Angle Kappa and its importance in refractive surgery
Identifieur interne : 002798 ( Pmc/Curation ); précédent : 002797; suivant : 002799Angle Kappa and its importance in refractive surgery
Auteurs : Majid Moshirfar [États-Unis] ; Ryan N. Hoggan [États-Unis] ; Valliammai Muthappan [États-Unis]Source :
- Oman Journal of Ophthalmology [ 0974-620X ] ; 2013.
Abstract
Angle kappa is the difference between the pupillary and visual axis. This measurement is of paramount consideration in refractive surgery, as proper centration is required for optimal results. Angle kappa may contribute to MFIOL decentration and its resultant photic phenomena. Adjusting placement of MFIOLs for angle kappa is not supported by the literature but is likely to help reduce glare and haloes. Centering LASIK in angle kappa patients over the corneal light reflex is safe, efficacious, and recommended. Centering in-between the corneal reflex and the entrance pupil is also safe and efficacious. The literature regarding PRK in patients with an angle kappa is sparse but centering on the corneal reflex is assumed to be similar to centering LASIK on the corneal reflex. Thus, centration of MFIOLs, LASIK, and PRK should be focused on the corneal reflex for patients with a large angle kappa. More research is needed to guide surgeons’ approach to angle kappa.
Url:
DOI: 10.4103/0974-620X.122268
PubMed: 24379548
PubMed Central: 3872563
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Hoggan</name><affiliation wicri:level="1"><nlm:aff id="aff2">University of Utah, School of Medicine, Salt Lake City, Utah, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Utah, School of Medicine, Salt Lake City, Utah</wicri:regionArea></affiliation></author><author><name sortKey="Muthappan, Valliammai" sort="Muthappan, Valliammai" uniqKey="Muthappan V" first="Valliammai" last="Muthappan">Valliammai Muthappan</name><affiliation wicri:level="1"><nlm:aff id="aff1">John A Moran Eye Center, Salt Lake City, Utah, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>John A Moran Eye Center, Salt Lake City, Utah</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24379548</idno><idno type="pmc">3872563</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872563</idno><idno type="RBID">PMC:3872563</idno><idno type="doi">10.4103/0974-620X.122268</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002798</idno><idno type="wicri:Area/Pmc/Curation">002798</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Angle Kappa and its importance in refractive surgery</title><author><name sortKey="Moshirfar, Majid" sort="Moshirfar, Majid" uniqKey="Moshirfar M" first="Majid" last="Moshirfar">Majid Moshirfar</name><affiliation wicri:level="1"><nlm:aff id="aff1">John A Moran Eye Center, Salt Lake City, Utah, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>John A Moran Eye Center, Salt Lake City, Utah</wicri:regionArea></affiliation></author><author><name sortKey="Hoggan, Ryan N" sort="Hoggan, Ryan N" uniqKey="Hoggan R" first="Ryan N." last="Hoggan">Ryan N. Hoggan</name><affiliation wicri:level="1"><nlm:aff id="aff2">University of Utah, School of Medicine, Salt Lake City, Utah, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Utah, School of Medicine, Salt Lake City, Utah</wicri:regionArea></affiliation></author><author><name sortKey="Muthappan, Valliammai" sort="Muthappan, Valliammai" uniqKey="Muthappan V" first="Valliammai" last="Muthappan">Valliammai Muthappan</name><affiliation wicri:level="1"><nlm:aff id="aff1">John A Moran Eye Center, Salt Lake City, Utah, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>John A Moran Eye Center, Salt Lake City, Utah</wicri:regionArea></affiliation></author></analytic><series><title level="j">Oman Journal of Ophthalmology</title><idno type="ISSN">0974-620X</idno><idno type="eISSN">0974-7842</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Angle kappa is the difference between the pupillary and visual axis. This measurement is of paramount consideration in refractive surgery, as proper centration is required for optimal results. Angle kappa may contribute to MFIOL decentration and its resultant photic phenomena. Adjusting placement of MFIOLs for angle kappa is not supported by the literature but is likely to help reduce glare and haloes. Centering LASIK in angle kappa patients over the corneal light reflex is safe, efficacious, and recommended. Centering in-between the corneal reflex and the entrance pupil is also safe and efficacious. The literature regarding PRK in patients with an angle kappa is sparse but centering on the corneal reflex is assumed to be similar to centering LASIK on the corneal reflex. Thus, centration of MFIOLs, LASIK, and PRK should be focused on the corneal reflex for patients with a large angle kappa. More research is needed to guide surgeons’ approach to angle kappa.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Hashemi, H" uniqKey="Hashemi H">H Hashemi</name></author><author><name sortKey="Khabazkhoob, M" uniqKey="Khabazkhoob M">M Khabazkhoob</name></author><author><name sortKey="Yazdani, K" uniqKey="Yazdani K">K Yazdani</name></author><author><name sortKey="Mehravaran, S" uniqKey="Mehravaran S">S Mehravaran</name></author><author><name sortKey="Jafarzadejpur, E" uniqKey="Jafarzadejpur E">E Jafarzadejpur</name></author><author><name sortKey="Fotouhi, A" uniqKey="Fotouhi A">A Fotouhi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Park, Cy" uniqKey="Park C">CY Park</name></author><author><name sortKey="Oh, Sy" uniqKey="Oh S">SY Oh</name></author><author><name sortKey="Chuck, Rs" uniqKey="Chuck R">RS Chuck</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Basmak, H" uniqKey="Basmak H">H Basmak</name></author><author><name sortKey="Sahin, A" uniqKey="Sahin A">A Sahin</name></author><author><name sortKey="Yildirim, N" uniqKey="Yildirim N">N Yildirim</name></author><author><name sortKey="Papakostas, Td" uniqKey="Papakostas T">TD Papakostas</name></author><author><name sortKey="Kanellopoulos, Ja" uniqKey="Kanellopoulos J">JA Kanellopoulos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pande, M" uniqKey="Pande M">M Pande</name></author><author><name sortKey="Hillman, Js" uniqKey="Hillman J">JS Hillman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Prakash, G" uniqKey="Prakash G">G Prakash</name></author><author><name sortKey="Prakash, Dr" uniqKey="Prakash D">DR Prakash</name></author><author><name sortKey="Agarwal, A" uniqKey="Agarwal A">A Agarwal</name></author><author><name sortKey="Kumar, Da" uniqKey="Kumar D">DA Kumar</name></author><author><name sortKey="Agarwal, A" uniqKey="Agarwal A">A Agarwal</name></author><author><name sortKey="Jacob, S" uniqKey="Jacob S">S Jacob</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hayashi, K" uniqKey="Hayashi K">K Hayashi</name></author><author><name sortKey="Hayashi, H" uniqKey="Hayashi H">H Hayashi</name></author><author><name sortKey="Nakao, F" uniqKey="Nakao F">F Nakao</name></author><author><name sortKey="Hayashi, F" uniqKey="Hayashi F">F Hayashi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kermani, O" uniqKey="Kermani O">O Kermani</name></author><author><name sortKey="Schmeidt, K" uniqKey="Schmeidt K">K Schmeidt</name></author><author><name sortKey="Oberheide, U" uniqKey="Oberheide U">U Oberheide</name></author><author><name sortKey="Gerten, Gl" uniqKey="Gerten G">Gl Gerten</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Srivannaboon, S" uniqKey="Srivannaboon S">S Srivannaboon</name></author><author><name sortKey="Chotikavanich, S" uniqKey="Chotikavanich S">S Chotikavanich</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Basmak, H" uniqKey="Basmak H">H Basmak</name></author><author><name sortKey="Sahin, A" uniqKey="Sahin A">A Sahin</name></author><author><name sortKey="Yildirim, N" uniqKey="Yildirim N">N Yildirim</name></author><author><name sortKey="Saricicek, T" uniqKey="Saricicek T">T Saricicek</name></author><author><name sortKey="Yurdakul, S" uniqKey="Yurdakul S">S Yurdakul</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zarei Ghanavati, S" uniqKey="Zarei Ghanavati S">S Zarei-Ghanavati</name></author><author><name sortKey="Gharaee, H" uniqKey="Gharaee H">H Gharaee</name></author><author><name sortKey="Eslampour, A" uniqKey="Eslampour A">A Eslampour</name></author><author><name sortKey="Abrishami, M" uniqKey="Abrishami M">M Abrishami</name></author><author><name sortKey="Ghasemi Moghadam, S" uniqKey="Ghasemi Moghadam S">S Ghasemi-Moghadam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Berrio, E" uniqKey="Berrio E">E Berrio</name></author><author><name sortKey="Tabernero, J" uniqKey="Tabernero J">J Tabernero</name></author><author><name sortKey="Artal, P" uniqKey="Artal P">P Artal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Leysen, I" uniqKey="Leysen I">I Leysen</name></author><author><name sortKey="Bartholomeeusen, E" uniqKey="Bartholomeeusen E">E Bartholomeeusen</name></author><author><name sortKey="Coeckelbergh, T" uniqKey="Coeckelbergh T">T Coeckelbergh</name></author><author><name