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Kanellopoulos AJ, Maus M, Bala C, Hamilton C, Lemonis S, Jockovich ME, Khoramnia R. The Importance of HOA Reduction Measurements to Improving Refractive Surgery Result Outcomes [Response to Letter]. Clin Ophthalmol 2024; 18:2383-2385. [PMID: 39206301 PMCID: PMC11350223 DOI: 10.2147/opth.s491356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
- Anastasios John Kanellopoulos
- LaserVision Ambulatory Surgical Unit, Athens, Greece
- Department of Ophthalmology, NYU Grossman School of Medicine, New York City, NY, USA
| | | | | | | | | | | | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Kanellopoulos AJ. Ray-Tracing Customization in Myopic and Myopic Astigmatism LASIK Treatments for Low and High Order Aberrations Treatment: 2-Year Visual Function and Psychometric Value Outcomes of a Consecutive Case Series. Clin Ophthalmol 2024; 18:565-574. [PMID: 38410630 PMCID: PMC10896098 DOI: 10.2147/opth.s444174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024] Open
Abstract
Purpose The safety and long-term efficacy of automated ray-tracing customized myopic and myopic astigmatic femtosecond laser-assisted LASIK. Methods This consecutive case series retrospective analysis, of 20 subjects (40 eyes) treated with automated raytracing named Wavelight Plus, to include low and high order aberrations based on a three-dimensional custom virtual eye for each case-calculated from interferometry data-obtained from a single diagnostic device that also provides Hartman-Shack Wavefront and Scheimpflug tomography data. We evaluated before and after the customized LASIK procedure: visual acuity, refractive error, high order aberrations, contrast sensitivity, and psychometric post-operative visual function data. Results At 24 months, the comparison of the pre-operative to the post-operative refractive and visual function value changes in average were: subjective manifest refraction from -4.38 ± 2.54 diopters (D) (range -9.75 to -1.25 D) to +0.11 ± 0.19 D; subjective manifest refractive astigmatism from -0.76 ± 0.91 D (range -2.75 to 0 D) to -0.13 ± 0.16 D, corneal astigmatism from -1.16 ± 0.64 D (range -0.2 to -2.8) to -0.47 ± 0.11 D. 65% of the eyes studied demonstrated an increase of at least one line of vision, while from the same group 38% demonstrated 2 lines of increase. High order aberrations, contrast sensitivity as well as the subjective psychometric input based on the VFQ-25 questionnaire demonstrated actual improvement. Conclusion This longer-term follow-up, single-arm retrospective consecutive case series documents LASIK treatment customization that appears to be safe and effective in the correction of myopia and myopic astigmatism. Markedly improved objective and subjective visual function post-operatively, underlying the potential importance of simultaneously attempting to correct high order aberrations and improving the spatial alignment of total, measured human eye optics.
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Affiliation(s)
- Anastasios John Kanellopoulos
- Medical Director: The Laservision Clinical and Research Institute, Athens, Greece
- Clinical Professor, Department of Ophthalmology, NYU Grossman Medical School, Department of Ophthalmology, New York City, NY, USA
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Zhang Q, Wu Y, Huang H, Qin G, Li L, Chen J, Che H, Xu L, Moore JE, He W, Yu S, Pazo EE, He X. The influence of pupil diameter upon and subjective quality of vision following implantable collamer lens (ICL V4c) implantation: An observational study. Medicine (Baltimore) 2023; 102:e35198. [PMID: 37800803 PMCID: PMC10553097 DOI: 10.1097/md.0000000000035198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 10/07/2023] Open
Abstract
This study aimed to assess the change in pupil size and its influence on subjective quality of vision (QoV) in subjects with implanted collamer lenses (ICLs). This retrospective study assessed 53 participants (53 eyes) implanted with ICL (V4c) and categorized them into incremental groups according to pupil diameter. Preoperative and postoperative photopic and mesopic pupil diameter, uncorrected distance visual acuity (UDVA), and QoV questionnaire scores were assessed and compared. Postoperatively, at 3 months, UDVA was -0.10 ± 0.06 logarithm of the minimum angle of resolution (LogMAR), and mean QoV for day and night was 9.34 ± 0.76 and 8.58 ± 1.29, respectively. The mean mesopic and photopic pupil diameters were 6.59 ± 0.79 mm and 4.61 ± 0.74 mm, respectively. Photopic pupil diameter negatively correlated with "QoV day" (Rs = -0.413, P = .001), positively correlated with "haloes" (Rs = 0.568*, P < .001) and "blurred vision" (Rs = 0.243, P = .04) respectively. Mesopic pupil diameter negatively correlated with "QoV night" (Rs = -0.426, P = .001), positively correlated with "haloes" (Rs = 0.624*, P < .001), "starburst" (Rs = 0.233, P = .046) and "difficulty focusing" (Rs = 0.27, P = .025), respectively. Participants had excellent VA at 3-month follow-up. Photopic and mesonic pupil diameter negatively correlated with QoV day and QoV night scores, respectively. Pupil diameter was found to have a more significant effect on visual symptoms at night, and lower QoV due to larger pupil size was more noticeable at night. Further investigation is needed to explore the importance of pupil diameter and its impact on the QoV in ICL implanted patients.
