Scientific Nomenclature for K eratorefractive Lenticule Extraction (KLEx) Procedures: A Joint Editorial Statement
2023; Slack Incorporated (United States); Volume: 39; Issue: 11 Linguagem: Inglês
10.3928/1081597x-20231010-0
ISSN1938-2391
AutoresWilliam J. Dupps, J. Bradley Randleman, Thomas Kohnen, Sathish Srinivasan, Liliana Werner,
Tópico(s)Ophthalmology and Visual Impairment Studies
ResumoEditorial freeScientific Nomenclature for Keratorefractive Lenticule Extraction (KLEx) Procedures: A Joint Editorial Statement William J. Dupps Jr., MD, PhD, ; , MD, PhD J. Bradley Randleman, MD, ; , MD Thomas Kohnen, MD, PhD, FEBO, ; , MD, PhD, FEBO Sathish Srinivasan, FRCSEd, FRCOphth, FACS, ; , FRCSEd, FRCOphth, FACS Liliana Werner, MD, PhD, , MD, PhD William J. Dupps Jr., MD, PhD , J. Bradley Randleman, MD Correspondence: J. Bradley Randleman, MD, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i-32, Cleveland, OH 44195. Email: E-mail Address: [email protected] , Thomas Kohnen, MD, PhD, FEBO , Sathish Srinivasan, FRCSEd, FRCOphth, FACS , and Liliana Werner, MD, PhD Journal of Refractive Surgery, 2023;39(11):726–727Published Online:November 01, 2023https://doi.org/10.3928/1081597X-20231010-0PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail SectionsMoreIntroductionCorneal refractive surgery has a rich history of novel procedures and nomenclature. For longstanding stalwarts such as photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK), the naming conventions were firmly established from the first publications on these approaches, in 1998 and 1990.1,2 For refractive lenticule extraction procedures, however, the development of nomenclature has been more evolutionary than revolutionary. Early scientific reports referred to the approach as femtosecond lenticule extraction (FLE or FLEx), which the manufacturer (Carl Zeiss Meditec AG) modified to refractive lenticule extraction (ReLEx) then branded with the proprietary term small incision lenticule extraction (SMILE) when the procedure incorporated a small incision as an alternative to a flap-dependent lenticule removal process.3,4As refractive lenticule extraction procedures have gained in popularity, other commercial entities are advancing similar approaches and thus introducing additional terminology to describe their proprietary efforts. These include corneal lenticule extraction for advanced refractive correction (CLEAR; Ziemer), smooth incision lenticule keratomileusis (SILK; Johnson & Johnson), and small incision–guided human-cornea treatment (SmartSight; SCHWIND eye-tech-solutions), and more are sure to come.This flourishing of a new class of procedure is an exciting development for refractive surgeons and the patients they serve. But, as others have pointed out, a proliferation of new proprietary terms aimed at market differentiation can also create confusion and obscure the common mechanistic underpinnings of these procedures.5,6 As the editors of scientific journals dedicated to the field of refractive surgery, we recognize a responsibility to agree upon a common term for these procedures that can be used as a nonproprietary descriptor alongside any other necessary methodological details that make it clear which tools and settings were used to perform the procedure under study. This is crucial for enhancing the discoverability of closely related research publications as the number of entries into the category increases.In deliberating on a term, we sought (1) descriptive accuracy, (2) sufficient specificity to differentiate it from other procedures, (3) sufficient breadth to be inclusive of variations that arise but are substantially the same procedure class, and (4) avoidance of any existing proprietary names. The result: keratorefractive lenticule extraction (KLEx). This term tells the reader the tissue altered (the cornea), the purpose of the alteration (refractive), and the mechanism of alteration (lenticule