sortKey="Tassignon, Mj" uniqKey="Tassignon M">MJ Tassignon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Woodward, Ma" uniqKey="Woodward M">MA Woodward</name></author><author><name sortKey="Randleman, Jb" uniqKey="Randleman J">JB Randleman</name></author><author><name sortKey="Stulting, Rd" uniqKey="Stulting R">RD Stulting</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Vries, Ne" uniqKey="De Vries N">NE De Vries</name></author><author><name sortKey="Webers, Ca" uniqKey="Webers C">CA Webers</name></author><author><name sortKey="Touwslager, Wr" uniqKey="Touwslager W">WR Touwslager</name></author><author><name sortKey="Bauer, Nj" uniqKey="Bauer N">NJ Bauer</name></author><author><name sortKey="De Branbander, J" uniqKey="De Branbander J">J De Branbander</name></author><author><name sortKey="Berendschot, Tt" uniqKey="Berendschot T">TT Berendschot</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rosales, P" uniqKey="Rosales P">P Rosales</name></author><author><name sortKey="De Castro, A" uniqKey="De Castro A">A De Castro</name></author><author><name sortKey="Jimenez Alfaro, I" uniqKey="Jimenez Alfaro I">I Jiménez-alfaro</name></author><author><name sortKey="Marcos, S" uniqKey="Marcos S">S Marcos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Berdahl, Jp" uniqKey="Berdahl J">JP Berdahl</name></author><author><name sortKey="Waring, Go" uniqKey="Waring G">GO Waring</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Solomon, R" uniqKey="Solomon R">R Solomon</name></author><author><name sortKey="Donnenfeld, Ed" uniqKey="Donnenfeld E">ED Donnenfeld</name></author><author><name sortKey="Perry, Hd" uniqKey="Perry H">HD Perry</name></author><author><name sortKey="Stein, Jj" uniqKey="Stein J">JJ Stein</name></author><author><name sortKey="Su, My" uniqKey="Su M">MY Su</name></author><author><name sortKey="Holladay, Jt" uniqKey="Holladay J">JT Holladay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Melki, Sa" uniqKey="Melki S">SA Melki</name></author><author><name sortKey="Harissi Dagher, M" uniqKey="Harissi Dagher M">M Harissi-dagher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Uozato, H" uniqKey="Uozato H">H Uozato</name></author><author><name sortKey="Guyton, Dl" uniqKey="Guyton D">DL Guyton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Enoch, Jm" uniqKey="Enoch J">JM Enoch</name></author><author><name sortKey="Laties, Am" uniqKey="Laties A">AM Laties</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mandell, Rb" uniqKey="Mandell R">RB Mandell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fay, Am" uniqKey="Fay A">AM Fay</name></author><author><name sortKey="Trokel, Sl" uniqKey="Trokel S">SL Trokel</name></author><author><name sortKey="Myers, Ja" uniqKey="Myers J">JA Myers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Ortueta, D" uniqKey="De Ortueta D">D De Ortueta</name></author><author><name sortKey="Schreyger, Fd" uniqKey="Schreyger F">FD Schreyger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kermani, O" uniqKey="Kermani O">O Kermani</name></author><author><name sortKey="Oberheide, U" uniqKey="Oberheide U">U Oberheide</name></author><author><name sortKey="Schmiedt, K" uniqKey="Schmiedt K">K Schmiedt</name></author><author><name sortKey="Gerten, G" uniqKey="Gerten G">G Gerten</name></author><author><name sortKey="Bains, Hs" uniqKey="Bains H">HS Bains</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nepomuceno, Rl" uniqKey="Nepomuceno R">RL Nepomuceno</name></author><author><name sortKey="Boxer, Wachler Bs" uniqKey="Boxer W">Wachler BS Boxer</name></author><author><name sortKey="Kim, Jm" uniqKey="Kim J">JM Kim</name></author><author><name sortKey="Scruggs, R" uniqKey="Scruggs R">R Scruggs</name></author><author><name sortKey="Sato, Ml" uniqKey="Sato M">Ml Sato</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kanellopoulos, Aj" uniqKey="Kanellopoulos A">AJ Kanellopoulos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, Cc" uniqKey="Chan C">CC Chan</name></author><author><name sortKey="Boxer, Wachler Bs" uniqKey="Boxer W">Wachler BS Boxer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kermani, O" uniqKey="Kermani O">O Kermani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wachler, Bs" uniqKey="Wachler B">BS Wachler</name></author><author><name sortKey="Korn, Ts" uniqKey="Korn T">TS Korn</name></author><author><name sortKey="Chandra, Ns" uniqKey="Chandra N">NS Chandra</name></author><author><name sortKey="Michel, Fk" uniqKey="Michel F">FK Michel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Soler, V" uniqKey="Soler V">V Soler</name></author><author><name sortKey="Benito, A" uniqKey="Benito A">A Benito</name></author><author><name sortKey="Soler, P" uniqKey="Soler P">P Soler</name></author><author><name sortKey="Triozon, C" uniqKey="Triozon C">C Triozon</name></author><author><name sortKey="Arne, Jl" uniqKey="Arne J">JL Arné</name></author><author><name sortKey="Madariaga, V" uniqKey="Madariaga V">V Madariaga</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cavanaugh, Tb" uniqKey="Cavanaugh T">TB Cavanaugh</name></author><author><name sortKey="Durrie, Ds" uniqKey="Durrie D">DS Durrie</name></author><author><name sortKey="Riedel, Sm" uniqKey="Riedel S">SM Riedel</name></author><author><name sortKey="Hunkeler, Jd" uniqKey="Hunkeler J">JD Hunkeler</name></author><author><name sortKey="Lesher, Mp" uniqKey="Lesher M">MP Lesher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Legrand, Y" uniqKey="Legrand Y">Y Legrand</name></author><author><name sortKey="El Hage, Sg" uniqKey="El Hage S">SG El Hage</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cavanaugh, Tb" uniqKey="Cavanaugh T">TB Cavanaugh</name></author><author><name sortKey="Durrie, Ds" uniqKey="Durrie D">DS Durrie</name></author><author><name sortKey="Riedel, Sm" uniqKey="Riedel S">SM Riedel</name></author><author><name sortKey="Hunkeler, Jd" uniqKey="Hunkeler J">JD Hunkeler</name></author><author><name sortKey="Lesher, Mp" uniqKey="Lesher M">MP Lesher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Ek" uniqKey="Kim E">EK Kim</name></author><author><name sortKey="Jang, Jw" uniqKey="Jang J">JW Jang</name></author><author><name sortKey="Lee, Jb" uniqKey="Lee J">JB Lee</name></author><author><name sortKey="Hong, Sb" uniqKey="Hong S">SB Hong</name></author><author><name sortKey="Lee, Yg" uniqKey="Lee Y">YG Lee</name></author><author><name sortKey="Kim, Hb" uniqKey="Kim H">HB Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reinstein, Dz" uniqKey="Reinstein D">DZ Reinstein</name></author><author><name sortKey="Archer, Tj" uniqKey="Archer T">TJ Archer</name></author><author><name sortKey="Gobbe, M" uniqKey="Gobbe M">M Gobbe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lin, Dt" uniqKey="Lin D">DT Lin</name></author><author><name sortKey="Sutton, Hf" uniqKey="Sutton H">HF Sutton</name></author><author><name sortKey="Berman, M" uniqKey="Berman M">M Berman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dausch, D" uniqKey="Dausch D">D Dausch</name></author><author><name sortKey="Klein, R" uniqKey="Klein R">R Klein</name></author><author><name sortKey="Schroder, E" uniqKey="Schroder E">E Schröder</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dausch, D" uniqKey="Dausch D">D Dausch</name></author><author><name sortKey="Smecka, Z" uniqKey="Smecka Z">Z Smecka</name></author><author><name sortKey="Klein, R" uniqKey="Klein R">R Klein</name></author><author><name sortKey="Schroder, E" uniqKey="Schroder E">E Schröder</name></author><author><name sortKey="Kirchner, Sl" uniqKey="Kirchner S">Sl Kirchner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Okamoto, S" uniqKey="Okamoto S">S Okamoto</name></author><author><name sortKey="Kimura, K" uniqKey="Kimura K">K Kimura</name></author><author><name sortKey="Funakura, M" uniqKey="Funakura M">M Funakura</name></author><author><name sortKey="Ikeda, N" uniqKey="Ikeda N">N Ikeda</name></author><author><name sortKey="Hiramatsu, H" uniqKey="Hiramatsu H">H Hiramatsu</name></author><author><name sortKey="Bains, Hs" uniqKey="Bains H">HS Bains</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arbelaez, Mc" uniqKey="Arbelaez M">MC Arbelaez</name></author><author><name sortKey="Vidal, C" uniqKey="Vidal C">C Vidal</name></author><author><name sortKey="Arba Mosquera, S" uniqKey="Arba Mosquera S">S Arba-mosquera</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Oman J Ophthalmol</journal-id><journal-id journal-id-type="iso-abbrev">Oman J Ophthalmol</journal-id><journal-id journal-id-type="publisher-id">OJO</journal-id><journal-title-group><journal-title>Oman Journal of Ophthalmology</journal-title></journal-title-group><issn pub-type="ppub">0974-620X</issn><issn pub-type="epub">0974-7842</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24379548</article-id><article-id pub-id-type="pmc">3872563</article-id><article-id pub-id-type="publisher-id">OJO-6-151</article-id><article-id pub-id-type="doi">10.4103/0974-620X.122268</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title>Angle Kappa and its importance in refractive surgery</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Moshirfar</surname><given-names>Majid</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Hoggan</surname><given-names>Ryan N.