Topography-guided laser refractive surgery

Size: px
Start display at page:

Download "Topography-guided laser refractive surgery"

Transcription

1 REVIEW C URRENT OPINION Topography-guided laser refractive surgery Simon Holland a,b, David T.C. Lin a, and Johnson C.H. Tan b,c Purpose of review Topography-guided laser refractive surgery regularizes the front corneal surface irregularities to achieve the desired refractive outcome. This is particularly applicable in highly aberrated corneas, where wavefront aberrometry is often not possible. This article aims to review the recently published results of topographyguided ablations in normal regular corneas, highly aberrated corneas, and its application in conjunction with collagen cross-linking (CXL) in cases of keratectasia. Recent findings Topography-guided laser ablation is increasingly used with good efficacy and safety outcomes in highly aberrated corneas with irregular astigmatism. These include eyes with refractive surgery complications including postlaser in-situ keratomileusis ectasia, decentered ablation, small optical zones, asymmetrical astigmatism, and postradial keratectomy astigmatism. Further indications are for postkeratoplasty astigmatism and keratoconus. Simultaneous topography-guided ablations with CXL in keratectasia have been promising, both in addressing the surface irregularities and progressive nature of the conditions. Summary Topography-guided laser refractive surgery is proving to be effective and well tolerated in the visual rehabilitation of highly aberrated eyes, with increasing predictability based on the recent research. Keywords laser in-situ keratomileusis, laser refractive surgery, photorefractive keratectomy, topography-guided INTRODUCTION After gaining Conformité Européenne mark approval in Europe more than a decade ago, topographyguided laser ablation is still undergoing various stages of United States (US) Food and Drug Administration (FDA) trials in the USA. Since Mrochen [1] reported his initial three cases of wavefront-guided laser in-situ keratomileusis (LASIK) in 2000, wavefront-guided ablation has been widely adopted in laser refractive surgery. That same year, Knorz and Jendritza [2] reported successful outcomes with topography-guided LASIK to treat corneal irregularities. Despite more than 10 years of experience, topography-guided ablation has not been accepted to the extent that wavefront-guided ablation has been, primarily because of its unpredictability, as any corneal topographic change will lead to an accompanying change in refraction. In the recent years, there is a resurgence of topography-guided ablations in corneas with high irregular astigmatism, including post-lasik ectasia, decentered ablation, small optical zones, postradial keratectomy, postkeratoplasty astigmatism, and keratoconus. There are increasing reports of simultaneous topography-guided treatment of keratectasia with collagen cross-linking (CXL), which is not yet FDA approved in the USA. We aim to review the recent advances in topography-guided ablations not only in this group of highly aberrated corneas, but also in corneas with regular astigmatism, specifically comparing topography guided with wavefront ablations in regular corneas. WAVEFRONT VS. TOPOGRAPHY MEASUREMENT Wavefront-guided treatments attempt to improve the refractive outcomes by addressing higher order aberrations of the optical system, which takes into a Pacific Laser Eye Centre, b Cornea Unit, Department of Ophthalmology, Eye Care Centre, University of British Columbia, Vancouver, British Columbia, Canada and c National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore Correspondence to Johnson C.H. Tan, MBBS, FRCSEd(Ophth), FAMS, Cornea Unit, Eye Care Centre, 2550 Willow Street, Vancouver, BC, Canada V5Z 3N9. Tel: ; com Curr Opin Ophthalmol 2013, 24: DOI: /ICU.0b013e a59 Volume 24 Number 4 July 2013

2 Topography-guided laser refractive surgery Holland et al. KEY POINTS Topography-guided ablation regularizes the front corneal surface irregularities based on the acquisition of topographic maps of the corneal surface. Results of topography-guided ablations are comparable to wavefront ablations in normal regular corneas. Successful topography-guided ablations have been achieved in highly aberrated corneas, which were otherwise not possible with wavefront-based treatments. account the aberrations from the cornea, the lens, and even the retina; topography-guided ablation aims to regularize the uneven corneal front surface to achieve the desired refractive outcome. Wavefront maps are derived from theoretical models, and are dependent on the pupil size and accommodation. In highly aberrated corneas with irregular astigmatism, such as post-lasik ectasia and postpenetrating keratoplasty astigmatism, it is often not possible to obtain a wavefront map or at least of a good quality. In these situations, corneal topography or tomography is usually possible to map out the irregularities on the corneal surfaces. A key difference is that in wavefront measurements, the Zernike expansion is calculated from the entrance pupil center [3]. Topographic measurements of the cornea are centered on the corneal vertex, which approximates best to the visual axis. In most cases with normal corneas, the line of sight and the visual axis are in close proximity. However, in cases with a large topographic decentration, or even in normal eyes with a large angle kappa, such as in hyperopes as illustrated by Reinstein [4] and Kanellopoulos [5 & ], the different reference axes may give very different ablation profiles and refractive outcomes between wavefront-guided and topography-guided treatments. PLANNING SOFTWARE A range of planning software and topographyguided ablation platforms are commercially available in the market. Topography-guided customized ablation treatment (T-CAT) planning software with ALLEGRETTO WAVE Eye-Q Excimer laser platform (Alcon Laboratories Inc, Ft Worth, Texas, USA) is currently under evaluation by the U.S. FDA, and has been approved in Europe since 2003 and in Canada. ALLEGRETTO T-CAT treatments usually result in a net hyperopic ablation, requiring a second myopic treatment to neutralize the cornea. Our group, Lin et al. [6] developed a custom topographic neutralization technique (TNT) to compensate for such a change in a single treatment (Fig. 1). Other platforms currently available outside the USA are the CRS-Master planning software (Carl Zeiss Meditec, Jena, Germany), Nidek Advanced Vision Excimer (NAVEX; Nidek, Gamagori, Japan), and the Corneal Interactive Programmed Topographic Ablation (CIPTAmax; ivis Technology, Taranto, Italy). Topography-guided platforms use a Placido disk, Scheimpflug rotating camera, or a combination of both to capture corneal topography images to be analyzed by the proprietary algorithms to determine the ablation profile. ALLEGRETTO WAVE platforms offer both types of topography. The Scheimpflugbased rotating camera scans the eye either 25 or 50 times, and is best for centrally located aberrations. The Placido disk-based Allegretto Topolyzer obtains data points to map the surface, but produces a central scotoma that needs to be extrapolated. Allan and Hassan [8] reported a prospective case series of topography-guided transepithelial photorefractive keratectomy (TG-PRK) using a 213-nm solid-state laser. The Pulsar Z1 platform (CV Laser Pty Ltd., Perth, Australia) has a combination of both Placido disk imaging and sequential spot aberrometry, which obtains readings even in the presence of significant corneal irregularities. This allows spherocylindrical corrections to be incorporated into topographic ablation design. This platform also has the potential to perform wet-field ablation, as at 213 nm far-ultraviolet irradiation is less strongly absorbed by water [9]. TOPOGRAPHY-GUIDED REFRACTIVE TREATMENT IN REGULAR CORNEAS The greatest benefit and application of topographyguided ablations is probably in the treatment of highly aberrated corneas. However, there are also reports of successful topography-guided ablations in regular corneas. Kanellopoulos [5 & ] in his study of 202 eyes with hyperopia and hyperopic astigmatism that had undergone topography-guided LASIK showed that 75.5% of eyes achieved within 0.5 diopters (D) and 94.4% within 1D of target spherical equivalent at 24 months, whereas 46.6% gained at least one line of acuity postoperatively. Hyperopes may have a significant angle kappa, and wavefrontguided ablation centered on the entrance pupil might potentially introduce astigmatism [4]. Tan et al. s [10] large retrospective series of 2051 eyes with low-to-high myopia and myopic astigmatism (mean spherical equivalent D, range 0.00 to 12.45D) treated topographically with T-CAT treatment planning on the ALLEGRETTO WAVE Eye-Q Excimer laser platform achieved 20/20 or better in 72.9% of the eyes, with good ß 2013 Wolters Kluwer Health Lippincott Williams & Wilkins 303