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Affiliation(s)
- Qing Zhang
- He Eye Specialist Hospital, Shenyang, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
- Cathedral Eye Clinic, Belfast, UK
| | - Yi Wu
- He Eye Specialist Hospital, Shenyang, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - He Huang
- He Eye Specialist Hospital, Shenyang, China
| | | | | | | | - Huixin Che
- He Eye Specialist Hospital, Shenyang, China
| | - Ling Xu
- He Eye Specialist Hospital, Shenyang, China
| | | | - Wei He
- He Eye Specialist Hospital, Shenyang, China
| | - Sile Yu
- He Eye Specialist Hospital, Shenyang, China
| | | | - Xingru He
- He Eye Specialist Hospital, Shenyang, China
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Moshirfar M, Basharat NF, Bundogji N, Ungricht EL, Darquea IM, Conley ME, Ronquillo YC, Hoopes PC. Laser-Assisted In Situ Keratomileusis (LASIK) Enhancement for Residual Refractive Error after Primary LASIK. J Clin Med 2022; 11:jcm11164832. [PMID: 36013070 PMCID: PMC9410252 DOI: 10.3390/jcm11164832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To evaluate the safety, efficacy, and predictability of laser-assisted in situ keratomileusis (LASIK) enhancement after primary LASIK and compare to Food and Drug Administration (FDA) criteria. Methods: Patients who underwent LASIK enhancement after primary LASIK between 2002 and 2019 were compared to those who underwent LASIK without retreatment. Patient demographics, preoperative characteristics, visual outcomes, and postoperative complications were compared between groups. Epithelial ingrowth (EI) development was stratified based on duration between primary and secondary procedures. Results: We compared 901 eyes with LASIK enhancement to 1127 eyes without retreatment. Age, sex, surgical eye, sphere, cylinder, and spherical equivalent (SE) were significantly different between groups (p < 0.05). At 12 months post-enhancement, 86% of the eyes had an uncorrected distance visual acuity of 20/20 or better and 93% of eyes were within ±0.50 D of the target. Development of EI (6.1%) demonstrated an odds ratio of 16.3 in the long-term compared to the short-term (95% CI: 5.9 to 45.18; p < 0.0001). Conclusions: Older age at primary LASIK, female sex, right eye, and larger sphere, cylinder and SE were risk factors for enhancement. Risk of EI significantly increased when duration between primary and enhancement procedures exceeded five years. LASIK enhancements produce favorable outcomes and meet FDA benchmarks for safety, efficacy, and predictability.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Utah Lions Eye Bank, Murray, UT 84107, USA
- Correspondence: ; Tel.: +1-801-568-0200
| | - Noor F. Basharat
- University of Arizona College of Medicine—Phoenix, Phoenix, AZ 85004, USA
| | - Nour Bundogji
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | | | - Ines M. Darquea
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
| | - Matthew E. Conley
- University of Utah School of Medicine, Salt Lake City, UT 84132, USA
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Kanellopoulos AJ. Initial Outcomes with Customized Myopic LASIK, Guided by Automated Ray Tracing Optimization: A Novel Technique. Clin Ophthalmol 2020; 14:3955-3963. [PMID: 33239861 PMCID: PMC7680798 DOI: 10.2147/opth.s280560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Safety and efficacy of a novel automated ray tracing optimization in customization of excimer ablation in myopic LASIK. Methods In a consecutive case series, 25 patients (50 eyes) undergoing femtosecond-laser-assisted myopic LASIK were evaluated. The novel, artificial-intelligence platform initially calculates the ablation profile based on a model eye for each case, based on interferometry axial length data. Low- and high-order aberration calculation is performed by raytracing based on wavefront and Scheimpflug tomography measurements, all from a single diagnostic device. Visual acuity, refractive error, keratometry, topography, high-order aberrations and contrast sensitivity were evaluated, over six months follow-up. Results Change from pre- to 6 months post-operative: mean refractive error improved from −5.06 ± 2.54 diopters (D) (range −8.0 to −0.50 D) to −0.11 ± 0.09 D (range −0.25 to + 0.25); refractive astigmatism from −1.07 ± 0.91 D (range −4.25 to 0 D) to −0.15 ± 0.04 D (range −0.25 to 0); and topographic astigmatism from −1.65 ± 0.85 D to −0.26 ± 0.11 D (range −0.60 to 0). About 65% of eyes gained one line of vision and 38% 2 lines. Pre- to post-operative high-order aberration average: RMSh changed from 0.25 um to 0.35 um. Contrast sensitivity improved post-operatively. Conclusion We report safe and effective preliminary outcomes with a novel excimer laser customization by ray tracing optimization, for myopic LASIK treatments, employing several independent up-till-now diagnostics and a customized eye model reference for each case. It bears the potential advantage through total eye aberration data and ray tracing refraction calculation to offer improved and more predictable visual outcomes. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/D9pRQDAcjLg
