.