Sharper, smarter, clearer: LASIK and ICL tech take center stage with vision so good, it’s personal.
In New Delhi, the second day of the 40th Congress of the Asia-Pacific Academy of Ophthalmology (APAO 2025), held in conjunction with the 83rd Annual Conference of the All India Ophthalmological Society (AIOC 2025), featured a dynamic afternoon session on customized LASIK and phakic IOLs for myopia and astigmatism. Leading experts gathered on stage to share how cutting-edge technologies are enhancing not only refractive accuracy—but also the overall visual quality patients experience.
Ray-tracing tech elevates LASIK
Dr. Pooja Khamar (India) opened the session with India’s early experience using ray-tracing guided LASIK, describing it as a significant leap in personalized refractive surgery.
“Ray tracing is a fully personalized treatment based on individual 3D modeling of the eye, which includes not just wavefront but also corneal tomography, anterior and posterior curvatures, biometry and anterior chamber geometry,” Dr. Khamar explained.
In a contralateral eye study comparing ray-tracing guided LASIK (Wavelight Plus; Alcon, Geneva, Switzerland) to topography-guided LASIK (Contoura; Alcon), ray tracing showed clear benefits:
- 72% of treated eyes achieved better than 20/20 vision, versus only 19% with Contoura
- 67.3% of patients gained at least one line of vision
Dr. Khamar also presented a case where ray-tracing detected subtle epithelial aberrations missed by standard assessments. “If I would have corrected just the sphere for this patient, this trefoil kind of profile wouldn’t have been corrected, and the patient post-op would have had 20/20 but poor quality of vision,” she noted.
FDA trial data shows high precision
Dr. Ronald Krueger (United States) followed with the first public presentation of the US Food and Drug Administration (FDA) trial results on ray-tracing guided LASIK. The study included 336 eyes from nine centers, with one-year follow-up data.
“Our results overall showed that 98.5% of patients were within one diopter of target correction, 92% within half a diopter, 92% achieved 20/20 or better outcome and 67% achieved 20/16,” he reported.
Dr. Krueger explained how the system builds a “digital twin model eye” for each patient by combining ocular wavefront, biometry and corneal tomography data. Using 2,000 light rays through this model, the algorithm calculates an individualized ablation profile.
“It’s the first time we’ve really seen that there’s no increase in higher-order aberrations going from pre to post, and statistically, spherical aberration actually decreased,” he said—especially significant for high myopia corrections.
China’s growing demand for customized LASIK
Dr. Chloe Mengdi Chen (China) offered insights into the Chinese market—the world’s largest for refractive surgery—where customized LASIK is rapidly gaining ground.
“China represents not only the largest but also the fastest growing refractive surgery market globally,” she reported. “Over 600 million people in China are affected by myopia.”
Despite economic headwinds in 2024, customized LASIK was the only one of the three mainstream refractive surgery procedures (LASIK, SMILE and SL) to show growth.
Data from Aier Eye Hospital Group, which performs approximately 800,000 refractive surgeries annually, confirmed the performance. Dr. Chen noted that the “Wavelight Plus system performs the best among all surgery types” in terms of post-op visual quality.
READ MORE: The Myopia Enigma
Fine-tuning ICL sizing and technique
Switching to phakic IOLs, Dr. Ashvin Agarwal (India) focused on the nuances of EVO ICL sizing and surgical technique.
“Getting ICL sizing right in refractive surgery is extremely important because these are made with particular sizes,” he emphasized. “They are sized for each eye in a particular way.”
Dr. Agarwal also shared a practical surgical tip, “Just ensuring to notice where the holes are before you implant the lens and rotating so that the holes face you really avoids having a flip inside the eye.”
On ideal vault parameters, he advised, “250 microns to 750 microns is an ideal vault. Anything below 125 microns is a low vault, and anything above one millimeter is a high vault.”
AI-driven approaches to ICL sizing
Dr. Naren Shetty (India) addressed the challenges of ICL sizing with a fresh approach—AI-powered prediction using densitometry scans.
“I’m sure each one of us has had days where we have done a perfect surgery. The patient is very happy. The vision is fantastic. But when you look at the slit lamp or the OCT, you see either a high vault or a low vault,” he said, laying the scene.
Dr. Shetty explained the pitfalls of using horizontal white-to-white (WTW) as the sole sizing metric. “We do certain assumptions—that the horizontal white-to-white is always maximum, vertical white-to-white is always minimum—which is actually not true.”
His team developed an AI-based vault prediction software using Pentacam (OCULUS, California, USA) densitometry, yielding excellent accuracy:
“The coefficient of determination R-squared was 0.74, and the interclass correlation coefficient was 0.92″—both significantly better than existing formulas.
READ MORE: The OCULUS Pentacam® Cornea OCT for Refractive and Cataract Management
Tackling highly aberrated corneas
Dr. Rohit Shetty (India) discussed topography-guided laser correction for irregular corneas, including post-refractive surgery cases and keratoconus.
“When you look at aberration, you are trying to look at both the quantity and quality of vision,” he explained.
Dr. Shetty noted that ray-tracing technology is improving outcomes in complex corneas. “The new aberrometers which use ray tracing do the ray tracing from your epithelium because the epithelium forms a very important refractive surface,” he said.
Looking ahead, Dr. Shetty predicted that “ray tracing technology will be the future of how topography-guided treatment will be done with more AI-driven processes and understanding of biomechanics and wound healing.”
ICLs for presbyopia correction
Dr. Robert Ang (Philippines) presented data on the EVO Viva ICL (STAAR Surgical, California, USA)—an extended-depth-of-focus (EDOF) lens for presbyopia.
“The ICL is probably an ideal treatment for presbyopia because many patients who come to our clinic have both refractive error and astigmatism. If they’re above 40, they want simultaneous treatment,” he said.
Describing the lens design, Dr. Ang explained, “It is not a multifocal ICL but a refractive change from the center to the periphery. The center has this add power which gives you around a diopter near add.”
In his study of 94 eyes (including 68 with toric lenses), results from the interim analysis showed that
- 80% achieved 20/30 or better distance
- 70% reached 20/25 or better distance
- 81% saw 20/25 or better intermediate
- 80% reached 20/30 for near
Proper counseling is key. “We counsel the patient, same as with a trifocal and EDOF, that there’s a little bit of trade-off,” he noted. “You won’t get perfect far, you won’t get perfect near. You have somewhere in between.”
At the end of this symposium, one thing is clear: technologies like ray-tracing guided LASIK and next-generation ICLs are redefining expectations—not just in terms of visual acuity, but the quality of vision itself.
As these innovations integrate AI and deepen their understanding of ocular biomechanics, eye care professionals can look forward to even more precise, patient-centric outcomes—moving closer to a future free from glasses and contact lenses.
Editor’s Note: Reporting for this story took place during the 40th Congress of the Asia-Pacific Academy of Ophthalmology (APAO 2025), being held in conjunction with the 83rd Annual Conference of the All India Ophthalmological Society (AIOC 2025) from 3-6 April in New Delhi, India.