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Affiliation(s)
- Anastasios John Kanellopoulos
- Laservision.gr Clinical and Research Institute, Athens, Greece.,NYU Medical School, Department of Ophthalmology, New York City, NY, USA
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Kanellopoulos AJ. September consultation #3. J Cataract Refract Surg 2018; 44:1159-1161. [PMID: 30165939 DOI: 10.1016/j.jcrs.2018.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Errors in Treatment of Lower-order Aberrations and Induction of Higher-order Aberrations in Laser Refractive Surgery. Int Ophthalmol Clin 2016; 56:19-45. [PMID: 26938336 DOI: 10.1097/iio.0000000000000113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kruh JN, Garrett KA, Huntington B, Robinson S, Melki SA. Risk Factors for Retreatment Following Myopic LASIK with Femtosecond Laser and Custom Ablation for the Treatment of Myopia. Semin Ophthalmol 2016; 32:316-320. [DOI: 10.3109/08820538.2015.1088552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jonathan N. Kruh
- Boston Eye Group, Boston, MA, USA
- Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Kenneth A. Garrett
- Boston Eye Group, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Brian Huntington
- Boston Eye Group, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Steve Robinson
- Boston Eye Group, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Samir A. Melki
- Boston Eye Group, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
- Massachusetts Eye & Ear Infirmary, Boston, MA, USA
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Broderick KM, Sia RK, Ryan DS, Stutzman RD, Mines MJ, Frazier TC, Torres MF, Bower KS. Wavefront-optimized surface retreatments of refractive error following previous laser refractive surgery: a retrospective study. EYE AND VISION 2016; 3:3. [PMID: 26870742 PMCID: PMC4750286 DOI: 10.1186/s40662-016-0034-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022]
Abstract
Background Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive surgery. Many different combinations of primary treatment methods and retreatment techniques have been studied, however, few studies have investigated wavefront-optimized (WFO) technology for retreatment following primary refractive surgery. This study aimed to report the outcomes of WFO photorefractive keratectomy (PRK) retreatments of refractive error following previous laser refractive surgery with PRK, laser in situ keratomileusis (LASIK), or laser-assisted subepithelial keratectomy (LASEK). Methods We reviewed records of patients who underwent WFO PRK retreatments using the Allegretto Wave Eye-Q 400 Hz Excimer Laser System (Alcon Surgical) between January 2008 and April 2011 at Walter Reed Army Medical Center and Madigan Army Medical Center. Outcomes were recorded in terms of uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), corrected distance visual acuity (CDVA), and complications at 1 month (M), 3 M, and 6 M post-op. Results Seventy-eight patients (120 eyes) underwent WFO PRK retreatment during the study period. Primary surgery was surface ablation in 87 eyes (78 PRK, 9 LASEK) and LASIK in 33 eyes. The mean spherical equivalent before retreatment was −0.79 ± 0.94 D (−3.00 to 1.88 D). UDVA was ≥ 20/20 in 69 eyes (60.0 %) at 1 M, 54 eyes (71.1 %) at 3 M, and 27 eyes (73.0 %) at 6 M follow-up. MRSE was within ±0.50 D of emmetropia in 78 eyes (67.8 %) at 1 M, 59 eyes (77.6 %) at 3 M, and 25 eyes (67.6 %) at 6 M follow-up. CDVA was maintained within ±1 line of pre-op in 113 of 115 eyes (98.3 %) at 1 M, 74 of 76 eyes (97.4 %) at 3 M, and 37 eyes (100 %) at 6 M follow-up. Conclusion Although follow-up was limited beyond 3 M, WFO PRK retreatments in patients with residual refractive error may be a safe and effective procedure. Further studies are necessary to determine the long-term safety and stability of outcomes.