3 Refractive surgery FIGURE 1. Four steps in custom topographic neutralization technique (TNT) with topography-guided customized ablation treatment (T-CAT) planning software, ALLEGRETTO WAVE Eye-Q Excimer laser. Reproduced with permission [7 & ]. predictability of 86.1% of eyes with spherical equivalent within 0.5D of target spherical equivalent. A total of 13.2% of eyes gained one or more lines in postoperative uncorrected distance visual acuity (UDVA) compared to preoperative corrected distance visual acuity (CDVA). These results were comparable to a recent study by Cummings and Mascharka [11], in which they demonstrated 88% of eyes achieved 0.5D of target spherical equivalent with the topolyzer-guided ablation, while 95% of eyes achieved 0.5D of target spherical equivalent with the oculyzer-guided ablation with the ALLEGRETTO WAVE Eye-Q system. Neither study had a control group of ALLEGRETTO WAVE wavefront-guided nor wavefront-optimized ablations. There appear to be limited data on the direct comparison of topography-guided with wavefrontguided ablations in regular corneas. Falavarjani et al. [12] studied 20 patients with low-to-moderate myopia with or without astigmatism who had received TG-PRK ablation and wavefront-optimized ablation on the contralateral eye. Though there were no statistical differences between the two eyes in terms of visual outcomes and photopic contrast sensitivity, UDVA and contrast sensitivity were better in the wavefront-optimized group. Farooqi [13] found that topography-guided LASIK treatments achieved better night vision than conventional LASIK, but this may be from the expanded treatment zone. There is no compelling evidence of wavefront ablations being superior to topography-guided ablations or vice versa. The difficulty with using topography-guided ablations for normal, regular corneas is that there is likely less predictability of refractive outcome. TOPOGRAPHY-GUIDED REFRACTIVE TREATMENT IN HIGHLY ABERRATED CORNEAS The greatest value of topography-guided treatment is in the treatment of highly aberrated corneas. Postlaser refractive surgery complications, such as post-lasik ectasia, decentered ablation, small optical 304 Volume 24 Number 4 July 2013

4 Topography-guided laser refractive surgery Holland et al. zones, postradial keratectomy astigmatism, and other highly irregular corneas seen in postkeratoplasty astigmatism and keratoconus, have been successfully treated with this modality. Postrefractive surgery complications In our series of 17 eyes treated for post-lasik ectasia, 71% of eyes achieved UDVA of 20/40, compared to 12% preoperatively, with 53% of eyes gaining 2 lines or more of CDVA [7 & ] (Fig. 2). Kanellopoulos and Binder [14] targeted a maximum ablation of 50 mm to limit possible exacerbation of ectasia. Thus, treatment was more therapeutic by reducing the corneal irregularities than refractive, although managed to decrease the mean refractive error by more than 2.5D in 27 of 32 eyes, and mean final spherical equivalent of 1.75D. Other postrefractive surgery complications were studied by our group and Chen et al. [15]. We showed an improvement in decentration and enlargement in optical zones after treatment with TG-PRK, with 94 and 92% of eyes within 1D of target refraction, respectively [7 & ] (Fig. 3). Also reported was the improvement in cylinders from 1.31D (range D) preoperatively to 0.52D (range D), and from 2.00D (range D) to 0.89D (range D) after treatment with TG-PRK with custom TNT for asymmetrical astigmatism and radial keratotomy. Chen et al. s [15] mixed group of 17 eyes with post-lasik complications (free cap, microfolds, buttonhole, decentered flap, small flap, epithelial ingrowth, diffuse lamellar keratitis scarring, lacerated flap interface, and double-flap interface) had an improvement in the irregularity index from mm preoperatively to mm, whereas asymmetry changed from D to D. A total of 47% of eyes were within 0.5D of intended refraction and 88% were within 1D of intended refraction. Postkeratoplasty astigmatism High astigmatism is common after penetrating keratoplasty, such as 38% of eyes having more than 5D of astigmatism [16]. Often these corneas are highly irregular, with astigmatism that cannot be corrected with glasses or contact lenses. Spadea [17] performed TG-PRK with prophylactic CXL for residual refractive error on 14 eyes that had previously undergone lamellar keratoplasty for keratoconus. Mean preoperative manifest refractive spherical equivalent improved from D (range 2.50 to 9.50D) to D (range þ1.0 to 3.0D). However, the improvement in topographic keratometric astigmatism was not significant (5.57D 3.52D to D). In our larger series of 27 eyes, mean cylinder improved from 4.46D (range D) preoperatively to FIGURE 2. Topography-guided photorefractive keratectomy for postlaser in-situ keratomileusis ectasia. Reproduced with permission [7 & ] ß 2013 Wolters Kluwer Health Lippincott Williams & Wilkins 305

5 Refractive surgery FIGURE 3. Enlargement of optical zone with topography-guided photorefractive keratectomy. Reproduced with permission [7 & ]. 1.64D (range D) [7 & ] (Fig. 4). The improvement was similarly seen in Ohno s small study of five eyes [18], in which the mean cylinder improved from 7.00D (range 4.75 to 9.00D) to 1.25D (range 0.50D to 2.50D). Gao et al. [19] also reported statistical improvement in asphericity and index of surface variance in his series of 10 eyes after topography-guided laser-assisted subepithelial keratectomy (LASEK) treatment for irregular astigmatism after epikeratophakia. FIGURE 4. Improvement in uncorrected distance visual acuity and astigmatism after topography-guided photorefractive keratectomy for postoperative keratoplasty astigmatism. Reproduced with permission [7 & ] Volume 24 Number 4 July 2013

6 Topography-guided laser refractive surgery Holland et al. Improvement in CDVA was higher for irregular astigmatism from refractive surgery than for postkeratoplasty astigmatism [7 &,8]. This could be explained by the higher amount of astigmatism and irregularities in the latter group. Keratoconus and cross-linking There are increasing reports of topography-guided laser treatment combined with CXL for keratoconus to achieve improved topography and reduction of refractive error. It has been shown that CXL is effective in halting or slowing the progression of keratoconus [20]. Neither procedure is yet approved by the U.S. FDA. Kanellopoulos and Binder [21] in 2007 reported CXL with sequential TG-PRK with significant clinical improvement and stability. However, sequential PRK will remove some of the previously cross-linked cornea. Corneal ablation may also be less predictable in cross-linked corneas. Kanellopoulos [22] also showed that same-day simultaneous TG-PRK with CXL was superior to sequential treatment in visual rehabilitation of patients with keratoconus. In the treatment planning of such cases, target was to undercorrect by 30% in anticipation of further flattening effect of CXL. We reported that 8 of 75 eyes in our study had a hyperopic spherical equivalent of greater than þ1.50d at 1 year despite targeting an outcome of 1.25D, but this may have been related to the treatment nomogram and the CXL flattening effect [7 & ] (Fig. 5). Kymionis [23] and Tuwairqi [24] showed a safety index of 1.21 and 1.6, respectively, in keratoconus patients treated with simultaneous TG-PRK and CXL. A total of 48 60% of eyes gained 1 line or more and % lost 1 line of acuity [7 &,23]. Our group reported 58% of eyes achieving UDVA of 20/40 or better, and 92% having CDVA of 20/40 or better. Keratometry readings decreased by 1.18D and 2.35D at the flat and steep meridians, respectively, in the study by Kymionis [23], which reported lower numbers than Kannellopoulos s large series of 198 eyes with a reduction of D [22]. The role of prophylactic CXL is controversial. Spadea [17] performed CXL after TG-PRK in eyes that had undergone lamellar keratoplasty for keratoconus. Although it is rare to get ectasia after PRK, prophylactic CXL may offer benefits to patients with a personal history of keratoconus. Although there are reports of recurrence of ectasia after keratoplasty in eyes with previous history of keratoconus, and usually at the host rim rather than true ectasia of the graft, it is extremely uncommon. Spadea performed CXL after epithelial ablation up to 9 mm. It is not known whether this larger diameter of irradiation is enough to strengthen the peripheral host cornea rim. FIGURE 5. Topography-guided photorefractive keratectomy with collagen cross-linking for keratoconus. Reproduced with permission [7 & ] ß 2013 Wolters Kluwer Health Lippincott Williams & Wilkins 307

