Trends in ophthalmology show a specialty that is increasingly reliant on technologies capable of enhancing the accuracy of diagnosis, treatment planning, and surgical procedures. In refractive surgery, this evolution is evident both in the refinement of established techniques and in the development of more personalized approaches for each patient.
LASIK and PRK remain part of ophthalmological practice, while procedures such as SMILE have expanded the options available for correcting certain refractive errors. At the same time, more advanced corneal topography and tomography, aberrometry, femtosecond lasers, eye-tracking systems, and artificial intelligence-based tools have come to play an increasingly important role in surgical assessment and planning.
In this article, you’ll learn about the main trends in ophthalmology related to refractive surgery, how new technologies are changing procedure planning, and what knowledge is becoming increasingly important for physicians who want to keep up with these changes.
What is changing in refractive surgery?
Refractive surgery encompasses procedures designed to correct refractive errors and reduce dependence on glasses or contact lenses in appropriately selected patients. Among the best-known techniques are photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK), while small incision lenticule extraction (SMILE) represents an alternative based on the removal of a corneal lenticule through a small incision.
The main recent change, however, lies not only in the emergence of new techniques. Planning has become increasingly individualized. Characteristics such as corneal shape and thickness, optical aberrations, topographic patterns, and biomechanical factors may all be considered in the evaluation leading up to the surgical decision.
For this reason, the current trend is not to consider a single procedure as a one-size-fits-all solution for all patients. The choice depends on the clinical evaluation, preoperative tests, anatomical characteristics, and visual needs of each individual.
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Are LASIK and PRK still relevant?
Despite the development of new procedures, LASIK and PRK remain important in refractive surgery. Both techniques reshape the cornea to correct refractive errors, but they differ in their surgical approach and postoperative recovery.
In LASIK, a corneal flap is created before the tissue is reshaped with the excimer laser. The incorporation of the femtosecond laser into the creation of this flap represented one of the technological advancements in the technique, allowing for greater control over this stage of the procedure.
In PRK, on the other hand, the treatment takes place on the corneal surface. The technique has also benefited from advances in excimer laser equipment, eye-tracking systems, and personalized ablation profiles. Recent reviews indicate that topography- or wavefront-guided features have helped expand the possibilities for personalized treatment.
Therefore, innovation does not necessarily replace a previous technique. In many cases, it changes the way ophthalmologists select patients, plan the procedure, and use established methods.
SMILE Expands the Possibilities of Refractive Surgery
Another technology that has gained ground in refractive surgery is SMILE, which stands for Small Incision Lenticule Extraction. Unlike LASIK, the procedure does not require the creation of a corneal flap.
The femtosecond laser creates a small lenticule within the cornea, which is then removed through a small incision. The technique is used primarily to correct myopia and astigmatism in patients who meet the eligibility criteria.
Recent studies continue to compare the results of SMILE with those of techniques such as wavefront-guided LASIK. The evidence shows that both can yield good results in selected patients, but it also points to differences related to optical aberrations, astigmatism correction, recovery, and the biomechanical characteristics of the cornea.
For the ophthalmologist, this reinforces the need to understand more than one approach. The decision regarding surgery tends to depend less on the idea of a universally superior technique and more on a combination of evidence, ocular profile, and individual indication.
Personalized Treatments Are Gaining Ground
One of the most significant trends in refractive surgery is the advancement of personalized treatments. Instead of using only the refractive error as the basis for determining the correction, new approaches can incorporate information about the eye’s anatomy and optical characteristics.
Wavefront-guided surgery
Wavefront aberrometry allows for the assessment of optical abnormalities that are not fully captured by conventional refraction. These include so-called high-order aberrations, which can influence aspects such as visual quality, contrast, halos, or glare.
This data can be incorporated into the planning of certain procedures. The goal is to create a treatment profile that is more closely tailored to the specific optical characteristics of that eye.
Topography-Guided Treatments
Corneal topography can also guide certain ablation profiles. In this case, the planning takes into account the characteristics of the corneal surface, allowing for a personalized approach based on its shape.
Studies continue to compare topography-guided and wavefront-guided strategies. The results reinforce that different technologies can offer specific advantages, while proper indication remains essential for determining which strategy to use.
Ray-tracing planning
A more recent approach uses ray-tracing algorithms to simulate the passage of light through the eye’s various optical components. The goal is to integrate multiple measurements to define the correction profile.
Studies published in 2025 evaluated ray-tracing-guided LASIK and observed favorable refractive and visual quality outcomes in selected groups. However, this is a technology still under development, and the available results should be interpreted within the context of each study’s characteristics and limitations.