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Affiliation(s)
- Kevin M Broderick
- Ophthalmology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Rose K Sia
- Warfighter Refractive Eye Surgery Program and Research Center, Ft. Belvoir, VA USA
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center, Ft. Belvoir, VA USA
| | - Richard D Stutzman
- Ophthalmology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Michael J Mines
- Ophthalmology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Travis C Frazier
- Ophthalmology Service, Madigan Army Medical Center, Tacoma, WA USA
| | - Mark F Torres
- Ophthalmology Service, Madigan Army Medical Center, Tacoma, WA USA
| | - Kraig S Bower
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD USA
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Distribution and Repeatability of Corneal Astigmatism Measurements (Magnitude and Axis) Evaluated With Color Light Emitting Diode Reflection Topography. Cornea 2016; 34:937-44. [PMID: 26057324 PMCID: PMC4500657 DOI: 10.1097/ico.0000000000000476] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: To evaluate and investigate the distribution and repeatability of anterior corneal surface astigmatism measurements (axis and magnitude) using a novel corneal topographer. Methods: Anterior corneal surface astigmatism was investigated in a total of 195 eyes using a novel multicolored spot reflection topographer (Cassini; i-Optics). Two patient groups were studied, a younger-age group A and an older-age group B. Three consecutive acquisitions were obtained from each eye. The repeatability of measurement was assessed using Bland–Altman plot analysis and is reported as the coefficient of repeatability. Results: Group A (average age 34.3 years) had on average with-the-rule astigmatism, whereas the older-age group B (average age 72.3 years) had on average against-the-rule astigmatism. Average astigmatism magnitude measurement repeatability in group A was 0.4 diopters (D) and in group B 0.4 D. Average astigmatism axis measurement repeatability in group A was 5.4 degrees and in group B 5.5 degrees. The axis measurement repeatability improved with increasing magnitude of astigmatism: in the subgroups with astigmatism between 3.0 and 6.0 D, the axis repeatability was 1.4 degrees (group A) and 1.2 degrees (group B), whereas in the subgroups with astigmatism larger than 6.0 D, the repeatability was 1.1 and 0.6 degrees, respectively. Conclusions: This novel corneal topography device seems to offer high precision in reporting corneal astigmatism. This study reaffirms the established trend of a corneal astigmatism shift from an average “with-the-rule” to “against-the-rule” with aging.