7 Refractive surgery Kanellopoulos introduced the concept of high irradiance, short exposure CXL in myopic LASIK (LASIK Xtra). In his recent study of topography-guided hyperopic LASIK with CXL to modulate the intrinsic corneal flattening effect of hyperopic ablation [25], he showed greater keratometric stability over 2 years in the 34 eyes in the study. There are no long-term results beyond 2 years and no similar published data to reach a consensus on the use of prophylactic CXL in such cases. NEW CONCEPTS The corneal epithelium had been shown to be able to compensate for irregular stromal surfaces by altering its thickness profile to achieve a smooth optical surface. Reinstein et al. [26 & ]reportedthat current planning treatment does not take into account the epithelial stromal interface, and significant regressions after refractive surgeries may be because of epithelial remodeling. They reported a case in which three-dimensional Artemis very highfrequency (VHF) digital ultrasound scan (Arcscan Inc, Morrison, Colorado) was used to provide pachymetric maps of the individual corneal layers, and found a 3.2D difference of inferior-superior asymmetrical index at 2 mm radius between the epithelial and stromal surface of an eye that had previously undergone radial keratotomy. The first step of the treatment was to perform an Artemisassisted transepithelial phototherapeutic keratectomy targeting at the component of the stromal irregularity compensated by the epithelium, and subsequent steps of topography-guided excimer ablation to correct the irregularities not masked by the epithelium. This case suggests that epithelial remodeling may result in unpredictable outcome after laser refractive surgery, presumably more in eyes with previous ocular surface injuries or surgeries. CONCLUSION Topography-guided ablation has the potential to be a valuable addition to laser vision correction, especially in highly aberrated eyes in which wavefront aberrometry cannot be reliably obtained. There are increasing studies on improving the predictability and safety profiles. Presently, the use of topographyguided ablation in regular corneas is undecided pending further studies. Acknowledgements None. Conflicts of interest S.H. received research support from Alcon Laboratories Inc., and travel support from Allergan and Bausch & Lomb. The other authors have no financial interests in the materials mentioned. REFERENCES AND RECOMMENDED READING Papers of particular interest, published within the annual period of review, have been highlighted as: & of special interest && of outstanding interest Additional references related to this topic can also be found in the Current World Literature section in this issue (pp ). 1. Mrochen M, Kaemmerer M, Seiler T. Wavefront-guided laser in situ keratomileusis: early results in three eyes. J Refract Surg 2000; 16: Knorz MC, Jendritza B. Topographically-guided laser in situ keratomileusis to treat corneal irregularities. Ophthalmology 2000; 107: Applegate RA, Thibos LN, Bradley A, et al. Reference axis selection: subcommittee report of the OSA Working Group to establish standards for measurement and reporting of optical aberrations of the eye. J Refract Surg 2000; 16:S656 S Reinstein DZ, Archer TJ, Gobbe M. Is topography-guided ablation profile centered on the corneal vertex better than wavefront-guided ablation profile centered on the entrance pupil? J Refract Surg 2012; 28: & Kanellopoulos AJ. Topography-guided hyperopic and hyperopic astigmatism femtosecond laser-assisted LASIK: long-term experience with the 400 Hz eye-q excimer platform. Clin Ophthalmol 2012; 6: A total of 75.5% of 202 eyes with hyperopia, with or without astigmatism, achieved within 0.5D and 94.4% within 1D of target spherical equivalent at 24 months, whereas 46.6% gained at least one line of acuity postoperatively. Hyperopes with significant angle kappa perform well with topography-guided LASIK centered on the corneal vertex. 6. Lin DT, Holland SR, Rocha KM, Krueger RR. Method for optimizing topography-guided ablation of highly aberrated eyes with the ALLEGRETTO WAVE excimer laser. J Refract Surg 2008; 24:S439 S & Lin DT, Holland S, Tan JC, Moloney G. Clinical results of topography-based customized ablations in highly aberrated eyes and keratoconus/ectasia with cross-linking. J Refract Surg 2012; 28:S841 S848. In eyes undergoing topography-guided photorefractive keratectomy for postkeratoplasty astigmatism (27 eyes), and combined with simultaneous collagen cross-linking for keratoconus (72 eyes) and post-lasik ectasia (17 eyes), mean cylinder improved from 4.46D to 1.64D, 2.87D to 1.40D and reduction of 2.56D of cylinder, respectively. 8. Allan BD, Hassan H. Topography-guided transepithelial photorefractive keratectomy for irregular astigmatism using a 213 nm solid-state laser. J Cataract Refract Surg 2013; 39: Shah S, Sheppard AL, Castle J, et al. Refractive outcomes of laser-assisted subepithelial keratectomy for myopia, hyperopia, and astigmatism using a 213 nm wavelength solid-state laser. J Cataract Refract Surg 2012; 38: Tan J, Simon D, Mrochen M, Por YM. Clinical results of topography-based customized ablations for myopia and myopic astigmatism. J Refract Surg 2012; 28:S829 S Cummings AB, Mascharka N. Outcomes after topography-based LASIK and LASEK with the wavelight oculyzer and topolyzer platforms. J Refract Surg 2010; 26: Falavarjani KG, Hashemi M, Modarres M, et al. Topography-guided vs wavefront-optimized surface ablation for myopia using the wavelight platform: a contralateral eye study. J Refract Surg 2011; 27: Farooqui MA, Al-Muammar AR. Topography-guided CATz versus conventional LASIK for myopia with the NIDEK EC-5000: a bilateral eye study. J Refract Surg 2006; 22: Kanellopoulos AJ, Binder PS. Management of corneal ectasia after LASIK with combined, same-day, topography-guided partial transepithelial PRK and collagen cross-linking: the Athens protocol. J Refract Surg 2011; 27: Chen X, Stojanovic A, Zhou W, et al. Transepithelial, topography-guided ablation in the treatment of visual disturbances in LASIK flap or interface complications. J Refract Surg 2012; 28: Williams KA, Ash JK, Pararajasegaram P, et al. Long-term outcome after corneal transplantation. Visual result and patient perception of success. Ophthalmology 1991; 98: Spadea L, Paroli M. Simultaneous topography-guided PRK followed by corneal collagen cross-linking after lamellar keratoplasty for keratoconus. Clin Ophthalmol 2012; 6: Volume 24 Number 4 July 2013

8 Topography-guided laser refractive surgery Holland et al. 18. Ohno K. Customized photorefractive keratectomy for the correction of regular and irregular astigmatism after penetrating keratoplasty. Cornea 2011; 30 (Suppl. 1):S41 S Gao H, Shi W, Liu M, et al. Advanced topography-guided (OcuLink) treatment of irregular astigmatism after epikeratophakia in keratoconus with the wavelight excimer laser. Cornea 2012; 31: Vinciguerra P, Albè E, Trazza S, et al. Intraoperative and postoperative effects of corneal collagen cross-linking on progressive keratoconus. Arch Ophthalmol 2009; 127: Kanellopoulos AJ, Binder PS. Collagen cross-linking (CCL) with sequential topography-guided PRK: a temporizing alternative for keratoconus to penetrating keratoplasty. Cornea 2007; 26: Kanellopoulos AJ. Comparison of sequential vs same-day simultaneous collagen cross-linking and topography-guided PRK for treatment of keratoconus. J Refract Surg 2009; 25:S812 S Kymionis GD, Portaliou DM, Kounis GA, et al. Simultaneous topographyguided photorefractive keratectomy followed by corneal collagen crosslinking for keratoconus. Am J Ophthalmol 2011; 152: Tuwairqi WS, Sinjab MM. Safety and efficacy of simultaneous corneal collagen cross-linking with topography-guided PRK in managing low-grade keratoconus: 1-year follow-up. J Refract Surg 2012; 28: Kanellopoulos AJ, Kahn J. Topography-guided hyperopic LASIK with and without high irradiance collagen cross-linking: initial comparative clinical findings in a contralateral eye study of 34 consecutive patients. J Refract Surg 2012; 28:S837 S & Reinstein DZ, Archer TJ, Gobbe M. Refractive and topographic errors in topography-guided ablation produced by epithelial compensation predicted by 3D Artemis VHF digital ultrasound stromal and epithelial thickness mapping. J Refract Surg 2012; 28: Epithelial remodeling over anterior stromal surface masked the underlying stromal irregularities. By first performing an Artemis-assisted transepithelial phototherapeutic keratectomy procedure targeting the component of the stromal irregularity compensated for by the epithelium, and subsequent ablations to correct for residual refractive error, uncorrected distance visual acuity of 20/20þ2 with plano refraction was achieved in a case with prior radial keratotomy. This case demonstrated the significant optical shift contributed by the epithelium that if not taken into account, may result in suboptimal refractive outcome ß 2013 Wolters Kluwer Health Lippincott Williams & Wilkins 309