</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib><contrib contrib-type="author"><name><surname>Muthappan</surname><given-names>Valliammai</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1">John A Moran Eye Center, Salt Lake City, Utah, USA</aff><aff id="aff2"><label>1</label>University of Utah, School of Medicine, Salt Lake City, Utah, USA</aff><author-notes><corresp id="cor1"><bold>Correspondence:</bold> Dr. Majid Moshirfar, John A. Moran Eye Center, 65 N Mario Capecchi, Salt Lake City, UT 84132, USA. E-mail: <email xlink:href="moshirfar@hsc.utah.edu">moshirfar@hsc.utah.edu</email></corresp></author-notes><pub-date pub-type="ppub"><season>Sep-Dec</season><year>2013</year></pub-date><volume>6</volume><issue>3</issue><fpage>151</fpage><lpage>158</lpage><permissions><copyright-statement>Copyright: © 2013 Moshirfar M, <italic>et al</italic></copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><p>Angle kappa is the difference between the pupillary and visual axis. This measurement is of paramount consideration in refractive surgery, as proper centration is required for optimal results. Angle kappa may contribute to MFIOL decentration and its resultant photic phenomena. Adjusting placement of MFIOLs for angle kappa is not supported by the literature but is likely to help reduce glare and haloes. Centering LASIK in angle kappa patients over the corneal light reflex is safe, efficacious, and recommended. Centering in-between the corneal reflex and the entrance pupil is also safe and efficacious. The literature regarding PRK in patients with an angle kappa is sparse but centering on the corneal reflex is assumed to be similar to centering LASIK on the corneal reflex. Thus, centration of MFIOLs, LASIK, and PRK should be focused on the corneal reflex for patients with a large angle kappa. More research is needed to guide surgeons’ approach to angle kappa.</p></abstract><kwd-group><kwd>Angle Kappa</kwd><kwd>Visual Axis</kwd><kwd>Pupillary Axis</kwd><kwd>LASIK</kwd><kwd>PRK</kwd><kwd>Multi focal Intra ocular lenses</kwd></kwd-group></article-meta></front><body><sec id="sec1-1"><title>Introduction</title><p>With recent advancements in the precision of refractive surgery angle kappa stands as an important consideration in improving visual outcomes. Angle kappa is defined as the angle between the visual axis (line connecting the fixation point with the fovea) and the pupillary axis (line that perpendicularly passes through the entrance pupil and the center of curvature of the cornea).[<xref ref-type="bibr" rid="ref1">1</xref>] It can be identified clinically by the nasal displacement of the corneal light reflex from the pupil center,[<xref ref-type="bibr" rid="ref2">2</xref>] and it represents a misalignment of light passing through the refractive surface of the cornea and the bundle of light formed by the pupil. <xref ref-type="fig" rid="F1">Figure 1</xref> depicts a coronal view of angle kappa as well as the surgeon's view when seen through the microscope.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>(a) Depicting angle κ, geometric center of the cornea (GCC), entrance pupil center (EPC), and coaxially sighted corneal light reflex (CSCLR) as identified by Pande and Hillman,[<xref ref-type="bibr" rid="ref4">4</xref>] (b) Surgeon's view of a large angle kappa, (c) Surgeon's view of a normal but small positive angle kappa. (•) = EPC (+) = CSCLR</p></caption><graphic xlink:href="OJO-6-151-g001"></graphic></fig><p>A large angle kappa is clinically significant as it may lead to alignment errors during photo ablation in laser refractive surgery,[<xref ref-type="bibr" rid="ref3">3</xref>] as well lens decentration in intraocular refractive surgery. The decentration of ablation zones can lead to under correction[<xref ref-type="bibr" rid="ref4">4</xref>] and irregular astigmatism.[<xref ref-type="bibr" rid="ref3">3</xref>] Decentration of intraocular lenses may cause photic phenomenon[<xref ref-type="bibr" rid="ref5">5</xref>] and decreased lens effectiveness.[<xref ref-type="bibr" rid="ref6">6</xref>] This issue is most important in hyperopic patients, who tend to have larger angle kappa values.[<xref ref-type="bibr" rid="ref3">3</xref><xref ref-type="bibr" rid="ref7">7</xref>]</p><p>A Pubmed literature review was conducted for several terms related to angle kappa and refractive surgery. Relevant manuscripts were compiled into this review to summarize the current literature on the role of angle kappa in refractive surgery, specifically as it relates to PRK, LASIK, and placement of multifocal intraocular lenses (MFIOLs).</p></sec><sec sec-type="materials|methods" id="sec1-2"><title>Materials and Methods</title><p>A thorough PubMed search was conducted using various combinations of the following terms: Angle Kappa, LASIK, PRK, Intraocular lenses, Capsulorrhexis, Centration, Refractive Surgery, Cataract Surgery, Pupillary Axis, Visual Axis, Coaxial Axis, Pupil Tracking, and Hyperopia. The search was limited to articles of the following types: Reviews, systematic reviews, randomized controlled trial, practice guidelines, meta-analysis, journal article, guideline, clinical trial, and case reports. The initial literature review resulted in 66 articles. From the initial inquiry articles were chosen based on their relevance to Angle kappa, MFIOLs, LASIK, PRK and Hyperopia. In total 40 articles were selected, reviewed for relevant content, and compiled into this review.</p><sec id="sec2-1"><title>Angle kappa in the general population</title><p>As the fovea lies slightly temporal to the point at which the pupillary axis intersects with the posterior pole of the globe, the normal angle kappa is slightly positive.[<xref ref-type="bibr" rid="ref3">3</xref>] The high prevalence of small positive angle kappa values in the non-hyperopic population was reported in 2005 by Srivannaboon and Chotikavanich. In 408/420 (97%) eyes undergoing refractive surgery for correction of myopia, a positive angle kappa of 0.5 mm or less was observed.[<xref ref-type="bibr" rid="ref8">8</xref>]</p><p>Several studies have been conducted to determine the population's mean value of a positive angle kappa. The results of these studies are summarized in <xref ref-type="table" rid="T1">Table 1</xref>. Based on current literature the mean value of angle kappa in a normal population of emmetropes lies between 2.78 ± 0.12° in right eyes and 3.32 ± 0.13° in left eyes when measured by the Syntophore corneal topography system (Clement Clarke International Ltd, London, UK).[<xref ref-type="bibr" rid="ref3">3</xref><xref ref-type="bibr" rid="ref9">9</xref>] The value lies between 5.55 ± 0.13° and 5.62 ± 0.10° in right and left eyes respectively when measured by the Orbscan II corneal topographer (Bausch and Lomb, USA).[<xref ref-type="bibr" rid="ref3">3</xref>] The range may slightly differ (4.97 ± 1.24°) if measured with the Orbscan IIz (Bausch and Lomb, USA).[<xref ref-type="bibr" rid="ref10">10</xref>]</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Summary of studies reporting normative angle kappa values</p></caption><graphic xlink:href="OJO-6-151-g002"></graphic></table-wrap><p>The significance of eye dominance as well as the machine used to measure angle kappa is not fully understood however, these are two variables that should likely be considered when contemplating issues related to angle kappa. Additionally gender does not appear to be correlated with angle kappa.[<xref ref-type="bibr" rid="ref1">1</xref>] While angle kappa tends to decrease with age,[<xref ref-type="bibr" rid="ref1">1</xref>] the change in direction or magnitude is not significant.[<xref ref-type="bibr" rid="ref11">11</xref>]</p></sec><sec id="sec2-2"><title>Angle kappa and multifocal intra ocular lenses</title><p>Multi-focal intraocular lenses (MFIOLs) are designed with concentric apodization to provide functional vision at distance as well as near. With this design distance and intermediate visual acuity are adversely affected if the lens is decentered.[<xref ref-type="bibr" rid="ref6">6</xref>] The etiology of this is not fully understood. Decentration can also cause photic phenomenon[<xref ref-type="bibr" rid="ref5">5</xref>] and is one of the main indications for MFIOL exchange.[<xref ref-type="bibr" rid="ref12">12</xref>] A large angle kappa could contribute to functional decentration if the MFIOL is centered on one axis, (pupillary or visual axis) and is not aligned with the other.</p><p>In 2011 Prakash <italic>et al</italic> reported that larger preoperative angle kappa values in MFIOL placement were correlated with patient complaints of glare (<italic>R<sup>2</sup>= 0.26, P= 0.033</italic>). They also reported that perceived severity of haloes were correlated to angle kappa and postoperative uncorrected distance visual acuity (UCVA) (<italic>R<sup>2</sup> = 0.26, P = 0.029</italic>).