Would you like to deepen your knowledge of Ophthalmology and closely follow the changes in the specialty? CLICK HERE to learn about the Postgraduate Program in Ophthalmology at São Leopoldo Mandic.
Corneal topography and tomography have become more sophisticated
Advances in refractive surgery also depend on advances in diagnosis. Therefore, before recommending any procedure, it is necessary to thoroughly understand the characteristics of the cornea and identify situations that may increase risks.
Corneal topography and tomography play a central role in this process. In addition, modern systems can assess different corneal surfaces, including thickness, elevation, curvature, and other characteristics used in preoperative analysis.
According to the review “Update on topography and tomography for refractive surgery,” published in 2026 in Current Opinion in Ophthalmology, advances such as three-dimensional corneal mapping, epithelial thickness analysis, and the integration of different imaging modalities have expanded preoperative evaluation. As a result, these technologies can contribute to the earlier identification of conditions such as subclinical keratoconus and to the assessment of the risk of ectasia.
The consequence is a significant change in clinical practice. The outcome of surgery depends not only on the laser procedure itself but also on the quality of the evaluation performed prior to the procedure.
How are trends in ophthalmology expanding the use of artificial intelligence in refractive planning?
Artificial intelligence is also among the trends in ophthalmology. In refractive surgery, the applications being studied primarily involve the interpretation of tests, the identification of corneal abnormalities, assistance in selecting intraocular lenses, and support for surgical planning.
According to the review “Artificial Intelligence in Refractive Surgery,” published in 2025 in *Current Opinion in Ophthalmology*, artificial intelligence already has applications in the detection of keratoconus and ectasia, in biometry, in the sizing of phakic intraocular lenses, and in decision support for refractive surgery.
According to the review “Update on topography and tomography for refractive surgery,” published in 2026 in Current Opinion in Ophthalmology, the integration of different corneal imaging modalities with artificial intelligence-based tools is among the leading areas of development in preoperative assessment for refractive surgery.
These tools do not eliminate the need for medical evaluation. They expand the amount of information available for interpretation and can support clinical decision-making. Therefore, understanding both their capabilities and their limitations has become an essential skill for ophthalmologists.
Patient selection remains a fundamental step
More advanced equipment does not make every patient a candidate for refractive surgery. Therefore, preoperative evaluation remains essential for identifying characteristics that influence the indication, planning, and risks associated with the procedure.
Medical history, refractive stability, and ophthalmic examination must be analyzed in conjunction with corneal characteristics and data obtained from supplementary tests. In this context, the FDA itself emphasizes that the decision regarding LASIK must take into account a proper evaluation, potential contraindications, risks, and expectations regarding the outcome.
This aspect becomes even more relevant given the increased availability of technology. Thus, the more data that is generated, the greater the need to interpret it within the clinical context of each patient.
What other technologies are transforming ophthalmology?
Although refractive surgery is one of the fields most closely associated with technological innovation, the transformation of ophthalmology is much broader. High-resolution imaging systems, artificial intelligence, biometrics, and new surgical equipment are also changing various areas of the specialty.
Artificial intelligence, for example, is already being studied in the analysis of images of the retina, glaucoma, cataracts, and anterior segment diseases. The vast amount of information produced by ophthalmological exams makes the specialty particularly well-suited for the development of diagnostic support tools.
In this context, technological advances are also changing the profile of professional training. Knowing how to use a particular device is only part of the process. Ophthalmologists need to understand how the data is generated, what limitations each method presents, and how to integrate this information into clinical reasoning.
What do these trends require of ophthalmologists?
The evolution of trends in ophthalmology makes continuing professional education an ongoing necessity. In refractive surgery, physicians must master the principles of optics, corneal assessment, patient selection, and test interpretation, in addition to understanding the indications and limitations of different techniques.
New equipment also requires critical thinking. The latest technology should not be adopted simply because it is new. It is up to the professional to evaluate the available evidence and identify which patients might benefit from a particular approach.
This combination of clinical knowledge and technological expertise is likely to become even more important. After all, trends in ophthalmology expand the possibilities for analysis, but the decision ultimately depends on medical judgment.
How can one deepen one’s knowledge of ophthalmology?
Keeping up with trends in ophthalmology requires more than just familiarity with new equipment. Therefore, physicians need to build a solid foundation in eye diseases, diagnostic procedures, test interpretation, treatment, and surgical principles to understand when and how to use each resource.