Clinical Results of Topography-based Customized Ablations in Highly Aberrated Eyes and Keratoconus/Ectasia With Cross-linking

Clinical Results of Topography-based Customized Ablations in Highly Aberrated Eyes and Keratoconus/Ectasia With Cross-linking Clinical Results of Topography-based Customized Ablations in Highly Aberrated Eyes and Keratoconus/Ectasia With Cross-linking David T.C. Lin, MD, FRCSC; Simon Holland, MD, FRCSC; Johnson C.H. Tan, MBBS,

More information

Case Reports Post-LASIK ectasia treated with intrastromal corneal ring segments and corneal crosslinking

Case Reports Post-LASIK ectasia treated with intrastromal corneal ring segments and corneal crosslinking Case Reports Post-LASIK ectasia treated with intrastromal corneal ring segments and corneal crosslinking Kay Lam, MD, Dan B. Rootman, MSc, Alejandro Lichtinger, and David S. Rootman, MD, FRCSC Author affiliations:

More information

Lasik Xtra in: Hyperopia AK Xtra Clear cornea cataract surgery

Lasik Xtra in: Hyperopia AK Xtra Clear cornea cataract surgery Lasik Xtra in: Hyperopia AK Xtra Clear cornea cataract surgery A. John Kanellopoulos, M.D. Clinical Profesor of Ophthalmology New York University School of Medicine, New York, NY, USA Laservision.gr Institute,

More information

Introducing TOPOGRAPHY-GUIDED REFRACTIVE SURGERY

Introducing TOPOGRAPHY-GUIDED REFRACTIVE SURGERY Sponsored by Introducing TOPOGRAPHY-GUIDED REFRACTIVE SURGERY Results of the T-CAT Phase III Clinical Trial TOPOGRAPHY-GUIDED REFRACTIVE SURGERY Topography-Guided Custom Ablation Treatments (T-CAT) with

More information

Crosslinking and Long-Term Hyperopic LASIK Stability Initial Clinical Findings in Contralateral Eye Study

Crosslinking and Long-Term Hyperopic LASIK Stability Initial Clinical Findings in Contralateral Eye Study ASCRS 2012 Crosslinking and Long-Term Hyperopic LASIK Stability Initial Clinical Findings in Contralateral Eye Study Jonathan B. Kahn, M.D. 1 and A. John Kanellopoulos, M.D. 1,2 1 New York University School

More information

Complications of Combined Topography-Guided Photorefractive Keratectomy and Corneal Collagen Crosslinking in Keratoconus

Complications of Combined Topography-Guided Photorefractive Keratectomy and Corneal Collagen Crosslinking in Keratoconus Complications of Combined Topography-Guided Photorefractive Keratectomy and Corneal Collagen Crosslinking in Keratoconus Michelle Cho, M.D. 1 Anastasios John Kanellopoulos, M.D 1,2 New York University

More information

Intracorneal Ring Segments Implantation Followed by Same-day Topography-guided PRK and Corneal Collagen CXL in Low to Moderate Keratoconus

Intracorneal Ring Segments Implantation Followed by Same-day Topography-guided PRK and Corneal Collagen CXL in Low to Moderate Keratoconus SURGICAL TECHNIQUE Intracorneal Ring Segments Implantation Followed by Same-day Topography-guided PRK and Corneal Collagen CXL in Low to Moderate Keratoconus Waleed Al-Tuwairqi, MD; Mazen M. Sinjab, MD,

More information

The pinnacle of refractive performance.

The pinnacle of refractive performance. Introducing! The pinnacle of refractive performance. REFRACTIVE SURGERY sets a new standard in LASIK outcomes More than 98% of patients would choose it again. 1 It even outperformed glasses and contacts

More information

Retreatment by Lifting the Original Laser in Situ Keratomileusis Flap after Eleven Years

Retreatment by Lifting the Original Laser in Situ Keratomileusis Flap after Eleven Years Retreatment by Lifting the Original Laser in Situ Keratomileusis Flap after Eleven Years Hassan Hashemi, MD 1,2 Mehrdad Mohammadpour, MD 3 Abstract Purpose: To describe a case of successful laser in situ

More information

Innovations in Refractive Surgery

Innovations in Refractive Surgery Innovations in Refractive Surgery Edward E. Manche, MD Byers Eye Institute Stanford University School of Medicine Financial Interest Disclosures AMO D Best Doctors A Calhoun Vision R Avellino Laboratories

More information

Overview of Refractive Surgery

Overview of Refractive Surgery Overview of Refractive Surgery Michael N. Wiggins, MD Assistant Professor, College of Health Related Professions and College of Medicine, Department of Ophthalmology Jones Eye Institute University of Arkansas

More information

SCHWIND CAM Perfect Planning wide range of applications

SCHWIND CAM Perfect Planning wide range of applications SCHWIND CAM Perfect Planning wide range of applications ORK-CAM PresbyMAX PALK-CAM PTK-CAM 2 SCHWIND CAM the system solution The latest version of the modular SCHWIND CAM represents an even more efficient

More information

Refractive Surgery Issue. Inlays and Presbyopia: On the Horizon P. 24. Crack a SMILE or Raise a Flap? P. 30. LASIK Xtra: Who Should Get It? P.

Refractive Surgery Issue. Inlays and Presbyopia: On the Horizon P. 24. Crack a SMILE or Raise a Flap? P. 30. LASIK Xtra: Who Should Get It? P. MULTIMODAL IMAGING OF PLACOID DISORDERS P. 42 WILLS RESIDENT CASE SERIES P. 67 NTG: THE NOCTURNAL BLOOD PRESSURE FACTOR P. 54 WISE CHOICES FOR OCULAR DIAGNOSES P. 50 NEW WAYS TO DETECT KERATOCONUS P. 58

More information

When refractive surgeons began to understand

When refractive surgeons began to understand The Fundamentals of Customized Ablation Customized treatments are especially useful when aberrations are high and symptomatic. BY LAURA DE BENITO-LLOPIS, MRCOphth, MD, PhD When refractive surgeons began

More information

Topography guided custom ablation treatment for treatment of keratoconus

Topography guided custom ablation treatment for treatment of keratoconus Symposium: Keratoconus Topography guided custom ablation treatment for treatment of keratoconus Rohit Shetty, Sharon D Souza, Samaresh Srivastava 1, R Ashwini Keratoconus is a progressive ectatic disorder

More information

Collagen Cross-linking combined with PRK and LASIK

Collagen Cross-linking combined with PRK and LASIK Collagen Cross-linking combined with PRK and LASIK./*0&1#*!"#$%%&'&(%&)2*+,* +$345"%*,46$57&62*8")$694)4&#/:6*;#)%4#45"%*?6&@$))&62*ABC*8"#:&#$*+$345"%*D51&&%2*AB!"#$%%&'&(%&)*+,!

More information

Refractive Surgery. Evolution of Refractive Error Correction

Refractive Surgery. Evolution of Refractive Error Correction Refractive Surgery Techniques that correct for refractive error in the eye have undergone dramatic evolution. The cornea is the easiest place to place a correction, so most techniques have focused on modifying

More information

The concept of a proactive intervention involving in situ

The concept of a proactive intervention involving in situ CLINICAL SCIENCE Epithelial Remodeling After Femtosecond Laser-assisted High Myopic LASIK: Comparison of Stand-alone With LASIK Combined With Prophylactic High-fluence Cross-linking Anastasios J. Kanellopoulos,

More information

ORIGINAL ARTICLES. Anastasios John Kanellopoulos, MD; Perry S. Binder, MS, MD

ORIGINAL ARTICLES. Anastasios John Kanellopoulos, MD; Perry S. Binder, MS, MD ORIGINAL ARTICLES Management of Corneal Ectasia After LASIK With Combined, Same-day, Topographyguided Partial Transepithelial PRK and Collagen Cross-linking: The Athens Protocol Anastasios John Kanellopoulos,

More information

Short and long term complications of combined. Protocol) in 412 keratoconus eyes (2 7 years follow up)

Short and long term complications of combined. Protocol) in 412 keratoconus eyes (2 7 years follow up) Short and long term complications of combined topography guided PRK and CXL (the Athens Protocol) in 412 keratoconus eyes (2 7 years follow up) Anastasios John Kanellopoulos, MD Director, Laservision.gr

More information

Richard S. Hoffman, MD. Clinical Associate Professor of Ophthalmology Oregon Health & Science University

