RELEX SMILE AND SMILE EXTRA.. OUR 1 YEAR RESULTS AND PATIENTS SURVEY

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1 RELEX SMILE AND SMILE EXTRA.. OUR 1 YEAR RESULTS AND PATIENTS SURVEY DR SANDIP MITRA MD FRCS CORNEA AND REFRACTIVE FELLOW (ROYAL VICTORIA EYE AND EAR HOSPITAL, AUSTRALIA)

2 RELEX SMILE UNIT AT THE ALZAHRA HOSPITAL SHARJAH UAE WHY WE STARTED RELEX SMILE AND WHAT WAS THE GOAL TO PROVIDE AN ALTERNATIVE TO LASIK AND PRK REDUCE THE HAZE, PAIN AND SLOW RECOVERY OF PRK TO REDUCE THE RISK OF MAKING FLAPS IN LASIK REDUCE DRY EYES, IMPROVE NIGHT VISION, MAINTAIN CORNEAL STRENGTH LASIK WITHOUT FLAP AND PRK WITHOUT HAZE AND PAIN

3 PROBLEMS OF PRK CORNEAL HAZE AND USE OF CYTOTOXIC DRUG MITOMYCIN C (WHICH IS OFF LABEL AND ERRATIC IN ACTION) DOSE NOT WELL ADJUSTED, CAN LEAD TO ENDOTHELIAL DAMAGE (STUDY BY MOHAN ET AL)

4 LASIK PROBLEMS PROPER CENTRATION IS A CHALLENGE AND DEPENDS ON PATIENTS CO OPERATION EPITHELIAL IN GROWTH DECENTERED ABLATION EDGE LIFT AND FLAP DISPLACEMENT

5 LASIK PROBLEMS DRY EYES BUTTON HOLE NIGHT GLARE FOLD AND STRIAE

6 REFRACTIVE LASER SET UP AT ALZAHRA PRIVATE HOSPITAL SHARJAH 1.Make a special unit for relex smile procedure 2. undergo special training for the smile procedure under special team from Carl zeiss 3. Prepare a team of ophthalmic technician, trained nurse 4. patient comfort and sterility 5. keep the price competitive 6. prepared information booklets and videos for the patient 6

7 WHAT ZEISS PROMISED US Minimally invasive surgery: 80% less side cut (compared to LASIK) 30% less cap cut Preserves integrity of upper corneal layers Indicates preservation of corneal biomechanical stability Less nerves severed Indicates less varying severity of dry eye syndrome no flap minimizes the risk for flap complications such as epithelium in-growing, flap dislocation, infections faster healing of epithelium

8 WHY RELEX SMILE Spherical patient interface and unique corneal suction for minimum eye irritation Less tissue compression Automated vacuum system Shortest suction time Minimal IOP increase No vision loss during suction Lowest IOP increase during treatment

9 ADVANTAGES No laser calibration or fluence test with impact on treatment result required No controlled airflow and plume removal necessary Refractive correction by femtosecond lenticule cut is not affected by ambient room conditions Fully corrected optical zone from center to periphery Corneal topography maps post-op confirm prolate shape of optical zone ReLEx smile user reports showed lower induction of wavefront errors than Lasik, in particular for spherical aberration

10 EYE TEST WITH THE DOCTOR MAPPING YOUR EYES AND MEASURING THE THICKNESS OF CORNEA MEASURING THE SIZE OF PUPIL MEASURING THE TEAR FILM WHO ARE ELIGIBLE? AGE ABOVE 18 YEARS WITH STABLE REFRACTION FOR LAST 2 YEARS MYOPIA FROM TO -10 DIOPTER AND ASTIGMATISM BETWEEN TO -5DIOPTER NOT ELIGIBLE FOR SMILE: PREGNANCY AND BREAST FEEDING, UNSTABLE REFRACTION AND HYPEROPIA

11 Our results for 200 eyes follow up of max 6 months Percentage of patients % 1 month % 1 week 25 5 % more than 1 month 0 <20/40 20/30-20/25 20/25-20/20 >20/20 SNELLEN VISUAL ACUITY UNAIDED 11

12 VISUAL OUTCOMES ARE THE LEVEL OF ADVANCED LASIK/PRK OR EVEN BETTER CONVINCING STABILITY WITH ALMOST NO REGRESSION OVER TIME 200 eyes reached 20/20 vision after 1 week None of the eyes had any regression after 6 months of follow up

13 EXCELLENT PREDICTABLITY, RESULTS VERY CLOSE TO TARGET REFRACTION, EVEN FOR HIGH MYOPIC CORRECTIONS REFRACTIVE OUTCOMES WITHIN ±0.5 D FOR 97% OF EYES 31% -10 to -8 D 8% 2% >-8 to -6 D 31% >- 6 to -4 D >-4 to -2 D MAJORITY OF PATIENTS WHERE BETWEEN -4 D TO -10 D 27% >-2 to 0 D PRE OPERATIVE EFRACTIVE ERROR DISTRIBUTION POST OPERATIVE REFRACTIVE ERROR DISTRIBUTION to -8 <-8 to -6 <-6 to -4 <-4 to -2 < -2 to 0 <0.25 to D >-0.25 to D >-0.50 to D >-0.75 D to - 1 D > -1 D NO STATISTICALLY SIGNIFICANT DIFFERENCE IN THE POST OPERATIVE CORRECTION IN SMALLER REFRACTIVE ERROR COMPARED TO THE THE LARGER REFRACTIVE ERROR * Excellent predictablity, results very close to target refraction, even for high myopic corrections Almost 100 % of all patients achieved target refraction within the typical satisfaction zone (± 1.0 D), 97% with a precision of ± 0.5 D.

