A patient from Santa Barbara recently asked me if there were any new vision correction surgeries on the horizon and what role they would fill. While I think that customized wavefront LASIK and PRK are highly evolved and will represent the state of the art for most patients for quite some time into the future, there is an interesting new surgery showing some early promise called “PiXL” that also could ultimately find its place as a useful tool for correcting vision for some patients.  Photorefractive intrastromal corneal collagen cross-linking, or Pixel, is a non-invasive treatment being studied for treatment of low degrees of nearsightedness. Two studies were recently presented at a meeting of the European Society of Cataract and Refractive Surgeons regarding PiXL. The first study was a study performed in Germany which analyzed PiXL eye surgery in 39 eyes with low degrees of nearsightedness. Average vision without glasses at one year was 20/20 and the authors of the study concluded that this new procedure showed “promise.”  A second study, conducted in Singapore, showed an average reduction of nearsightedness of 0.75 diopters at 9 months. This is a relatively small improvement and clearly PiXL is in a very early stage of its development. Further studies will need to be conducted to see if PiXL can be used to treat more significant amounts of correction and whether it also can correct astigmatism and farsightedness. Finally, larger long terms studies will need to be performed to determine its safety and stability over time. One potential benefit of PiXL is that it could make the cornea actually stronger than it was before surgery. At this point in its development, I consider PiXL to be promising, particularly as a treatment for those patients with structurally weak corneas.