Richard S. Hoffman, MD. Clinical Associate Professor of Ophthalmology Oregon Health & Science University Zeiss Mel 80 and Visumax Refractive Laser Systems Richard S. Hoffman, MD Clinical Associate Professor of Ophthalmology Oregon Health & Science University No Financial Interest ZEISS Workstation CRS-Master

More information

Surgical Advances in Keratoconus. Keratoconus. Innovations in Ophthalmology. New Surgical Advances. Diagnosis of Keratoconus. Scheimpflug imaging

Surgical Advances in Keratoconus. Keratoconus. Innovations in Ophthalmology. New Surgical Advances. Diagnosis of Keratoconus. Scheimpflug imaging Surgical Advances in Keratoconus Keratoconus Ectatic disorder 1 in 1,000 individuals Starts in adolescence & early adulthood Uncertain cause 20% require corneal transplant Innovations in Ophthalmology

More information

Wavefront technology has been used in our

Wavefront technology has been used in our Wavefront Customized Ablations With the WASCA Asclepion Workstation Sophia I. Panagopoulou, BSc; Ioannis G. Pallikaris, MD ABSTRACT PURPOSE: WASCA (Wavefront Aberration Supported Cornea Ablation) is a

More information

Accelerated Refractive Performance

Accelerated Refractive Performance Accelerated Refractive Performance Get There at the Speed of WaveLight Designed to accommodate your refractive technology goals now and into the future, the WaveLight Workstation is a faster way to get

More information

VISX Wavefront-Guided LASIK for Correction of Myopic Astigmatism, Hyperopic Astigmatism and Mixed Astigmatism (CustomVue LASIK Laser Treatment)

VISX Wavefront-Guided LASIK for Correction of Myopic Astigmatism, Hyperopic Astigmatism and Mixed Astigmatism (CustomVue LASIK Laser Treatment) CustomVue Advantage Patient Information Sheet VISX Wavefront-Guided LASIK for Correction of Myopic Astigmatism, Hyperopic Astigmatism and Mixed Astigmatism (CustomVue LASIK Laser Treatment) Statements

More information

MicroScan. Excimer laser system for all types of vision corrections OPTOSYSTEMS LTD.

MicroScan. Excimer laser system for all types of vision corrections OPTOSYSTEMS LTD. MicroScan Excimer laser system for all types of vision corrections OPTOSYSTEMS LTD. МicroScan is a new generation excimer laser system for all types of vision corrections: myopia, hypermetropia, astigmatism.

More information

Keratoconus is a bilateral, nonsymmetric, and noninflammatory

Keratoconus is a bilateral, nonsymmetric, and noninflammatory CASE REPORT Collagen Cross-Linking (CCL) With Sequential Topography-Guided PRK A Temporizing Alternative for Keratoconus to Penetrating Keratoplasty A. John Kanellopoulos, MD* and Perry S. Binder, MS,

More information

Our Commitment To You

Our Commitment To You SYSTEM SUPPORT Quality-crafted, the system boasts dependability with high efficiency and low gas usage. We provide responsive service and maintenance contract options, supported by our nationwide direct

More information

Customized corneal ablation and super vision. Customized Corneal Ablation and Super Vision

Customized corneal ablation and super vision. Customized Corneal Ablation and Super Vision Customized Corneal Ablation and Super Vision Scott M. MacRae, MD; James Schwiegerling, PhD; Robert Snyder, MD, PhD ABSTRACT PURPOSE: To review the early development of new technologies that are becoming

More information

(Mazzotta et al, 2007) Human corneal rigidity increases 329 % (Wollensak, 2006)

(Mazzotta et al, 2007) Human corneal rigidity increases 329 % (Wollensak, 2006) Simultaneous PRK and CXL Corneal Crosslinking (CXL): UV-A light, 365 nm, causes riboflavin, 0.1 %, to release oxygen radicals which create new cross-linking bonds between collagen lameller fibres and within

More information

Ectasia after laser in-situ keratomileusis (LASIK)

Ectasia after laser in-situ keratomileusis (LASIK) Ectasia after laser in-situ keratomileusis (LASIK) 長 庚 紀 念 醫 院 眼 科 蕭 靜 熹 Post-LASIK ectasia A rare complication of LASIK Manhattan jury awarded a former investment banker a record $7.25 million for post-lasik

More information

Keratoconus is one of the most challenging corneal

Keratoconus is one of the most challenging corneal Corneal Remodeling Using the Keraring A variety of thicknesses, arc lengths, and optical zone sizes allows tailoring of the procedure to the individual patient. BY DOMINIQUE PIETRINI, MD; AND TONY GUEDJ

More information

The future of laser refractive surgery is exciting

The future of laser refractive surgery is exciting The Cornea is Not a Piece of Plastic Cynthia Roberts, PhD Editorial The future of laser refractive surgery is exciting with the potential for ever-improved postoperative visual performance. In the past,

More information

THE BEST OF BOTH WORLDS Dual-Scheimpflug and Placido Reaching a new level in refractive screening

THE BEST OF BOTH WORLDS Dual-Scheimpflug and Placido Reaching a new level in refractive screening THE BEST OF BOTH WORLDS Dual-Scheimpflug and Placido Reaching a new level in refractive screening GALILEI G4 Clinical Applications Corneal Implant Planning The comes with a licensable corneal inlay software

More information

Comparison of Residual Stromal Bed Thickness and Flap Thickness at LASIK and Post-LASIK Enhancement in Femtosecond Laser-Created Flaps

Comparison of Residual Stromal Bed Thickness and Flap Thickness at LASIK and Post-LASIK Enhancement in Femtosecond Laser-Created Flaps Comparison of Residual Stromal Bed Thickness and Flap Thickness at LASIK and Post-LASIK Enhancement in Femtosecond Laser-Created Flaps Lingo Y. Lai, MD William G. Zeh, MD Clark L. Springs, MD The authors

More information

Comparison of corneal epithelial and stromal thickness distribution between eyes with keratoconus and healthy eyes with corneal astigmatism >2.

Comparison of corneal epithelial and stromal thickness distribution between eyes with keratoconus and healthy eyes with corneal astigmatism >2. Comparison of corneal epithelial and stromal thickness distribution between eyes with keratoconus and healthy eyes with corneal astigmatism >2.0 D Principal Investigator, Research Team, and Study Site:

More information

Management of Unpredictable Post-PRK Corneal Ectasia with Intacs Implantation

Management of Unpredictable Post-PRK Corneal Ectasia with Intacs Implantation Management of Unpredictable Post-PRK Corneal Ectasia with Intacs Implantation Mohammad Naser Hashemian, MD 1 Mahdi AliZadeh, MD 2 Hassan Hashemi, MD 1,3 Firoozeh Rahimi, MD 4 Abstract Purpose: To present

More information

Topographically-guided Laser In Situ Keratomileusis to Treat Corneal Irregularities

Topographically-guided Laser In Situ Keratomileusis to Treat Corneal Irregularities Topographically-guided Laser In Situ Keratomileusis to Treat Corneal Irregularities Michael C. Knorz, MD, Bettina Jendritza, MD Objective: To evaluate the predictability and safety of topographically guided

More information

Validation of a New Scoring System for the Detection of Early Forme of Keratoconus

Validation of a New Scoring System for the Detection of Early Forme of Keratoconus 10.5005/jp-journals-10025-1019 Alain Saad, Damien Gatinel ORIGINAL ARTICLE Validation of a New Scoring System for the Detection of Early Forme of Keratoconus Alain Saad, Damien Gatinel ABSTRACT Purpose:

More information

TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM

TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM 1 BoydVision TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM Risks and Side Effects... 2 Risks Specific to PRK... 3 Risks Specific to LASIK... 4 Patient Statement of Consent... 5 Consent for Laser Eye

More information

LASIK SURGERY IN AL- NASSIRYA CITY A CLINICOSTATISTICAL STUDY

LASIK SURGERY IN AL- NASSIRYA CITY A CLINICOSTATISTICAL STUDY Thi-Qar Medical Journal (TQMJ): Vol(4) No(4):1(14-21) SUMMARY: LASIK SURGERY IN AL- NASSIRYA CITY A CLINICOSTATISTICAL STUDY Dr. Ali Jawad AL- Gidis (M.B.Ch.B., D.O., F.I.C.O.)* Background: LASIK which

More information

Life Science Journal 2014;11(9) http://www.lifesciencesite.com. Cross cylinder Challenging cases and their resultswith Nidek Quest (EC-5000)

Life Science Journal 2014;11(9) http://www.lifesciencesite.com. Cross cylinder Challenging cases and their resultswith Nidek Quest (EC-5000) Cross cylinder Challenging cases and their resultswith Nidek Quest (EC-5000) Gamal Mostafa Abo El Maaty, Mohamed Elmoddather, Mahmoud Ibrahem Ghazy, Mohamed Al-Taher Ophthalmology Department, Faculty of

More information

New topographic custom ablation procedure for treating irregular astigmatism post keratoplasty with high frequency (1 KHz) excimer laser.