[<xref ref-type="bibr" rid="ref5">5</xref>] While positive angle kappa may play a role in contributing to glare and haloes, dissatisfaction with MFIOLs is truly multifactorial. Blurry vision of various etiologies,[<xref ref-type="bibr" rid="ref13">13</xref>] other forms of photic phenomenon,[<xref ref-type="bibr" rid="ref14">14</xref>] and unsatisfactory postoperative distance UCVA[<xref ref-type="bibr" rid="ref5">5</xref>] are more common patient complaints after receiving MFIOLs.</p><p>A large angle kappa may contribute to functional decentration of MFIOLs, but the effect of this decentration is not clear. In 2010, Rosales <italic>et al</italic> used simulated aberration models generated from the anatomical, Purkinje, and Sheimpflug data of 21 eyes to show that the tilt and decentration of IOLs have only a minor effect on higher order aberrations.[<xref ref-type="bibr" rid="ref15">15</xref>] However, it has been reported that decentration of MFIOLs greater than 0.7 mm substantially impairs distance visual acuity.[<xref ref-type="bibr" rid="ref6">6</xref>]</p><p>If the lens is significantly decentered because of failure to accommodate for angle kappa, then central light rays may miss the central optical zone and pass through one of the multifocal rings, leading to glare. In 2012, Berdahl suggested that MFIOLs are unacceptable for use if the angle kappa is greater than half of the diameter of the central optical zone for the respective lens. For the ReSTOR lens (Alcon TX, USA) this would be an angle kappa greater than 0.4mm and for the Tecnis lens (Abbott Illinois, USA) this would be a value greater than 0.5 mm.[<xref ref-type="bibr" rid="ref16">16</xref>]</p><p>One proposed method for compensating for large angle kappa in MFIOLs is to purposely decenter the lens toward the visual axis. Due to contraction of the capsule, memory of the haptics, and IOL rotation, it is uncertain if the lens would stay in the decentered position.[<xref ref-type="bibr" rid="ref5">5</xref>] Gluing a single haptic of the IOL to align its position with the visual axis has also been suggested.[<xref ref-type="bibr" rid="ref5">5</xref>] Solomon and Donnefield have reported performing post-operative pupilloplasty with argon laser to center the pupil, and move the pupillary axis closer to the visual axis in MFIOL cases with a large angle kappa.[<xref ref-type="bibr" rid="ref17">17</xref>] Melki and Harissi-Dagher described a method for centering the capsulorrhexis on the coaxially sighted intraocular lens reflex instead of the corneal reflex as a way to accommodate for angle kappa.[<xref ref-type="bibr" rid="ref18">18</xref>] These methods may be effective but have not been validated in large studies. More research is needed to determine their clinical relevance.</p><p>Based on the current literature, a large angle kappa may contribute to decentration of MFIOLs potentially resulting in glare and decreased visual acuity. However, the clinical significance of lens decentration as a direct result of angle kappa is not fully understood. There is no evidence to show that altering centration of MFIOLs is detrimental or dangerous for the patient. Thus we recommend centering these lenses on the corneal reflex in eyes with angle kappa values greater than the normative values discussed earlier as per eye and per topography system used.</p></sec><sec id="sec2-3"><title>Angle kappa in laser guided refractive surgery: the debate over where to center ablation profiles</title><p>There are four main methods for centration of laser refractive surgery that have been suggested in the literature:</p><p><list list-type="order"><list-item><p>Center of the pupil: In 1987, Uozato and Guyton suggested using the center of the pupil[<xref ref-type="bibr" rid="ref19">19</xref>] as it has been shown that photoreceptors actively orient themselves toward the pupillary center.[<xref ref-type="bibr" rid="ref20">20</xref>] Mandell seconded this suggestions with the rationale that the pupil defines the bundle of light that passes through the eye and forms the retinal image.[<xref ref-type="bibr" rid="ref21">21</xref>]</p></list-item><list-item><p>Coaxially Sighted Corneal Light Reflex: In 1993, Pande and Hillman concluded that the coaxially sighted corneal light reflex (CSCLR) should be used for centration as it was the closest measurable point to the visual axis.[<xref ref-type="bibr" rid="ref4">4</xref>] Additionally, they noted that the center of the pupil changes position with changes in the size of the pupil,[<xref ref-type="bibr" rid="ref22">22</xref>] and thus should not be used for centration.[<xref ref-type="bibr" rid="ref4">4</xref>]</p></list-item><list-item><p>Corneal Vertex Normal: In 2006, De Ortueta <italic>et al</italic> centered ablation zones on the corneal vertex normal,[<xref ref-type="bibr" rid="ref23">23</xref>] which is the point of maximum elevation in corneal topography.[<xref ref-type="bibr" rid="ref2">2</xref>] This was combined with videokeratoscopy/pupil tracking which allowed the ablation zone to shift a fixed amount in relation to the center of the pupil as it changed with differing light conditions.[<xref ref-type="bibr" rid="ref23">23</xref>] The results of this study are summarized in <xref ref-type="table" rid="T2">Table 2</xref>.</p></list-item><list-item><p>Between the pupillary and visual axis: In 2009 Kermani <italic>et al</italic> centered on a distance halfway between the center of the pupil (line of sight) and the corneal light reflex (visual axis) in patients with a large angle kappa.[<xref ref-type="bibr" rid="ref24">24</xref>]</p></list-item></list></p><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Summary of articles relating angle kappa to LASIK</p></caption><graphic xlink:href="OJO-6-151-g003"></graphic></table-wrap><p>These four methods of centration have not simultaneously been compared in head to head trials. The following will discuss what has been accomplished in the literature specifically as it relates centering in patients with a large angle kappa.</p></sec><sec id="sec2-4"><title>Angle kappa and hyperopic laser assisted in situ keratomileusis (LASIK)</title><p>Several studies are found in the literature that demonstrate the benefits of moving centration for hyperopic LASIK to the CSCLR to adjust for a large angle kappa. This review focused on hyperopic LASIK as hyperopes are more likely to have a large angle kappa. These studies are summarized in <xref ref-type="table" rid="T2">Table 2</xref>.</p><p>Nepomuceno <italic>et al</italic> was the first to validate this method in 2004 with patients who underwent hyperopic LASIK correction using the LADARVision 4000 excimer laser (Alcon, TX, USA). They reported an increased safety profile which they attributed to this centration technique because the same surgeon did not have equivalently good results when using other centration sites. The authors stressed the importance of centering over the CSCLR for hyperopes due to a large angle kappa, and also because hyperopes have smaller functional optical zones and less tolerance of decentration.[<xref ref-type="bibr" rid="ref25">25</xref>] Several years later, Kanellopoulos also reported a good safety profile when centering on the CSCLR to accommodate for angle kappa. In addition, he reported a significant postoperative improvement in uncorrected visual acuity and an increase in best spectacle corrected visual acuity (BSCVA).[<xref ref-type="bibr" rid="ref26">26</xref>]</p><p>Chan and Boxer Wachler measured the amount of post-operative decentration of ablation zones centered on the CSCLR in patients with a large angle kappa. This value was added to the pre-operative angle kappa to represent the amount of decentration that would have occurred if the ablation had been centered on the entrance pupil. The theoretical decentration from entrance pupil centration was significantly larger than the decentration that actually occurred when centering on the corneal reflex.[<xref ref-type="bibr" rid="ref27">27</xref>]</p><p>Kermani reported a case of a patient with a large angle kappa who underwent LASIK with ablation centered on the entrance pupil. Postoperatively he had lost two lines of BSCVA, his hyperopia was under corrected, and astigmatic error was introduced. The patient later had a repeat procedure centered on the CSCLR. The refractive error was corrected and the BSCVA was restored.[<xref ref-type="bibr" rid="ref28">28</xref>]</p><p>The above reviewed studies helped establish the safety and efficacy of centering ablation profiles on or near the visual axis in patients with a large angle kappa. In 2003, a case report of a patient with bilateral large angle kappa provided the first direct comparison of centering on the entrance pupil versus centering on the CSCLR. He had LASIK centered on the entrance pupil in the right eye, and over the CSCLR in the left eye. The left eye demonstrated significantly better visual acuity, smaller refractive error, and a smaller amount of post-operative decentration.