4/2/2014. Management of Highly Aberrated Corneas After Keratorefractive Surgery

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1 Management of an irregular cornea and unsatisfied patients after previous kertorefractive procedures has been always a real challenge in our daily practice. Management of Highly Aberrated Corneas After Keratorefractive Surgery Mohamed Shafik MD, PhD Professor of Ophthalmology, University of Alexandria, Horus Vision Correction Center, Egypt A Topo-guided ablation profile: Various Topo-guided/Corneal WF-guided ablation pattern could be used in spite of their insufficiency! Uses the elevation topography to create an essential surgical plan to regularize the corneal surface This is a crude concept of the Cause / Effect relation! Weaknesses of Topo-guided procedures: WF-guided ablation Profile Surgical plan is generally subjective and individual Difficult to predict the precise spherical or Cylindrical component that will be corrected/remained Potential for a hyperopic shift (excess central ablation) Possibility to increase (rather than decrease) the irregularity if the exact corneal elevation is not treated. Inadvertent localized ablation of the steepest area as opposed to the most elevated area can compromise vision rather than improve vision by increase the slope of elevation. Provides a more constant measure of the Cause / Effect relationship This can enables the surgeon to develop an ablation nomogram for irregular customization

2 WFG Laser Vision Correction using the idesign System High-resolution sensor maximizes capture rates High-resolution Hartmann-Shack wavefront sensor (5 times higher than WaveScan) Fourier reconstruction algorithms using up to 257 microrefractions over a 7 mm diameter wavefront Outstanding accuracy, and ability to measure complex wavefronts or highly aberrated eyes for treatment planning Increasing resolution provides Ability to capture more patients Improved spot quality, reduces spot cross over effect Detection of HOAs Better reconstruction High-Definition Hartman-Shack Sensor WaveScan vs. idesign system comparison Improved spot quality Better detection of highly aberrated eyes For example: keratoconus, post incisional refractive procedures, irregular ablation profiles. Neal D.R, Baer C.D., Copland J, et al. Combined wavefront aberrometer and new advanced corneal topographer. ASCRS 28; MP RF5224 (OUS Version) Low Resolution Measurement High Resolution Measurement 22 Abbott Medical Optics Inc. Keratoconus Eye with 4 m Resolution Keratoconus Eye with 2 m Resolution 8 The Time-Honored WF Ablation!! JRS-December 23 Objectives To evaluate the visual, refractive, contrast sensitivity, and aberrometric outcomes in a group of highly aberrated corneas undergoing wavefront-guided LVC surgery using the idesign high definition aberrometer and the Star S4IR excimer laser platform from Abbott Medical Optics CONCLUSION: Wavefront-guided LASIK using the VISX CustomVue technology provides an effective and predictable correction of low to moderate myopia in the 4/2/24Presentation long term, preserving Title the patient s Company visual Confidential acuity 2 and Abbott quality. 9 and Date Medical Optics Inc. [J Refract Surg. 23;29(2): ] Subjects & Methods Subjects & Methods 9 eyes of Nine patients with highly irregular cornea (6 females, 3 males) (Age: 2 to 52 ys.) Horus Vision Correction Center, Alexandria Nov. 22 to August 23 2 clinical groups: I- Post RK (4 eyes) Full preoperative evaluation for Topography, Tomography, Refraction and Visual performance evaluation idesign-generated ablation profile PRK with MMC / LASIK redo by flap lift All patients were followed up for more than 6 months II- Post LASIK decentration/irregular ablation (5 eyes) 2

3 Pentacam 52 years old women Had RK in 995 (8 radial cuts at 3.5 mm OZ with 2 cuts invading optical zone). Presented with a halos, glare and ghosting UCVA. Manifest Refraction x 5 BCVA CCC 583 µm Irregularity Indices Untreatable to date due to lack of capture with previous aberrometer idesign MAP Ablation Profile design over the irregular cornea Results: 6 months after CustomVue PRK powered by idesign vs Pentacam Ablated tissue thickness 57 µm Manifest Refraction X 45 Pre Op.4. UCVA UCVA.4.3 Very significant improvement in Corneal Irregularity indices and Aberrations 3

4 . vs Corneal Irregularity Indices Pre Op. vs idesign Map Pre Op Post Op CASE 3. Post LASIK Decentration 25 y lady Had LASIK in July 2 for -.?. Presented with ghosting, poor night vision UCVA. Manifest Refraction x 2 BCVA.3 CCC 468 µm Untreatable to date due to lack of capture with previous aberrometer CASE 3. Post LASIK Decentration Pentacam Irregularity Indices CASE 3. Post LASIK Decentration idesign MAP CASE 3. Post LASIK Decentration Ablation Profile design over the irregular cornea 4

5 CASE 3. Post LASIK Decentration. Results: 4 months after CustomVue LASIK powered by idesign Ablated tissue thickness 4 µm Manifest Refraction X8 CASE 3. Post LASIK Decentration. vs Pentacam Pre- Op UCVA.4 UCVA.4.3. CASE 3. Post LASIK Decentration. Prop vs idesign Map Results of the total Sample Mean (SD) erative erative p-value Pre- Op Median (Range) (22 eyes) (22 eyes) (test) LogMAR UDVA.98 (.34). (.4 to.3) (.) 2 (.5 to.4). Sphere (D) -.78 (.97) -.5 (-4. to +3.) -.33 (.7). (-.5 to +.5).5 Cylinder (D) (.54) -2.5 (-5.5 to -.) -. (.73) -. (-2.5 to.).2 Spherical equivalent (D) -2. (.8) -.88 (-5.5 to +.38) -8 (8) -3 (-2.25 to +5).5 LogMAR 2 (7) (. to.).5 (.).9 (. to.3). Efficacy Safety (.5) 2.33 (.3 to 6.) (.46) 3. (.3 to 6.) Efficacy Changes in Corrected Distance Visual Acuity after surgery 5

6 erative and erative Contrast Sensitivity Function Conclusions The New idesign System allows us to measure eyes with high aberrations that were not captured with previous aberrometers. With idesign we avoid to treat the patients twice one with Topo Guided LVC to smooth the cornea and another ablation for refractive correction. The higher Iris Registration capture rate allows to center the ablation in the right place. Wavefront guided ablations are now my preferred choice for normal and highly aberrated eyes. 6