New topographic custom ablation procedure for treating irregular astigmatism post keratoplasty with high frequency (1 KHz) excimer laser. New topographic custom ablation procedure for treating irregular astigmatism post keratoplasty with high frequency (1 KHz) excimer laser. G. COLONNA M.D., G. Lorusso M.D., S. Santoro M.D. ESCRS Berlin

More information

Wavefront-guided Enhancements Using the WaveLight Excimer Laser in Symptomatic Eyes Previously Treated With LASIK

Wavefront-guided Enhancements Using the WaveLight Excimer Laser in Symptomatic Eyes Previously Treated With LASIK Wavefront-guided Enhancements Using the WaveLight Excimer Laser in Symptomatic Eyes Previously Treated With LASIK A. John Kanellopoulos, MD; Lawrence H. Pe, MD ABSTRACT PURPOSE: To describe our clinical

More information

Keratoconus. Progressive bilateral ectasia. Onset puberty. Prevalence 1:2000. 20% progress to transplantation. Pathogenesis unclear

Keratoconus. Progressive bilateral ectasia. Onset puberty. Prevalence 1:2000. 20% progress to transplantation. Pathogenesis unclear Keratoconus Progressive bilateral ectasia Onset puberty Prevalence 1:2000 20% progress to transplantation Pathogenesis unclear Increased pepsin and catalase Decreased collagen crosslinking cf normal Conventional

More information

Save the Date. 16th SCHWIND User Meeting January 21-24, 2016, Singapore

Save the Date. 16th SCHWIND User Meeting January 21-24, 2016, Singapore Save the Date 16th SCHWIND User Meeting January 21-24, 2016, Singapore SCHWIND Programme Booklet ESCRS Barcelona September 5-8, 2015 SCHWIND eye-tech-solutions, Programme ESCRS 2015 3 ESCRS Congress 2015

More information

Consumer s Guide to LASIK

Consumer s Guide to LASIK Consumer s Guide to LASIK A Community Service Project brought to you by Price Vision Group Your Guide To A Successful LASIK Procedure The purpose of this educational guide is to help prospective patients

More information

Excimer Laser Eye Surgery

Excimer Laser Eye Surgery Excimer Laser Eye Surgery This booklet contains general information that is not specific to you. If you have any questions after reading this, ask your own physician or health care worker. They know you

More information

KERATOCONUS IS A BILATERAL, ASYMMETRIC, CHRONIC,

KERATOCONUS IS A BILATERAL, ASYMMETRIC, CHRONIC, Comparison of and Intacs for Keratoconus and Post-LASIK Ectasia MUNISH SHARMA, MD, AND BRIAN S. BOXER WACHLER, MD PURPOSE: To evaluate the efficacy of single-segment Intacs and compare with double-segment

More information

WILL SURFACE ABLATION TECHNIQUES SURVIVE?

WILL SURFACE ABLATION TECHNIQUES SURVIVE? WILL SURFACE ABLATION TECHNIQUES SURVIVE? There will always be situations in which the original laser approach works best. BY SUPHI TANERI, MD I had the privilege of being trained in refractive surgery

More information

Medical Director, Shinagawa LASIK Center, Tokyo, Japan Adjunct Professor, Department of Ophthalmology, Wenzhou Medical College, Wenzhou, China

Medical Director, Shinagawa LASIK Center, Tokyo, Japan Adjunct Professor, Department of Ophthalmology, Wenzhou Medical College, Wenzhou, China Medical Director,, Tokyo, Japan Adjunct Professor, Department of Ophthalmology, Wenzhou Medical College, Wenzhou, China Financial disclosure: Ziemer Group AG, Switzerland AcuFocus, CA Schwind Eye-Tech-Solutions,

More information

Therapeutic Flap Amputation for Atypical LASIK Flap and Interface Abnormalities

Therapeutic Flap Amputation for Atypical LASIK Flap and Interface Abnormalities THERAPEUTIC REFRACTIVE SURGERY Therapeutic Flap Amputation for Atypical LASIK Flap and Interface Abnormalities Heather M. Weissman, MD; J. Bradley Randleman, MD ABSTRACT PURPOSE: To describe LASIK flap

More information

Short and long term complications of combined. Protocol) in 412 keratoconus eyes (2 7 years follow up)

Short and long term complications of combined. Protocol) in 412 keratoconus eyes (2 7 years follow up) Short and long term complications of combined topography guided PRK and CXL (the Athens Protocol) in 412 keratoconus eyes (2 7 years follow up) Anastasios John Kanellopoulos, MD Director, Laservision.gr

More information

Correction of High Astigmatism: Case Studies Using the Mixed-cylinder Approach

Correction of High Astigmatism: Case Studies Using the Mixed-cylinder Approach Correction of High Astigmatism: Case Studies Using the Mixed-cylinder Approach Hamza N. Khan, MD, MPH, FRCSC; Geoffrey B. Kaye, MBChB, FCS(SA), FRCSC; Jean Luc Febbraro, MD ABSTRACT PURPOSE: To explain

More information

Cornea and Refractive Surgery Update

Cornea and Refractive Surgery Update Cornea and Refractive Surgery Update Fall 2015 Optometric Education Dinner Sebastian Lesniak MD Matossian Eye Associates Disclosures: None Bio: Anterior Segment and Cornea Surgery Fellowship Wills Eye

More information

LASIK. Complications. Customized Ablations. Photorefractive Keratectomy. Femtosecond Keratome for LASIK. Cornea Resculpted

LASIK. Complications. Customized Ablations. Photorefractive Keratectomy. Femtosecond Keratome for LASIK. Cornea Resculpted Refractive Surgery: Which Procedure for Which Patient? David R. Hardten, M.D. Minneapolis, Minnesota Have done research, consulting, or speaking for: Alcon, Allergan, AMO, Bausch & Lomb, Inspire, Medtronic,

More information

Διαθλαζηικη Χειροσργικη 2014

Διαθλαζηικη Χειροσργικη 2014 Διαθλαζηικη Χειροσργικη 2014 Επιθηλιο Femto Κεραηοκωνος Διαζσνδεζη Κολλαγονοσ Anastasios John Kanellopoulos, MD Professor: NYU Medical School, New York, NY LaserVision.gr Eye Institute, Athens, Greece

More information

It has been 10 years since ophthalmology was captivated

It has been 10 years since ophthalmology was captivated Wavefront-Guided Treatments: Past, Present, and Future An overview of wavefront basics and a personal account of one surgeon s experience. BY A. JOHN KANELLOPOULOS, MD It has been 10 years since ophthalmology

More information

Keratoconus Detection Using Corneal Topography

Keratoconus Detection Using Corneal Topography Keratoconus Detection Using Corneal Topography Jack T. Holladay, MD, MSEE, FACS ABSTRACT PURPOSE: To review the topographic patterns associated with keratoconus suspects and provide criteria for keratoconus

More information

Alain Saad, MD, Alice Grise-Dulac, MD, Damien Gatinel, MD, PhD

Alain Saad, MD, Alice Grise-Dulac, MD, Damien Gatinel, MD, PhD CASE REPORT Bilateral loss in the quality of vision associated with anterior corneal protrusion after hyperopic LASIK followed by intrastromal femtolaser-assisted incisions Alain Saad, MD, Alice Grise-Dulac,

More information

Active Cyclotorsion Error Correction During LASIK for Myopia and Myopic Astigmatism With the NIDEK EC-5000 CX III Laser

Active Cyclotorsion Error Correction During LASIK for Myopia and Myopic Astigmatism With the NIDEK EC-5000 CX III Laser Active Cyclotorsion Error Correction During LASIK for Myopia and Myopic Astigmatism With the NIDEK EC-5000 CX III Laser Sudhank Bharti, MD; Harkaran S. Bains ABSTRACT PURPOSE: To investigate the predictability