extraction). KLEx avoids proprietary terms, both past and present, and it represents a consistent common denominator that is also easily expressed phonetically as an acronym ("kay-lex"). We ask that authors use this term as a generic expression for such procedures in their submissions but also include the necessary details in the Methods section to ensure that the research is repeatable.7"All language—especially English—is flooded with neologisms continuously. In refractive surgery, let us use accurate scientific and clinical terminology for those purposes, while enjoying the manipulative marketing jargon that will inevitably arise." —George O. Waring, III81.Munnerlyn CR, Koons SJ, Marshall J. Photorefractive keratectomy: a technique for laser refractive surgery. J Cataract Refract Surg. 1988; 14(1):46–52. 10.1016/S0886-3350(88)80063-4 PMID:3339547 > Crossref MedlineGoogle Scholar2.Pallikaris IG, Papatzanaki ME, Stathi EZ, Frenschock O, Georgiadis A. Laser in situ keratomileusis. Lasers Surg Med. 1990; 10(5):463–468. 10.1002/lsm.1900100511 PMID:2233101 > Crossref MedlineGoogle Scholar3.Sekundo W, Kunert K, Russmann Cet al.. First efficacy and safety study of femtosecond lenticule extraction for the correction of myopia: six-month results. J Cataract Refract Surg. 2008; 34(9):1513–1520. 10.1016/j.jcrs.2008.05.033 PMID:18721712 > Crossref MedlineGoogle Scholar4.Blum M, Sekundo W. [Femtosecond lenticule extraction (FLEx)] [in German]. Ophthalmologe. 2010; 107(10):967–970. 10.1007/s00347-010-2222-8 PMID:20694728 > Crossref MedlineGoogle Scholar5.Moshirfar M, Tuttle JJ, Stoakes IM, Bundogji N, Hoopes PC. SMILE, CLEAR, SILK: it's time for a common term. J Refract Surg. 2023; 39(8):575. 10.3928/1081597X-20230711-01 PMID:37578175 > LinkGoogle Scholar6.Dick HB, Seiler T, Cummings AB. Lenticule extraction. J Refract Surg. 2022; 38(9):618. 10.3928/1081597X-20220817-01 PMID:36098389 > LinkGoogle Scholar7.Dupps WJ, Randleman JB, Kohnen T, Srinivasan S, Werner L. Scientific nomenclature for keratorefractive lenticule extraction (KLEx) procedures: a joint editorial statement. J Cataract Refract Surg. 2023; 49:1085. > Crossref MedlineGoogle Scholar8.Waring GO. Neo-neologisms. J Refract Surg. 2008; 24(1):7–8. 10.3928/1081597X-20080101-02 PMID:18269142 > LinkGoogle Scholar Next article FiguresReferencesRelatedDetails Request Permissions InformationCopyright 2023, SLACK IncorporatedPDF download • 128 KBCorrespondence: J. Bradley Randleman, MD, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i-32, Cleveland, OH 44195. Email: randlej@ccf.orgFrom Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio (WJD, JBR); Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (WJD); the Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio (WJD); the Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany (TK); University Hospital Ayr, Ayr, Scotland, United Kingdom (SS); and John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (LW).Disclosure: Dr. Dupps has received grants from Alcon Laboratories and the National Institutes of Health/National Eye Institute, RO1 and UO2 grants, and Seed Fund grants, has received consulting fees from Alcon Laboratories, Inc, has patents under Cleveland Clini Innovation, and is an advisory board member for the National Institutes of Health/National Eye Institute. Dr. Kohnen is a consultant and researcher for Alcon/Novartis, J&J, Lensgen, Oculentis, Oculus, Presbia, SCHWIND, and Zeiss, and a consultant for Allergan, Bausch & Lomb, Geuder, Med Update, Santen, STAAR, Thieme, and Ziemer. The remaining authors have no financial or proprietary interest in the materials presented herein.This editorial is a joint publication by the Journal of Cataract & Refractive Surgery and the Journal of Refractive Surgery.Drs. Dupps and Randleman contributed equally to this work and should be considered as equal first authors. Published online11/01/23
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