If at first you don't succeed, then wavefront could be the new technology in laser eye surgery to stifle the critics. One company promotes the treatment by saying in its press release that it takes most of the 'guesswork' out of predicting the results of surgery.
The technology is a byproduct of astronomy, which uses it to unscramble starlight from space. A fine beam of light is shone into each eye and reflected back by the retina. The returning reflection is assessed over many different points on the pupil, and surgeons are now able to spot very slight imperfections and aberrations more accurately than before. This allows the subsequent treatment with the laser to be 'tailor-made' for each patient in a more precise way, or so its advocates claim.
One overview of US trends in eye surgery reported their findings that the new forms of laser surgery 'were minimally employed but appear poised to be the wave of the future' (J Refract Surg, 2003, 1: 357-63).
Science magazine (14 March 2003) describes new developments in eye examination that peer into the eye, rather than assessing the information that comes back from it. 'Adaptive optics' again uses space-honed technology on the human eye to examine single cells deep in the eye. The world's first and only scanning laser ophthalmoscope can look at the retina at different depths, and 'each layer of the retina tells its own story', says Science. This has enormous potential for a range of eye diseases and conditions.
Presbyopia can sometimes be treated with laser surgery using a treatment known as monovision. The laser is used to deliberately make one eye slightly shortsighted - the resulting imbalance aims to improve vision for close objects. It's usual to advise a prospective patient to first try contact lenses or spectacles to see if this imbalance in the eyes works, as the surgery is not reversible.
So does this new technology offer a safer way forward? It's just too early to say. Watchful waiting has to be the best approach at the moment.