More information

OCT-guided Femtosecond Laser for LASIK and Presbyopia Treatment

OCT-guided Femtosecond Laser for LASIK and Presbyopia Treatment Shinagawa LASIK Center OCT-guided Femtosecond Laser for LASIK and Presbyopia Treatment Minoru Tomita, MD, Ph.D 1) Executive Medical Director at Shinagawa LASIK Center, Tokyo, Japan 2) Clinical Professor

More information

Anterior Lamellar Keratoplasty With a Microkeratome: A Method for Managing Complications After Refractive Surgery

Anterior Lamellar Keratoplasty With a Microkeratome: A Method for Managing Complications After Refractive Surgery Anterior Lamellar Keratoplasty With a Microkeratome: A Method for Managing Complications After Refractive Surgery Farhad Hafezi, MD; Michael Mrochen, PhD; Franz Fankhauser II, MD; Theo Seiler, MD, PhD

More information

Epithelial Measurement and Healing

Epithelial Measurement and Healing Epithelial Measurement and Healing Dan Z Reinstein, MD MA(Cantab) FRCSC DABO FRCOphth FEBO Introduction The corneal epithelium is a highly active, self-renewing layer; a complete turnover occurs in approximately

More information

REFRACTIVE ERROR AND SURGERIES IN THE UNITED STATES

REFRACTIVE ERROR AND SURGERIES IN THE UNITED STATES Introduction REFRACTIVE ERROR AND SURGERIES IN THE UNITED STATES 150 million wear eyeglasses or contact lenses 2.3 million refractive surgeries performed between 1995 and 2001 Introduction REFRACTIVE SURGERY:

More information

By Dr Waleed Al-Tuwairqi, MD Dr Omnia Sherif, MD Ophthalmology Consultants, Elite Medical & Surgical Center Riyadh -KSA.

By Dr Waleed Al-Tuwairqi, MD Dr Omnia Sherif, MD Ophthalmology Consultants, Elite Medical & Surgical Center Riyadh -KSA. By Dr Waleed Al-Tuwairqi, MD Dr Omnia Sherif, MD Ophthalmology Consultants, Elite Medical & Surgical Center Riyadh -KSA Rome, Italy 2013 بسم الرحمن الرحيم In the name of Allah, Most Gracious, Most Merciful

More information

Customized corneal ablation can be designed. Slit Skiascopic-guided Ablation Using the Nidek Laser. Scott MacRae, MD; Masanao Fujieda

Customized corneal ablation can be designed. Slit Skiascopic-guided Ablation Using the Nidek Laser. Scott MacRae, MD; Masanao Fujieda Slit Skiascopic-guided Ablation Using the Nidek Laser Scott MacRae, MD; Masanao Fujieda ABSTRACT PURPOSE: To present the approach of using a scanning slit refractometer (the ARK 10000) in conjunction with

More information

Lasik Xtra Clinical Data Overview. MA-00354 Rev A

Lasik Xtra Clinical Data Overview. MA-00354 Rev A Lasik Xtra Clinical Data Overview Table of Contents What is Lasik Xtra? Who is Lasik Xtra being performed on? How is Lasik Xtra performed? What data to support Lasik Xtra? What is Lasik Xtra? Performed

More information

Diego Fernando Suárez Sierra, MD Fellow Cornea and Refractive Surgery Fellow Lens and Ocular Surface Vejarano Laser Vision Center

Diego Fernando Suárez Sierra, MD Fellow Cornea and Refractive Surgery Fellow Lens and Ocular Surface Vejarano Laser Vision Center Corneal crosslinking with riboflavin and ultraviolet light before or after subepithelial keratectomy laser-assisted (LASEK) in patients with thin corneas. Diego Fernando Suárez Sierra, MD Fellow Cornea

More information

One of the exciting new research areas in laser

One of the exciting new research areas in laser Future Challenges to Aberration-free Ablative Procedures Cynthia Roberts, PhD One of the exciting new research areas in laser refractive surgery is the development of sophisticated devices to measure the

More information

Irregular astigmatism:

Irregular astigmatism: Irregular astigmatism: definition, classification, topographic and clinical presentation Ming X. Wang, MD, PhD Clinical Associate Professor of Ophthalmology of University of Tennessee Director, Wang Vision

More information

Solid-State Laser Platforms: Two Reviews The benefits of using the Pulzar Z1 and LaserSoft technologies.

Solid-State Laser Platforms: Two Reviews The benefits of using the Pulzar Z1 and LaserSoft technologies. Solid-State Laser Platforms: Two Reviews The benefits of using the Pulzar Z1 and LaserSoft technologies. BY SUNIL SHAH, MBBS, FRCOPHTH, FRCS(ED), FBCLA; AND MATTEO PIOVELLA, MD An Attractive Proposition

More information

Surgical Management of Irregular Astigmatism

Surgical Management of Irregular Astigmatism Peer-Reviewed Literature: Surgical Management of Irregular Astigmatism Editor: Ming Wang, MD, PhD, Clinical Associate Professor of Ophthalmology at the University of Tennessee and Director of the Wang

More information

The Evolution of the Optical Zone in Corneal Refractive Surgery. Bruce Drum, Ph.D.

The Evolution of the Optical Zone in Corneal Refractive Surgery. Bruce Drum, Ph.D. The Evolution of the Optical Zone in Corneal Refractive Surgery. Bruce Drum, Ph.D. FDA, Division of Ophthalmic and ENT Devices, Rockville, MD Disclaimer This presentation represents the professional opinion

More information

Laser-assisted In Situ Keratomileusis for Correction of Astigmatism and Increasing Contact Lens Tolerance after Penetrating Keratoplasty

Laser-assisted In Situ Keratomileusis for Correction of Astigmatism and Increasing Contact Lens Tolerance after Penetrating Keratoplasty pissn: -9 eissn: 9-9 Korean J Ophthalmol ;(5):59- http://dx.doi.org/./kjo...5.59 Original Article Laser-assisted In Situ Keratomileusis for Correction of Astigmatism and Increasing Contact Lens Tolerance

More information

Corneal Collagen Cross-Linking (CXL) With Riboflavin

Corneal Collagen Cross-Linking (CXL) With Riboflavin Dr. Paul J. Dubord, MD, FRCSC Clinical Professor Department of Ophthalmology and Visual Sciences University of British Columbia Patient Information Guide Corneal Collagen Cross-Linking (CXL) With Riboflavin

More information

LASIK for Hyperopia With the WaveLight Excimer Laser

LASIK for Hyperopia With the WaveLight Excimer Laser LASIK for Hyperopia With the WaveLight Excimer Laser A. John Kanellopoulos, MD; Joseph Conway, MD; Lawrence H. Pe, MD ABSTRACT PURPOSE: To evaluate the safety and effi cacy of the ALLEGRETTO WAVE excimer

More information

Patient Information Booklet Information for patients considering Laser Assisted In-Situ Keratomileusis (LASIK) Surgery

Patient Information Booklet Information for patients considering Laser Assisted In-Situ Keratomileusis (LASIK) Surgery WaveLight EX500 Patient Information Booklet Information for patients considering Laser Assisted In-Situ Keratomileusis (LASIK) Surgery Please read this entire booklet. If you have any questions about it,

More information

Excimer Laser Photorefractive Keratectomy for Keratoconus

Excimer Laser Photorefractive Keratectomy for Keratoconus C H A P T E R 1 4 Excimer Laser Photorefractive Keratectomy for Keratoconus Arun C. Gulani, MD; Lee T. Nordan, MD; Noel Alpins, FRANZCO, FRCOphth, FACS; and George Stamatelatos, BSCOptom P atients with

More information

ESCRS 2011 Complications after LASIK/PRK Dan Reinstein MD MA(Cantab) FRCSC FRCOphth

ESCRS 2011 Complications after LASIK/PRK Dan Reinstein MD MA(Cantab) FRCSC FRCOphth Complications after LASIK or PRK: achieving excellent outcomes in therapeutic corneal refractive surgery Dan Reinstein, MD MA(Cantab) FRCSC DABO FRCOphth Introduction The options for repair of complications

More information

Transepithelial, Topography-guided Ablation in the Treatment of Visual Disturbances in LASIK Flap or Interface Complications

Transepithelial, Topography-guided Ablation in the Treatment of Visual Disturbances in LASIK Flap or Interface Complications Transepithelial, Topography-guided Ablation in the Treatment of Visual Disturbances in LASIK Flap or Interface Complications Xiangjun Chen, MD, MS; Aleksandar Stojanovic, MD; Wen Zhou; Tor Paaske Utheim,

More information

CXL With the Epithelium on or off: Which Is Better?

