Current paradigms in refractive surgery.

Refractive surgeries have evolved from the archaic incisional corneal procedures to the use of sophisticated femtosecond lasers and new-generation phakic intraocular lenses (pIOL) for surgical correction of refractive errors. The armamentarium of modern-day refractive surgery includes corneal-based procedures such as photorefractive keratectomy, laser-assisted in situ keratomileusis and keratorefractive lenticule extraction, as well as lensbased pIOL implantation. The current procedures are associated with a high index of efficacy and predictability, with enhanced safety and a significant reduction in sight-threatening complications. Patient counselling and case selection is imperative to achieve optimal visual outcomes and patient satisfaction. This review article provides a comprehensive overview of current refractive surgery procedures, with an emphasis on decision-making. Evolving frontiers in refractive surgeries like customised corneal ablation and presbyopia correcting pIOL are also discussed.