14 PATIENTS SURVEY OF POST OPERATIVE GLARE AND NIGHT VISION AFTER RELEX SMILE PROBLEMS IN NIGHT VISION AFTER THE SURGERY 1% 4% 95% no glare moderate glare mild glare severe glare

15 NIGHT VISION SATISFACTION excellent night vision in 99% of patients Pupil size varied from 5mm till 7 mm 1 patient developed glare which disappeared after 1 month, (wavefront optimised treatment) average Lenticule size 6.7 5mm, which was more than the size of the scotopic pupil in 99% of cases

16 PAIN SCORE DURING THE PROCEDURE 5% 8% 87% no pain mild pain moderate pain severe pain very sever pain worst possible pain

17 Post Smile Dry eye score from our patient based on number of Artelec Adv minims used after 1 week post operatively using no drops once a day twice a day thrice a day more than 4 times 8% 3% 20% 50% 20%

18 EFFECT ON DRY EYES 99 % of patients did not complain any dry eye problems after the Smile procedure Average use of eye lubricants was from 2 weeks no need for any ointment in any patients Early return of corneal sensation after 1 week after the procedure

19 BASED ON EXPERIENCE WOULD YOU RECOMMEND SIMILAR TREATMENT TO YOUR FAMILY AND FRIENDS yes with great pleasure 90 % yes with pleasure 5 % yes 5% no 0%

20 RELEX SMILE PLUS COLLAGEN CROSS LINKAGE Name: sneade, adam Pat. ID: Date of birth: Physician: Treatment date: Time: Göschwitzer Str Jena, Germany Cornea vertex distance [mm]: Manifest Sphere [D]: Cylinder [D]: Axis [ ]: Corneal radius [mm]: Mean K-reading [D]: Pachymetry [µm]: Treatment pack size: Nomogram info Suction time [hh:mm:ss]: Lenticule data Cap data Optical zone [mm]: Diameter [mm]: Thickness [µm]: Side cut angle [ ]: Incision position [ ]: Incision angle [ ]: Incision width [mm]: Transition zone [mm]: Thickness [µm]: Side cut angle [ ]: Refractive correction Sphere [D]: Cylinder [D]: Min: Max: Axis [ ]: SMILE cuts created. Remaining refraction Sphere [D]: Cylinder [D]: Axis [ ]: RST [µm]: VisuMax Software version 1.16 Copyright Carl Zeiss Meditec AG All rights reserved. Page 1 of 1 20

21 SMILE EXTRA AND RESULTS 6 eyes were treated with relex smile with collagen cross linkage we have used Vibex extra infusion for 8 minutes and UV exposure 30mW/cm 2 for 3 minutes (Avedro platform) none of the patients showed any significant haze and any loss of Snellen s visual acuity There was stabilisation of topography and no signs of keratinous after the treatment

22 COMPLICATIONS WE HAVE NOTICED AND HOW WE MANAGED Two eyes had vacuum loss One was converted to RElex FLEX and one eye was treated with Femto Lasik One eye had poor lenticular cut which was dissected manually and had no loss of visual acuity

23 WHAT ARE THE PROBLEMS WITH RELEX SMILE! learning curve for this procedure and needs training and certification! proper instrumentation and avoid dissection and only use blunt instrument to separate the bubble.! Vacuum loss, loss of lenticule, under correction and overcorrection! Retreatment can be done if enough corneal thickness is available or PRK can be done 23

24 QUALITY OF LIFE BEFORE AND AFTER RELEX SMILE PROCEDURE MUCH BETTER SLIGHTLY BETTER SUBSTANTIALLY WORSE 10% 4% 0% BETTER SLIGHTLY WORSE OUR CONTACTS: TEL: %

25 PROPER CENTRATION

26 TECHNIQUES TO IMPROVE YOUR RESULTS proper head positioning and docking by placing Toric mark keep the area free of excess fluid, perforated speculum communicate with the patient during the surgery develop the expert mode for reducing the laser time and smother cut, proper energy and spot size avoid excessive dissection and use blunt instrument proper detection of anterior and posterior layers of the lenticule

27 VIDEO PRESENTATION OF THE SURGERY

28 PROPER DOCKING AND MARKER FOR CORRECTING CYCLOTORTION

29 Enjoy fashion and swim without glasses after Relex Smile THANKS /

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