CXL With the Epithelium on or off: Which Is Better? CXL With the Epithelium on or off: Which Is Better? Transepithelial CXL Is Gaining Ground By Roy S. Rubinfeld, MD, and the CXL-USA Study Group At its simplest, corneal collagen cross-linking (CXL) is a

More information

FIRST EXPERIENCE WITH THE ZEISS FEMTOSECOND SYSTEM IN CONJUNC- TION WITH THE MEL 80 IN THE US

FIRST EXPERIENCE WITH THE ZEISS FEMTOSECOND SYSTEM IN CONJUNC- TION WITH THE MEL 80 IN THE US FIRST EXPERIENCE WITH THE ZEISS FEMTOSECOND SYSTEM IN CONJUNC- TION WITH THE MEL 80 IN THE US JON DISHLER, MD DENVER, COLORADO, USA INTRODUCTION AND STUDY OBJECTIVES This article summarizes the first US

More information

ABLATION-RELATED COMPLICATIONS FOLLOWING

ABLATION-RELATED COMPLICATIONS FOLLOWING Topographically Supported Customized Ablation for the Management of Decentered Laser In Situ Keratomileusis GEORGE D. KYMIONIS, MD, PHD, SOPHIA I. PANAGOPOULOU, BSC, IOANNIS M. ASLANIDES, MD, PHD, SOTIRIS

More information

The optical quality of the human eye suffers

The optical quality of the human eye suffers Operative Correction of Ocular Aberrations to Improve Visual Acuity Theo Seiler, MD, PhD; Michael Mrochen, PhD; Maik Kaemmerer, PhD ABSTRACT PURPOSE: Optical aberrations of the human eye degrade the quality

More information

Multi-Centre Evaluation of TransPRK outcomes with SCHWIND AMARIS using SmartPulse Technology

Multi-Centre Evaluation of TransPRK outcomes with SCHWIND AMARIS using SmartPulse Technology study 2015 Multi-Centre Evaluation of TransPRK outcomes with SCHWIND AMARIS using SmartPulse Technology David T. Lin, MD, Canada, Paolo Vinciguerra, MD, Italy, Maria C. Arbelaez, MD, Oman, Shady T. Awwad,

More information

LASIK/PRK following previous eye Surgery

LASIK/PRK following previous eye Surgery AAO Chicago 2010 LASIK/PRK following previous eye Surgery A. John Kanellopoulos, MD Associate Clinical Professor, NYU Medical School Director: Laservision.gr Eye Institute, Athens, Greece www.brilliantvision.com

More information

Refractive errors, such as residual astigmatism after

Refractive errors, such as residual astigmatism after CLINICAL SCIENCE Intrastromal Corneal Ring Segment Implantation by Femtosecond Laser for the Correction of Residual Astigmatism After Penetrating Keratoplasty Tatiana Moura Bastos Prazeres, MD,* Allan

More information

LASIK/PRK following previous eye Surgery

LASIK/PRK following previous eye Surgery AAO San Francisco 2009 LASIK/PRK following previous eye Surgery A. John Kanellopoulos, MD Associate Clinical Professor, NYU Medical School Director: Laservision.gr Eye Institute, Athens, Greece www.brilliantvision.com

More information

Eye Care In Modern Life

Eye Care In Modern Life Eye Care In Modern Life Dr. Dorothy Fan Department of Ophthalmology & Visual Sciences November 2009 dorothyfan@cuhk.edu.hk Structure of the Eye Information age > 90% of sensory input Blindness is one of

More information

ANGLE KAPPA. Copyrighted material. Not for distribution. chapter. Anastasios John Kanellopoulos, MD - 139 -

ANGLE KAPPA. Copyrighted material. Not for distribution. chapter. Anastasios John Kanellopoulos, MD - 139 - chapter 21 Femto-LASIK for Hyperopia and Hyperopic Astigmatism: Practical Pearls From 8 Years of Experience With Topography-Guided Corrections for Hyperopic LASIK Anastasios John Kanellopoulos, MD Refractive

More information

Transepithelial Crosslinking vs. Corneal Pocket Crosslinking. Christoph Kranemann MD Anna Yu OD

Transepithelial Crosslinking vs. Corneal Pocket Crosslinking. Christoph Kranemann MD Anna Yu OD Transepithelial Crosslinking vs. Corneal Pocket Crosslinking Christoph Kranemann MD Anna Yu OD Rome 2013 We have no financial interests in this presentation. Corneal collagen cross linking Creates new

More information

Wavefront Analysis in Post-LASIK Eyes and Its Correlation with Visual Symptoms, Refraction, and Topography

Wavefront Analysis in Post-LASIK Eyes and Its Correlation with Visual Symptoms, Refraction, and Topography Analysis in Post-LASIK Eyes and Its Correlation with Visual Symptoms, Refraction, and Topography Maria Regina Chalita, MD, 1 Sai Chavala, MD, 1 Meng Xu, MS, 2 Ronald R. Krueger, MD, MSE 1 Purpose: To evaluate

More information

Keratoconus surgery: what works best and why-

Keratoconus surgery: what works best and why- Keratoconus surgery: what works best and why-./-0&1#-!"#$%%&'&(%&)*-+,-,23$45&3*-6")$372)2&#/83-9#):5(5$*-.51$#)*-;3$$4$-

More information

Assessment of Contrast Sensitivity and Aberrations After Photorefractive Keratectomy in Patients with Myopia Greater than 5 Diopters

Assessment of Contrast Sensitivity and Aberrations After Photorefractive Keratectomy in Patients with Myopia Greater than 5 Diopters ORIGINAL REPORT Assessment of Contrast Sensitivity and Aberrations After Photorefractive Keratectomy in Patients with Myopia Greater than 5 Diopters Alireza Fahim 1, Bijan Rezvan 1, and Hassan Hashemi

More information

Collagen cross-linking should be done separately. Canan Asli Utine, MD, MSc, FICO Yeditepe University, Istanbul, Turkey

Collagen cross-linking should be done separately. Canan Asli Utine, MD, MSc, FICO Yeditepe University, Istanbul, Turkey Collagen cross-linking should be done separately Canan Asli Utine, MD, MSc, FICO Yeditepe University, Istanbul, Turkey Collagen cross linking 1st established tx addressing the pathophysiology of corneal

More information

Early results at 1 and 3 months after Trans-PRK with AMARIS. a no-touch, one-step treatment

Early results at 1 and 3 months after Trans-PRK with AMARIS. a no-touch, one-step treatment Early results at 1 and 3 months after Trans-PRK with AMARIS a no-touch, one-step treatment Trans-PRK advantages - No-Touch treatment in one step (much faster than in the past with 2 steps) - Significantly

More information

EVEN THOUGH EARLY CUSTOMIZED ABLATION RESULTS

EVEN THOUGH EARLY CUSTOMIZED ABLATION RESULTS Separate Effects of the Microkeratome Incision and Laser Ablation on the Eye s Wave Aberration JASON PORTER, MS, SCOTT MACRAE, MD, GEUNYOUNG YOON, PHD, CYNTHIA ROBERTS, PHD, IAN G. COX, PHD, AND DAVID

More information

Refractive Errors. Refractive Surgery. Eye Care In Modern Life. Structure of the Eye. Structure of the Eye. Structure of the Eye. Structure of the Eye

Refractive Errors. Refractive Surgery. Eye Care In Modern Life. Structure of the Eye. Structure of the Eye. Structure of the Eye. Structure of the Eye Structure of the Eye Eye Care In Modern Life Dr. Dorothy Fan Department of Ophthalmology & Visual Sciences September 2007 Information age > 90% of sensory input Blindness is one of the most fearful disabilities

More information

ALL-IN-ONE Optical Biometry, Dual Scheimpflug Tomography and Placido Topography

ALL-IN-ONE Optical Biometry, Dual Scheimpflug Tomography and Placido Topography ALL-IN-ONE Optical Biometry, Dual Scheimpflug Tomography and Placido Topography GALILEI G6 Clinical Applications High confidence premium IOL selection The GALILEI G6 offers a link to the ray-tracing software

More information