Laser Refractive Surgery Outcomes in >

13 000 EyesArthur Cummings, Richard CorkinWellington Eye ClinicUPMC Beacon Hospital, Dublin

ICOCavan, 12th May 2011

Background

Collectively we have performed >30 000 LASIK, LASEK and PRK procedures

All surgery performed by AC or RC WaveLight Allegretto 200, 400 & 500 Hz lasers Hansatome, XP, Rondo, WaveLight FS200 This paper is made up of a collection of papers

that have been presented over the past few years

LASIK vs. Surface Treatments

• In myopia < -8.00 LASIK and ASA (Advanced Surface Ablation) provide very similar outcomes• In myopia > -8.00 LASIK provides better and more stable outcomes• A great percentage of eyes gain lines of BCVA in the higher myopia group• LASIK outperforms ASA for hyperopia

SAFETY – Myopia (IK vs. EK)

SAFETY – Myopia > -8.00 (IK vs. EK)

LASIK 12 Months LASEK 12 Months

High Myopia > -8.00: Stability

Microkeratomes vs.

Femtosecond lasers

Numbers of Eyes & Flap Thickness

3 Months Follow-up Flap ThicknessHansatome 8361 136.88 ± 23.14Hansatome XP 2092 141.16 ± 22.23Rondo 712 115.96 ± 24.7FS200 476 120.4 ± 7.6

Epithelial Erosions Button Hole / Free CapHansatome 3.2% 0Hansatome XP 1.1% 0Rondo 0.1% 0FS200 0 0

Intra-Operative Complications

UCVA at 3 Months

BCVA at 3 Months

SAFETY

PREDICTABILITY AT 3 MONTHS

VECTORGRAM AT 3 MONTHS

CYLINDER SD

HANSATOME 0.36 0.34

XP 0.31 0.30

RONDO 0.28 0.26

FS 200 0.26 0.20

Comparing Lasers of Different Speeds:

200, 400 & 500 Hz

Safety >-2 -2 -1 0 +1 +2 >+2

LASIK200 0.3 1.3 10.1 65.8 17.8 4.4 0.3

400 0.4 1.2 8.6 70.8 15.5 2.8 0.7

500 0 1 4 65 24 5 1

LASEK / ASA200 0 0 8.6 52.7 29 9.7 0

400 0.2 2 10.3 65.6 17.8 3.4 0.8

500 0 0 5 60 35 8 2

ENHANCEMENTS200 0.4 1.7 15.1 57.6 22.3 2.5 0.4

400 0.8 2.2 16.3 61.3 15.9 2.8 0.8

500 0 0 13.3 60 20 6.7 0

PARA-METER

LASER 6/4 6/5 6/6 6/7.5 6/12

UCVA 200 1.3 43 63.5 77.5 87.5400 3.3 49.2 68.2 78.8 87.9500 6 50 72 88 93

BCVA 200 2.2 70 89.6 97.1 99.5400 3.8 75.1 91 97.1 99.3500 15 87 92 94 97

UCVA, BCVA, PREDICTABILITY

PREDICTABILITY 200 Hz 400 Hz 500 Hz± 0.50 85% 83% 88%

Primary Treatments

• Primary treatments have better safety profiles than secondary treatments• Enhancement surgery has a very high success rate in terms of improving UCVA• It does however lead to more loss of lines of BCVA than the primary procedure• This is true for myopia & hyperopia as well as LASIK and ASA• “Get it right the 1st time” has merit

LASIK 6 Months

7.2% of Myopic LASIK eyes lose 1 or more lines of BCVA while15.7% of LASIK Enhancement eyes lose 1 or more lines of BCVA.1.1% of enhancement eyes lose >2 lines of BCVA which very comfortably meets the FDA requirements of a safe procedure (less than 5% should lose >2 lines)

LASIK: Primary vs. Secondary

Enhancements 6 Months

6.9% of Myopic LASEK eyes lose 1 or more lines of BCVA while9.8% of LASEK Enhancement eyes lose 1 or more lines of BCVA.0.3% of LASEK eyes lose >2 lines of BCVA which very comfortably meets the FDA requirements of a safe procedure (less than 5% should lose >2 lines)

ASA: Primary vs. Secondary

LASEK 6 Months Enhancements 6 Months

Ablation Profiles

The WaveLight Allegretto offers the widest range of refractive tools in the form of:• WaveFront Optimised treatments• WaveFront-Guided treatments• Topography-Guided profiles (2 modes)• Asphericity-Guided profiles• Ray-Tracing profiles

Primary Treatments

85% receive WFO treatments 15% receive customized treatments How do they compare?

Primary Treatments

Compare 4 profiles across all refractive errors

WFO WFG T-CAT Custom-Q

Comparing 4 Ablation ProfilesWFO WFG

Topography-GuidedCustom-Q

Ray Tracing Profiles

European Multicentre Trial completed 3 Centres (Zurich, Cologne, Dublin) 132 Eyes treated, 111 with full

follow-up Ray Tracing was only done on

Primary treatments in this clinic trial All eyes > -4.00 myopia or > 2.00

DC

SAFETY at 3 Months

WFO WFG

T-CAT RT

WFO WFG

Topography-Guided RT

Secondary Treatments

75% receive WFO treatments 25% receive customized treatments How do they compare? RT not used in this cohort in this

study

WFO enhancement WFG enhancement

Custom Q enhancement T-CAT enhancement

WFO enhancement WFG enhancement

Custom Q enhancement T-CAT enhancement

SAFETY

Summary

LASIK and ASA have proven to be very effective and safe

LASIK better than ASA in high myopia / hyperopia Primary treatments safer than Secondary

treatments Different profiles have different applications Ray Tracing promises to get closer to the “holy

grail”

Thank You for Your Attention