Scientific Nomenclature for K eratorefractive Lenticule Extraction (KLEx) Procedures: A Joint Editorial Statement.

Cornea refractive surgery has a rich history of new procedures and nomenclature. For long-standing 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) and 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.3,4 As refractive lenticule extraction procedures have gained 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 represents a consistent common denominator that is easily expressed phonetically as an acronym (“kay-lex”). We ask that authors use this term as a generic expression for all refractive lenticule extraction 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, III8 William J. Dupps Jr, MD, PhD Thomas Kohnen, MD, PhD, FEBO Editors Sathish Srinivasan, FRCSEd, FRCOphth, FACS Liliana Werner, MD, PhD Associate Editors Journal of Cataract & Refractive Surgery J. Bradley Randleman, MD Editor-in-Chief Journal of Refractive Surgery