This deepening of knowledge can occur through various avenues, such as continuous scientific education, conferences, supervised practical activities, and specialized training. Furthermore, the more exposure a professional has to different clinical cases, the broader their repertoire tends to be for relating test findings to decision-making.
Graduate Program in Ophthalmology at São Leopoldo Mandic
For physicians who wish to keep up with trends in Ophthalmology and deepen their knowledge in the specialty, São Leopoldo Mandic College offers a Postgraduate Program in Ophthalmology. The program covers the diagnosis, treatment, and prevention of eye diseases, combining theoretical content, clinical practice, and surgical concepts. In addition, the curriculum includes topics on refraction and refractive surgery.
The institution reports that its Postgraduate Program in Ophthalmology offers classes at various campuses. For this reason, the program’s official website highlights a significant amount of supervised practice and care for real patients, allowing physicians to develop their knowledge within concrete clinical situations and stay up to date with trends in ophthalmology.
Would you like to deepen your knowledge of Ophthalmology and closely follow the changes in the specialty? CLICK HERE to learn more about the Postgraduate Program in Ophthalmology at São Leopoldo Mandic.
Final Thoughts
Trends in ophthalmology show that refractive surgery is moving toward procedures that are increasingly tailored to each patient’s individual characteristics. LASIK and PRK remain relevant, while SMILE and new customization strategies expand the available options.
At the same time, advances in topography, corneal tomography, aberrometry, ray tracing, and artificial intelligence are making preoperative evaluation increasingly sophisticated. For the physician, keeping pace with this process means developing not only technical skills but also the ability to interpret data, evaluate evidence, and appropriately select each approach.
FAQ: Trends in Ophthalmology and Refractive Surgery
What are the main trends in refractive surgery?
Current trends include the expanding use of techniques such as SMILE, topography- or wavefront-guided treatments, ray-tracing-based systems, and increasingly detailed imaging tests for preoperative planning. Artificial intelligence is also beginning to play a role in data analysis and decision support.
Is LASIK still a current technique?
Yes. LASIK remains one of the techniques used in refractive surgery and has benefited from various technological advances over time, including flap creation with a femtosecond laser and personalized treatments. The recommendation depends on each patient’s clinical characteristics.
What is the difference between LASIK and SMILE?
In LASIK, a corneal flap is created to allow for corneal reshaping. In SMILE, a femtosecond laser creates a lenticule within the cornea, which is then removed through a small incision, without forming the same type of flap.
Is artificial intelligence already used in refractive surgery?
Artificial intelligence is already the subject of studies and applications involving the interpretation of tests, the detection of corneal abnormalities, biometrics, and procedure planning. Its use tends to serve as a support tool rather than a substitute for medical evaluation.
Why are topography and tomography important before surgery?
These tests help analyze the shape, thickness, and other characteristics of the cornea. More recent systems have expanded the ability to identify subtle changes and assist in risk assessment prior to refractive procedures.
Is there a postgraduate program in ophthalmology?
Yes. São Leopoldo Mandic College offers a postgraduate program in Ophthalmology designed for physicians, with content related to diagnosis, treatment, diagnostic tests, and various areas of the specialty, including refractive surgery.
If you want to deepen your practice and keep up with the new technologies that are transforming the specialty, the Postgraduate Program in Ophthalmology at São Leopoldo Mandic may be your next step. CLICK HERE to learn more.
References
AMERICAN ACADEMY OF OPHTHALMOLOGY. LASIK — Laser Eye Surgery. 2026.
AMERICAN ACADEMY OF OPHTHALMOLOGY. What Is Small Incision Lenticule Extraction? 2026.
FERNANDES, Victoria Moreira et al. Update on topography and tomography for refractive surgery. Current Opinion in Ophthalmology, vol. 37, no. 4, pp. 267–274, 2026.
GURNANI, Bharat et al. Recent Advances in Refractive Surgery: An Overview. 2024.
HOOPES JR., Phillip C.; MOIN, Kayvon A.; MOSHIRFAR, Majid. Artificial intelligence in refractive surgery. Current Opinion in Ophthalmology, vol. 36, no. 4, pp. 271–275, 2025.
LU, L. et al. Prospective, randomized, contralateral eye comparison of wavefront-guided LASIK vs. topography-guided LASIK. 2025.
WANG, Yue et al. Refractive outcome and visual quality of Ray-Tracing Guided LASIK: a prospective study. BMC Ophthalmology, vol. 25, 2025.
WEI, C. et al. Clinical outcomes of SMILE and WFG-LASIK used to treat myopia and astigmatism. 2024.