[<xref ref-type="bibr" rid="ref29">29</xref>]</p><p>While this case report was intriguing, it was not until 2009 that a larger study comparing the two methods was published. Kermani <italic>et al</italic> conducted a retrospective review of LASIK centered on the pupil versus centration focused on the CSCLR in eyes with a positive angle kappa. Based on their previous experience the researchers centered the CSCLR group on a point midway between the line of sight and the corneal reflex. They reported only minimal differences in safety and efficacy between the two centration points. However, they did report a decrease in total higher order aberrations in the CSCLR group; this effect was not seen in the pupil centered group.[<xref ref-type="bibr" rid="ref24">24</xref>]</p><p>In 2011, Soler <italic>et al</italic> published the only randomized double masked comparison of pupil centered vs. corneal reflex centered hyperopic LASIK. This study concluded that there were no statistical differences in terms of safety, efficacy, or accuracy between the two different centration points[<xref ref-type="bibr" rid="ref30">30</xref>] However, this study was limited by a small sample size and by a patient population of mild to moderate hyperopes. The smaller angle kappa values associated with lower degrees of hyperopia may have masked prominent differences between the two centration options.</p><p>From the current literature, several conclusions can be drawn. Angle kappa generally is larger in hyperopic patients.[<xref ref-type="bibr" rid="ref3">3</xref>] A larger angle kappa increases the risk for decentration of the optical zone from the visual axis if ablation is centered over the entrance pupil. Such decentration can cause many optical problems, induce astigmatism,[<xref ref-type="bibr" rid="ref26">26</xref>] and leave the patient's visual deficits uncorrected. Thus, centering over the corneal reflex may decrease higher order aberrations which the patient is likely to appreciate.[<xref ref-type="bibr" rid="ref30">30</xref>]</p><p>We recommend using the corneal reflex when performing LASIK on hyperopes, especially when they have a large angle kappa. Centering over a point half of the distance between the CSCLR and the pupil center may also be an effective method in angle kappa patients.[<xref ref-type="bibr" rid="ref24">24</xref>] Using the entrance pupil when performing LASIK on myopes or mild hyperopes with a small angle kappa is safe and efficacious as the entrance pupil and CSCLR will nearly align. A large double masked head to head trial comparing the various centration techniques is needed to further guide this debate. This study would be most helpful if it had a large array of hyperopes with multiple ranges of angle kappa values that could be individually analysed.</p></sec><sec id="sec2-5"><title>Angle kappa and photorefractive keratectomy (PRK)</title><p>There have been very few studies conducted concerning angle kappa and PRK. Many of these studies only indirectly address angle kappa by touching on principles of decentration in myopes or principles applied to hyperopic surgery where angle kappa is more prevalent. The results of these studies are summarized in <xref ref-type="table" rid="T3">Table 3</xref>.</p><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Summary of articles relating angle kappa to PRK</p></caption><graphic xlink:href="OJO-6-151-g004"></graphic></table-wrap><p>In 1993, Cavanaugh <italic>et al</italic> noted that angle lambda, the angle between the pupillary axis and the line of sight, could contribute to decentration error when performing PRK.[<xref ref-type="bibr" rid="ref31">31</xref>] Angle kappa and angle lambda are nearly identical at distance fixation.[<xref ref-type="bibr" rid="ref32">32</xref>] This study emphasized centering ablation zones for PRK over the entrance pupil as crucial to the success of the procedure.[<xref ref-type="bibr" rid="ref31">31</xref>] However, it should be noted that this study was conducted on myopes, who are not as likely as hyperopes to have a large angle kappa.[<xref ref-type="bibr" rid="ref3">3</xref>]</p><p>In 1993, Cavanaugh <italic>et al</italic> published a separate study on PRK centered over the entrance pupil, which measured the average amount of decentration from the corneal vertex that occurs and resultant effects on visual acuity. They reported a positive correlation between preserved UCVA and BCVA in patients whose decentration was less than 1.0 mm.[<xref ref-type="bibr" rid="ref33">33</xref>] This would suggest that if PRK is centered on the entrance pupil in a patient with a large angle kappa, decentration may be insignificant if it is less than 1.0 mm. However, the relevance of this measurement is hard to extrapolate as the authors centered their procedures over the entrance pupil but then measured decentration from the corneal vertex.</p><p>In 1998, Kim <italic>et al</italic> measured and compared the post-operative decentration of ablation zones in PRK using three different methods: 1) ablation zones centered on the corneal light reflex as viewed by both eyes of the surgeon, 2) ablation zones centered on the corneal reflex viewed with only the surgeon's left eye, and 3) ablation zones centered on the entrance pupil viewed with only the surgeon's left eye. The smallest amount of decentration was seen in the group which was centered on the entrance pupil viewed by the surgeons left eye. The largest decentration was seen when centered on the corneal reflex viewed by the surgeons left eye only. They attributed this result partly to a large angle kappa and misalignment, but mainly thought it to be a product misalignment of the fixation tube when viewing the patient's right eye with the surgeon's left eye.[<xref ref-type="bibr" rid="ref34">34</xref>]</p><p>In 2012, Reinstein <italic>et al</italic> reported a case of PRK centered on the corneal vertex in a patient with a large vertical angle kappa. The patient had significant night vision disturbances after having radial keratotomy. The authors speculated that wave front guided profiles centered on his pupil would have been inappropriate for the irregular surface of his cornea and potentially could have made his symptoms worse. The corneal topography ablation profile centered on his corneal reflex addressed these irregularities and was better suited to fix his problem. PRK was performed using the profile centered on the corneal light reflex. The patient had improved visual results and a subjective reduction in his night vision disturbances.[<xref ref-type="bibr" rid="ref35">35</xref>]</p><p>While investigating decentration patterns in myopic patients that underwent PRK, Lin <italic>et al</italic> reported moving the ablation zone to a point half of the distance between the pupil center and the corneal reflex when the discrepancy between them (angle kappa) was more than 0.2 mm. This represented an undisclosed percentage of the study population and they did not perform sub group analysis. However, they did report that moving the ablation zone such a small distance was tolerable for the patients.[<xref ref-type="bibr" rid="ref36">36</xref>]</p><p>Although centering PRK over the entrance pupil has not been specifically tested in patients with a large angle kappa, it has been tested in hyperopes which tend to have larger angle kappa values.[<xref ref-type="bibr" rid="ref3">3</xref>] Dausch <italic>et al</italic> reported standard PRK with a 7.0 mm ablation zone centered over the entrance pupil to be efficient and relatively safe for correction of hyperopia up to 7.5 diopters.[<xref ref-type="bibr" rid="ref37">37</xref>] They also reported that PRK with a 9.0 mm ablation zone centered over the entrance pupil is safe and efficient in treating hyperopia up to 8.25 diopters.[<xref ref-type="bibr" rid="ref38">38</xref>]</p><p>The data regarding angle kappa and PRK is very limited, and no specific conclusions can be drawn. This is likely to be due to the limited number of publications on the topic of angle kappa combined with the nationwide trend to perform LASIK more frequently than PRK. Although the limited data suggest that centering on the entrance pupil is safe and effective, this data comes largely from studies which only indirectly addressed the issue of angle kappa. Centering on the entrance pupil may be safe if the ablation zone is made large enough to cover the misalignment induced by angle kappa. The optical and refractive principles of PRK very closely mimic those used in LASIK. Given this similarity and the body of evidence which supports LASIK centration over the corneal reflex, we recommend centering PRK over the corneal reflex in patients with a large angle kappa.</p></sec><sec id="sec2-6"><title>Angle kappa and myopic LASIK</title><p>It may also necessary to consider angle kappa in centration for treatment in myopic patients. It has been suggested by Okamoto <italic>et al</italic> that approximately 30% of myopic refractive surgery candidates have an angle kappa large enough to warrant centering closer to the visual axis.