Recent Advances in Refractive and Corneal Surgery: A Perspective from Tamil Nadu

Dr. Sujatha Mohan, President – TNOA (2025–2026) The field of ophthalmology has always stood at the confluence of tradition and technology. In recent years, refractive and corneal surgery has undergone a transformational evolution—driven by cutting-edge innovation, improved surgical precision, and a deeper understanding of corneal physiology. As an ophthalmologist based in Tamil Nadu, I have had the privilege to witness not only global advancements but also the remarkable strides made within our own ophthalmic community. REFRACTIVE SURGERY: MOVING TOWARDS MINIMALISM AND CUSTOMISATION Refractive surgery has moved well beyond its early roots in LASIK and PRK. Today, techniques such as small incision lenticule extraction (SMILE) are changing the landscape, offering patients quicker recovery, greater biomechanical stability, and reduced post-operative discomfort.[1] SMILE is already gaining popularity across major eye care centres in Tamil Nadu, with promising long-term outcomes.[2] Equally significant is the growing adoption of topography-guided and wavefront-optimised LASIK, which allows for a higher degree of customisation. These techniques are particularly beneficial in treating irregular astigmatism and higher-order aberrations, enabling better contrast sensitivity and night vision.[3] In high refractive errors or thin corneas, phakic IOLs and refractive lens exchange (RLE) have become valuable alternatives. Newer IOL technologies, including light-adjustable lenses (LALs), hold the potential to enhance post-operative refractive precision—an exciting development we are beginning to explore in Indian clinical settings.[4] CORNEAL SURGERY: FROM TRANSPLANTS TO TISSUE ENGINEERING Corneal transplantation has become more selective, thanks to the rise of lamellar keratoplasty. Tamil Nadu has led the way in early adoption of procedures like DSEK and DMEK, which preserve healthy corneal layers and improve recovery time.[5,6] An area of growing interest is the regenerative approach to endothelial dysfunction. The early clinical use of cultured endothelial cell injections and Descemet’s membrane endothelial transfer (DMET) marks a paradigm shift in treating Fuchs’ dystrophy and related conditions. These therapies, while still under investigation, reflect a future where donor tissue dependence may significantly reduce.[7] CROSS-LINKING AND BEYOND Corneal cross-linking (CXL) has matured from a keratoconus-only therapy to a versatile tool for strengthening corneal tissue in a range of ectatic disorders. The use of accelerated protocols, epithelium-on techniques, and personalised CXL methods offers both patient comfort and clinical efficacy. In India, early adoption of these techniques has been met with encouraging results, especially among younger keratoconus patients.[8,9] ARTIFICIAL INTELLIGENCE AND DIAGNOSTIC INNOVATION Tamil Nadu has not remained untouched by the AI revolution in eye care. Start-ups and academic institutions alike are working on AI-based algorithms to detect keratoconus, assess corneal topography, and predict post-surgical outcomes.[10] AI-driven screening tools could prove transformative in rural outreach programs where specialist access remains limited. Moreover, advances in anterior segment OCT, Scheimpflug imaging, and dynamic corneal response measurement have enabled earlier detection and better risk stratification of corneal disorders—critical in a country like India where late presentation is common.[11] BRIDGING GLOBAL INNOVATION WITH LOCAL IMPACT One of the key challenges we face in Tamil Nadu—and across India—is ensuring that global innovations are adapted to local realities. Cost, accessibility, and patient awareness remain significant barriers. However, through government–private collaborations, skill development initiatives, and a growing culture of clinical research, we are gradually closing this gap. As an ophthalmologist, I am heartened to see growing interest in translational ophthalmic science across our state. Conferences, workshops, and fellowships are now making global knowledge accessible to young ophthalmologists, residents, and researchers. CONCLUSION: A FUTURE WORTH SEEING The future of refractive and corneal surgery lies in precision, personalisation, and preventive care. Whether it is a new AI diagnostic tool or novel surgical protocol, Tamil Nadu continues to contribute meaningfully to the global narrative in ophthalmology. I hope this special issue offers not only scientific insights but also inspiration—for clinicians, researchers, and students—to continue pushing the boundaries of what is possible. Our shared mission remains clear: to preserve and restore vision with compassion, innovation, and integrity.