[<xref ref-type="bibr" rid="ref39">39</xref>] However, other authors have suggested that angle kappa in myopia is usually negligible.[<xref ref-type="bibr" rid="ref19">19</xref><xref ref-type="bibr" rid="ref25">25</xref>] A full discussion of the centration techniques in myopia is beyond the scope of this article but two studies deserve mention. Arbelaez <italic>et al</italic> compared LASIK centered over the pupil to LASIK centered over the corneal vertex in 52 myopic patients with a moderate to large angle kappa. The corneal vertex centered treatments performed better in terms of induced ocular aberrations and asphericity, but there was no difference in photopic visual acuity.[<xref ref-type="bibr" rid="ref40">40</xref>] In 2009 Okamoto <italic>et al</italic> compared myopic LASIK centered on the CSCLR with centration on the entrance pupil in 556 eyes with unknown angle kappa values. LASIK centered on the CSCLR was significantly safer, more effective, and had lower induction of coma and total higher order aberrations than LASIK treatments centered on the pupil.[<xref ref-type="bibr" rid="ref39">39</xref>]</p></sec></sec><sec sec-type="conclusions" id="sec1-3"><title>Conclusions</title><p>Angle kappa is of great importance in refractive surgery, particularly when treating hyperopes, who tend have large angle kappa values. In some instances, this may also be important for myopes. Angle kappa may play a role in MFIOL decentration, possibly leading to increased glare and haloes. This decentration may be clinically insignificant; however, centering the MFIOLs on the corneal reflex will likely decrease this risk. In hyperopic LASIK or PRK, centration should be focused on either the corneal reflex or the distance half way between pupillary center and the corneal reflex, especially in patients with a large angle kappa. Further studies are needed to fully establish the difference between the various centration methods used in refractive surgery and their effects on eyes with a large angle kappa.</p></sec></body><back><ack><title>Acknowledgement</title><p>Special thanks to Cody Hockin, Graphic Designer, BFA Visual Communication, for his assistance in generation of <xref ref-type="fig" rid="F1">Figure 1</xref>. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.</p></ack><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold> Nil</p></fn><fn fn-type="conflict"><p><bold>Conflict of Interest:</bold> None declared.</p></fn></fn-group><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hashemi</surname><given-names>H</given-names></name><name><surname>Khabazkhoob</surname><given-names>M</given-names></name><name><surname>Yazdani</surname><given-names>K</given-names></name><name><surname>Mehravaran</surname><given-names>S</given-names></name><name><surname>Jafarzadejpur</surname><given-names>E</given-names></name><name><surname>Fotouhi</surname><given-names>A</given-names></name></person-group><article-title>Distribution of angle kappa measurements with Orbscan II in a population-based survey</article-title><source>J Refract Surg</source><year>2010</year><volume>26</volume><fpage>966</fpage><lpage>71</lpage><pub-id pub-id-type="pmid">20128530</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Park</surname><given-names>CY</given-names></name><name><surname>Oh</surname><given-names>SY</given-names></name><name><surname>Chuck</surname><given-names>RS</given-names></name></person-group><article-title>Measurement of angle kappa and centration in refractive surgery</article-title><source>Curr Opin Ophthalmol</source><year>2012</year><volume>23</volume><fpage>269</fpage><lpage>75</lpage><pub-id pub-id-type="pmid">22569467</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Basmak</surname><given-names>H</given-names></name><name><surname>Sahin</surname><given-names>A</given-names></name><name><surname>Yildirim</surname><given-names>N</given-names></name><name><surname>Papakostas</surname><given-names>TD</given-names></name><name><surname>Kanellopoulos</surname><given-names>JA</given-names></name></person-group><article-title>Measurement of angle kappa with synoptophore and Orbscan II in a normal population</article-title><source>J Refract Surg</source><year>2007</year><volume>23</volume><fpage>456</fpage><lpage>60</lpage><pub-id pub-id-type="pmid">17523505</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pande</surname><given-names>M</given-names></name><name><surname>Hillman</surname><given-names>JS</given-names></name></person-group><article-title>Optical zone centration in keratorefractive surgery. Entrance pupil center, visual axis, coaxially sighted corneal reflex, or geometric corneal center?</article-title><source>Ophthalmology</source><year>1993</year><volume>100</volume><fpage>1230</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">8341507</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Prakash</surname><given-names>G</given-names></name><name><surname>Prakash</surname><given-names>DR</given-names></name><name><surname>Agarwal</surname><given-names>A</given-names></name><name><surname>Kumar</surname><given-names>DA</given-names></name><name><surname>Agarwal</surname><given-names>A</given-names></name><name><surname>Jacob</surname><given-names>S</given-names></name></person-group><article-title>Predictive factor and kappa angle analysis for visual satisfactions in patients with multifocal IOL implantation</article-title><source>Eye (Lond)</source><year>2011</year><volume>25</volume><fpage>1187</fpage><lpage>93</lpage><pub-id pub-id-type="pmid">21681216</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hayashi</surname><given-names>K</given-names></name><name><surname>Hayashi</surname><given-names>H</given-names></name><name><surname>Nakao</surname><given-names>F</given-names></name><name><surname>Hayashi</surname><given-names>F</given-names></name></person-group><article-title>Correlation between pupillary size and intraocular lens decentration and visual acuity of a zonal-progressive multifocal lens and a monofocal lens</article-title><source>Ophthalmology</source><year>2001</year><volume>108</volume><fpage>2011</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">11713071</pub-id></element-citation></ref><ref id="ref7"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kermani</surname><given-names>O</given-names></name><name><surname>Schmeidt</surname><given-names>K</given-names></name><name><surname>Oberheide</surname><given-names>U</given-names></name><name><surname>Gerten</surname><given-names>Gl</given-names></name></person-group><article-title>Hyperopic laser <italic>in situ</italic> keratomileusis with 5.5-, 6.5-, and 7.0-mm optical zones</article-title><source>J Refract Surg</source><year>2005</year><volume>21</volume><fpage>52</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">15724685</pub-id></element-citation></ref><ref id="ref8"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Srivannaboon</surname><given-names>S</given-names></name><name><surname>Chotikavanich</surname><given-names>S</given-names></name></person-group><article-title>Corneal characteristics in myopic patients</article-title><source>J Med Assoc Thai</source><year>2005</year><volume>88</volume><fpage>1222</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">16536108</pub-id></element-citation></ref><ref id="ref9"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Basmak</surname><given-names>H</given-names></name><name><surname>Sahin</surname><given-names>A</given-names></name><name><surname>Yildirim</surname><given-names>N</given-names></name><name><surname>Saricicek</surname><given-names>T</given-names></name><name><surname>Yurdakul</surname><given-names>S</given-names></name></person-group><article-title>The angle kappa in strabismic individuals</article-title><source>Strabismus</source><year>2007</year><volume>15</volume><fpage>193</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">18058355</pub-id></element-citation></ref><ref id="ref10"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zarei-Ghanavati</surname><given-names>S</given-names></name><name><surname>Gharaee</surname><given-names>H</given-names></name><name><surname>Eslampour</surname><given-names>A</given-names></name><name><surname>Abrishami</surname><given-names>M</given-names></name><name><surname>Ghasemi-Moghadam</surname><given-names>S</given-names></name></person-group><article-title>Angle kappa changes after photorefractive keratectomy for myopia</article-title><source>Int Ophthalmol</source><year>2013</year><comment>In press</comment></element-citation></ref><ref id="ref11"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Berrio</surname><given-names>E</given-names></name><name><surname>Tabernero</surname><given-names>J</given-names></name><name><surname>Artal</surname><given-names>P</given-names></name></person-group><article-title>Optical aberrations and alignment of the eye with age</article-title><source>J Vis</source><year>2010</year><volume>10</volume><fpage>34</fpage><pub-id pub-id-type="pmid">21196516</pub-id></element-citation></ref><ref id="ref12"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Leysen</surname><given-names>I</given-names></name><name><surname>Bartholomeeusen</surname><given-names>E</given-names></name><name><surname>Coeckelbergh</surname><given-names>T</given-names></name><name><surname>Tassignon</surname><given-names>MJ</given-names></name></person-group><article-title>Surgical outcomes of intraocular lens exchange: Five-year study</article-title><source>J Cataract Refract Surg</source><year>2009</year><volume>35</volume><fpage>1013</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">19465286</pub-id></element-citation></ref><ref id="ref13"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Woodward</surname><given-names>MA</given-names></name><name><surname>Randleman</surname><given-names>JB</given-names></name><name><surname>Stulting</surname><given-names>RD</given-names></name></person-group><article-title>Dissatisfaction after multifocal intraocular lens implantation</article-title><source>J Cataract Refract Surg</source><year>2009</year><volume>35</volume><fpage>992</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">19465282</pub-id></element-citation></ref><ref id="ref14"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>De Vries</surname><given-names>NE</given-names></name><name><surname>Webers</surname><given-names>CA</given-names></name><name><surname>Touwslager</surname><given-names>WR</given-names></name><name><surname>Bauer</surname><given-names>NJ</given-names></name><name><surname>De Branbander</surname><given-names>J</given-names></name><name><surname>Berendschot</surname><given-names>TT</given-names></name><etal></etal></person-group><article-title>Dissatisfaction after implantation of multifocal intraocular lenses</article-title><source>J Cataract Refract Surg</source><year>2011</year><volume>37</volume><fpage>859</fpage><lpage>65</lpage><pub-id pub-id-type="pmid">21397457</pub-id></element-citation></ref><ref id="ref15"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rosales</surname><given-names>P</given-names></name><name><surname>De Castro</surname><given-names>A</given-names></name><name><surname>Jiménez-alfaro</surname><given-names>I</given-names></name><name><surname>Marcos</surname><given-names>S</given-names></name></person-group><article-title>Intraocular lens alignment from purkinje and Scheimpflug imaging</article-title><source>Clin Exp Optom</source><year>2010</year><volume>93</volume><fpage>400</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">20738324</pub-id></element-citation></ref><ref id="ref16"><label>16</label><element-citation publication-type="webpage"><person-group person-group-type="author"><name><surname>Berdahl</surname><given-names>JP</given-names></name><name><surname>Waring</surname><given-names>GO</given-names></name></person-group><article-title>Match right lens to patient needs: 10 objective measurements can improve multifocal IOL implantation outcomes [monograph on the internet]</article-title><source>Ophthalmology Times</source><year>2012</year><date-in-citation>Last cited 2013 Oct 4</date-in-citation><fpage>28</fpage><lpage>9</lpage><comment>Available from: <uri xlink:type="simple" xlink:href="http://digital.healthcaregroup.advanstar.com">http://digital.healthcaregroup.advanstar.com</uri></comment></element-citation></ref><ref id="ref17"><label>17</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Solomon</surname><given-names>R</given-names></name><name><surname>Donnenfeld</surname><given-names>ED</given-names></name><name><surname>Perry</surname><given-names>HD</given-names></name><name><surname>Stein</surname><given-names>JJ</given-names></name><name><surname>Su</surname><given-names>MY</given-names></name><name><surname>Holladay</surname><given-names>JT</given-names></name></person-group><article-title>Argon laser iridoplasty to improve visual function following multifocal IOL implantation</article-title><year>2007</year><month>11</month><day>12</day><publisher-loc>New Orleans, LA</publisher-loc><publisher-name>Poster presented at: The AAO Annual Meeting</publisher-name></element-citation></ref><ref id="ref18"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Melki</surname><given-names>SA</given-names></name><name><surname>Harissi-dagher</surname><given-names>M</given-names></name></person-group><article-title>Coaxially sighted intraocular lens light reflex for centration of the multifocal single piece intraocular lens</article-title><source>Can J Ophthalmol</source><year>2011</year><volume>46</volume><fpage>319</fpage><lpage>21</lpage><pub-id pub-id-type="pmid">21816250</pub-id></element-citation></ref><ref id="ref19"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Uozato</surname><given-names>H</given-names></name><name><surname>Guyton</surname><given-names>DL</given-names></name></person-group><article-title>Centering corneal surgical procedures</article-title><source>Am J Ophthalmol</source><year>1987</year><volume>103</volume><fpage>264</fpage><lpage>75</lpage><pub-id pub-id-type="pmid">3826233</pub-id></element-citation></ref><ref id="ref20"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Enoch</surname><given-names>JM</given-names></name><name><surname>Laties</surname><given-names>AM</given-names></name></person-group><article-title>An analysis of retinal receptor orientation. II. Predictions for psychophysical tests</article-title><source>Invest Ophthalmol</source><year>1971</year><volume>10</volume><fpage>959</fpage><lpage>70</lpage><pub-id pub-id-type="pmid">5128771</pub-id></element-citation></ref><ref id="ref21"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mandell</surname><given-names>RB</given-names></name></person-group><article-title>Apparent pupil displacement in videokeratography</article-title><source>CLAO J</source><year>1994</year><volume>20</volume><fpage>123</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">8044978</pub-id></element-citation></ref><ref id="ref22"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fay</surname><given-names>AM</given-names></name><name><surname>Trokel</surname><given-names>SL</given-names></name><name><surname>Myers</surname><given-names>JA</given-names></name></person-group><article-title>Pupil diameter and the principal ray</article-title><source>J Cataract Refract Surg</source><year>1992</year><volume>18</volume><fpage>348</fpage><lpage>51</lpage><pub-id pub-id-type="pmid">1501085</pub-id></element-citation></ref><ref id="ref23"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>De Ortueta</surname><given-names>D</given-names></name><name><surname>Schreyger</surname><given-names>FD</given-names></name></person-group><article-title>Centration on the cornea vertex normal during hyperopic refractive photoablation using videokeratoscopy</article-title><source>J Refract Surg</source><year>2007</year><volume>23</volume><fpage>198</fpage><lpage>200</lpage><pub-id pub-id-type="pmid">17326360</pub-id></element-citation></ref><ref id="ref24"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kermani</surname><given-names>O</given-names></name><name><surname>Oberheide</surname><given-names>U</given-names></name><name><surname>Schmiedt</surname><given-names>K</given-names></name><name><surname>Gerten</surname><given-names>G</given-names></name><name><surname>Bains</surname><given-names>HS</given-names></name></person-group><article-title>Outcomes of hyperopic LASIK with the NIDEK NAVEX platform centered on the visual axis or line of sight</article-title><source>J Refract Surg</source><year>2009</year><volume>25</volume><issue>Suppl 1</issue><fpage>S98</fpage><lpage>103</lpage><pub-id pub-id-type="pmid">19248536</pub-id></element-citation></ref><ref id="ref25"><label>25</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nepomuceno</surname><given-names>RL</given-names></name><name><surname>Boxer</surname><given-names>Wachler BS</given-names></name><name><surname>Kim</surname><given-names>JM</given-names></name><name><surname>Scruggs</surname><given-names>R</given-names></name><name><surname>Sato</surname><given-names>Ml</given-names></name></person-group><article-title>Laser <italic>in situ</italic> keratomileusis for hyperopia with the LADAR Vision 4000 with centration on the coaxially sighted corneal light reflex</article-title><source>J Cataract Refract Surg</source><year>2004</year><volume>30</volume><fpage>1281</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">15177605</pub-id></element-citation></ref><ref id="ref26"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kanellopoulos</surname><given-names>AJ</given-names></name></person-group><article-title>Topography-guided hyperopic and hyperopic astigmatism femtosecond laser-assisted LASIK: Long-term experience with the 400 Hz eye-Q excimer platform</article-title><source>Clin Ophthalmol</source><year>2012</year><volume>6</volume><fpage>895</fpage><lpage>901</lpage><pub-id pub-id-type="pmid">22791969</pub-id></element-citation></ref><ref id="ref27"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chan</surname><given-names>CC</given-names></name><name><surname>Boxer</surname><given-names>Wachler BS</given-names></name></person-group><article-title>Centration analysis of ablation over the coaxial corneal light reflex for hyperopic LASIK</article-title><source>J Refract Surg</source><year>2006</year><volume>22</volume><fpage>467</fpage><lpage>71</lpage><pub-id pub-id-type="pmid">16722485</pub-id></element-citation></ref><ref id="ref28"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kermani</surname><given-names>O</given-names></name></person-group><article-title>Alignment in customized laser <italic>in situ</italic> keratomileusis</article-title><source>J Refract Surg</source><year>2004</year><volume>20</volume><issue>Suppl 5</issue><fpage>S651</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">15521260</pub-id></element-citation></ref><ref id="ref29"><label>29</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wachler</surname><given-names>BS</given-names></name><name><surname>Korn</surname><given-names>TS</given-names></name><name><surname>Chandra</surname><given-names>NS</given-names></name><name><surname>Michel</surname><given-names>FK</given-names></name></person-group><article-title>Decentration of the optical zone: centering on the pupil versus the coaxially sighted corneal light reflex in LASIK for hyperopia</article-title><source>J Refract Surg</source><year>2003</year><volume>19</volume><fpage>464</fpage><lpage>5</lpage><pub-id pub-id-type="pmid">12899481</pub-id></element-citation></ref><ref id="ref30"><label>30</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Soler</surname><given-names>V</given-names></name><name><surname>Benito</surname><given-names>A</given-names></name><name><surname>Soler</surname><given-names>P</given-names></name><name><surname>Triozon</surname><given-names>C</given-names></name><name><surname>Arné</surname><given-names>JL</given-names></name><name><surname>Madariaga</surname><given-names>V</given-names></name><etal></etal></person-group><article-title>A randomized comparison of pupil-centered versus vertex-centered ablation in LASIK correction of hyperopia</article-title><source>Am J Ophthalmol</source><year>2011</year><volume>152</volume><fpage>591</fpage><lpage>9.e2</lpage><pub-id pub-id-type="pmid">21726847</pub-id></element-citation></ref><ref id="ref31"><label>31</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cavanaugh</surname><given-names>TB</given-names></name><name><surname>Durrie</surname><given-names>DS</given-names></name><name><surname>Riedel</surname><given-names>SM</given-names></name><name><surname>Hunkeler</surname><given-names>JD</given-names></name><name><surname>Lesher</surname><given-names>MP</given-names></name></person-group><article-title>Centration of excimer laser photorefractive keratectomy relative to the pupil</article-title><source>J Cataract Refract Surg</source><year>1993</year><volume>19</volume><issue>Suppl</issue><fpage>S144</fpage><lpage>8</lpage></element-citation></ref><ref id="ref32"><label>32</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Legrand</surname><given-names>Y</given-names></name><name><surname>El Hage</surname><given-names>SG</given-names></name></person-group><article-title>Physiologic optics</article-title><source>Springer series in optical sciences</source><year>1980</year><publisher-loc>Berlin, Germany</publisher-loc><publisher-name>Springer</publisher-name><fpage>72</fpage></element-citation></ref><ref id="ref33"><label>33</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cavanaugh</surname><given-names>TB</given-names></name><name><surname>Durrie</surname><given-names>DS</given-names></name><name><surname>Riedel</surname><given-names>SM</given-names></name><name><surname>Hunkeler</surname><given-names>JD</given-names></name><name><surname>Lesher</surname><given-names>MP</given-names></name></person-group><article-title>Topographical analysis of the centration of excimer laser photorefractive keratectomy</article-title><source>J Cataract Refract Surg</source><year>1993</year><volume>19</volume><issue>Suppl</issue><fpage>136</fpage><lpage>43</lpage><pub-id pub-id-type="pmid">8450435</pub-id></element-citation></ref><ref id="ref34"><label>34</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kim</surname><given-names>EK</given-names></name><name><surname>Jang</surname><given-names>JW</given-names></name><name><surname>Lee</surname><given-names>JB</given-names></name><name><surname>Hong</surname><given-names>SB</given-names></name><name><surname>Lee</surname><given-names>YG</given-names></name><name><surname>Kim</surname><given-names>HB</given-names></name></person-group><article-title>Comparison of corneal centering in photorefractive keratectomy</article-title><source>Yonsei Med J</source><year>1998</year><volume>39</volume><fpage>317</fpage><lpage>21</lpage><pub-id pub-id-type="pmid">9752797</pub-id></element-citation></ref><ref id="ref35"><label>35</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Reinstein</surname><given-names>DZ</given-names></name><name><surname>Archer</surname><given-names>TJ</given-names></name><name><surname>Gobbe</surname><given-names>M</given-names></name></person-group><article-title>Is topography-guided ablation profile centered on the corneal vertex better than wavefront-guided ablation profile centered on the entrance pupil?</article-title><source>J Refract Surg</source><year>2012</year><volume>28</volume><fpage>139</fpage><lpage>43</lpage><pub-id pub-id-type="pmid">22107064</pub-id></element-citation></ref><ref id="ref36"><label>36</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lin</surname><given-names>DT</given-names></name><name><surname>Sutton</surname><given-names>HF</given-names></name><name><surname>Berman</surname><given-names>M</given-names></name></person-group><article-title>Corneal topography following excimer photorefractive keratectomy for myopia</article-title><source>J Cataract Refract Surg</source><year>1993</year><volume>19</volume><issue>Suppl</issue><fpage>149</fpage><lpage>54</lpage><pub-id pub-id-type="pmid">8450437</pub-id></element-citation></ref><ref id="ref37"><label>37</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dausch</surname><given-names>D</given-names></name><name><surname>Klein</surname><given-names>R</given-names></name><name><surname>Schröder</surname><given-names>E</given-names></name></person-group><article-title>Excimer laser photorefractive keratectomy for hyperopia</article-title><source>Refract Corneal Surg</source><year>1993</year><volume>9</volume><fpage>20</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">8481369</pub-id></element-citation></ref><ref id="ref38"><label>38</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dausch</surname><given-names>D</given-names></name><name><surname>Smecka</surname><given-names>Z</given-names></name><name><surname>Klein</surname><given-names>R</given-names></name><name><surname>Schröder</surname><given-names>E</given-names></name><name><surname>Kirchner</surname><given-names>Sl</given-names></name></person-group><article-title>Excimer laser photorefractive keratectomy for hyperopia</article-title><source>J Cataract Refract Surg</source><year>1997</year><volume>23</volume><fpage>169</fpage><lpage>76</lpage><pub-id pub-id-type="pmid">9113566</pub-id></element-citation></ref><ref id="ref39"><label>39</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Okamoto</surname><given-names>S</given-names></name><name><surname>Kimura</surname><given-names>K</given-names></name><name><surname>Funakura</surname><given-names>M</given-names></name><name><surname>Ikeda</surname><given-names>N</given-names></name><name><surname>Hiramatsu</surname><given-names>H</given-names></name><name><surname>Bains</surname><given-names>HS</given-names></name></person-group><article-title>Comparison of myopic LASIK centered on the coaxially sighted corneal light reflex or line of sight</article-title><source>J Refract Surg</source><year>2009</year><volume>25</volume><issue>Suppl 10</issue><fpage>S944</fpage><lpage>50</lpage><pub-id pub-id-type="pmid">19848376</pub-id></element-citation></ref><ref id="ref40"><label>40</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Arbelaez</surname><given-names>MC</given-names></name><name><surname>Vidal</surname><given-names>C</given-names></name><name><surname>Arba-mosquera</surname><given-names>S</given-names></name></person-group><article-title>Clinical outcomes of corneal vertex versus central pupil references with aberration-free ablation strategies and LASIK</article-title><source>Invest Ophthalmol Vis Sci</source><year>2008</year><volume>49</volume><fpage>5287</fpage><lpage>94</lpage><pub-id pub-id-type="pmid">18658090</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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