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Shaheen MS, El-Kateb M, Hafez TA, Piñero DP, Khalifa MA. Wavefront-Guided Laser Treatment Using a High-Resolution Aberrometer to Measure Irregular Corneas: A Pilot Study. J Refract Surg 2015; 31:411-8. [DOI: 10.3928/1081597x-20150521-08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/09/2015] [Indexed: 11/20/2022]
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Kanellopoulos AJ, Asimellis G. LASIK ablation centration: an objective digitized assessment and comparison between two generations of an excimer laser. J Refract Surg 2015; 31:164-9. [PMID: 25751832 DOI: 10.3928/1081597x-20150225-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/08/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To objectively define the effective centration of myopic femtosecond laser-assisted LASIK ablation pattern, evaluate the difference between achieved versus planned excimer laser ablation centration, and compare these results from two different generations of an excimer laser system. METHODS The study retrospectively evaluated 280 eyes subjected to myopic LASIK. Digital image analysis was performed on Scheimpflug sagittal curvature maps (difference of preoperative to postoperative). Centration was assessed via proprietary software digital analysis of the coordinate displacement between the achieved ablation geometric center and the planned ablation center, which was the corneal vertex. Results from two different excimer laser generations (Eye-Q 400 [140 eyes] and EX500 [140 eyes]; Alcon/WaveLight, Fort Worth, TX) were compared. RESULTS Radial displacement was on average 360 ± 220 µm (range: 0 to 1,030 µm) in the Eye-Q 400 laser group and 120 ± 110 µm (range: 0 to 580 µm) in the EX500 laser group (P < .01). The percentage of eyes with displacement of greater than 300 µm was 52% in the Eye-Q 400 laser group and 4% in the EX500 laser group. CONCLUSIONS Displacement of ablation pattern may depend on the laser platform used. The improvement in the efficiency of centration indicates that newer generation excimer lasers with faster eye tracking and active centration control appear to achieve a significantly more accurate centration of myopic ablation patterns. The authors propose this novel, objective technique for laser refractive surgeon evaluation may point out significant outcome measures not currently used in standard metrics of refractive laser efficiency.
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Kanellopoulos JA. September consultation #7. J Cataract Refract Surg 2014; 40:1574-5; discussion 1575. [PMID: 25135559 DOI: 10.1016/j.jcrs.2014.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Management of residual refractive error after laser in situ keratomileusis and photorefractive keratectomy. Curr Opin Ophthalmol 2014; 25:275-80. [PMID: 24837577 DOI: 10.1097/icu.0000000000000059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the various steps and methods in managing residual refractive error after laser in situ keratomileusis and photorefractive keratectomy (PRK). RECENT FINDINGS Past studies have shown the efficacy and safety of flap relifts over recuts and for surface ablation over the flap. Other previous and also more recent studies show the use of a femtosecond laser for side cuts only. Recently, the creation of a femtosecond mini flap has been described. New studies also demonstrate the use of collagen cross-linking in postrefractive surgery ectasia. SUMMARY Residual refractive error is a known complication after both laser in situ keratomileusis and PRK. A systematic approach should be taken to manage this complication starting with a thorough evaluation to determine if an enhancement is indicated and if so, which method will be the safest and most efficacious for the patient.
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Tan G, Yang J, Chen X, He H, Zhong X. Changes in wave-front aberrations after rigid gas permeable contact lens fitting in post-laser in situ keratomileusis patients with visual complaints. Can J Ophthalmol 2010; 45:264-8. [PMID: 20436548 DOI: 10.3129/i09-268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To evaluate the effect of rigid gas permeable (RGP) contact lenses in reducing wave-front aberrations in post-laser in situ keratomileusis (LASIK) myopic patients. DESIGN Cross-sectional study. PARTICIPANTS Thirty patients with visual complaints after conventional LASIK procedure for correcting myopia. METHODS The 30 patients were fitted with RGP contact lenses. Wave-front measurements were taken before and after RGP contact lens wearing. RESULTS Compared with bare eye examinations, root mean-square values of higher-order aberrations (HOAs) significantly decreased with RGP contact lens use. Among these, spherical aberration decreased from 0.507 (SD 0.304) microm to 0.164 (SD 0.121) microm (t = 7.186, p < 0.001); coma decreased from 0.470 (SD 0.312) microm to 0.165 (SD 0.090) microm (t = 5.566, p < 0.001); secondary coma decreased from 0.079 (SD 0.050) microm to 0.044 (SD 0.027) m (t = 4.118, p < 0.001); and total HOAs decreased from 0.782 (SD 0.449) microm to 0.307 (SD 0.140) microm (t = 6.710, p < 0.001). CONCLUSIONS Fitting RGP contact lenses effectively decreased HOAs induced by conventional myopic LASIK surgery. Possible reasons may be the elimination of irregularity and dissymmetry on the corneal anterior surface, relief of the aspherical extent of the central corneal surface, and enlargement of the effective optical zone.
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Affiliation(s)
- Gan Tan
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
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Cheng X, Bradley A, Ravikumar S, Thibos LN. Visual impact of Zernike and Seidel forms of monochromatic aberrations. Optom Vis Sci 2010; 87:300-12. [PMID: 20351600 PMCID: PMC3144141 DOI: 10.1097/opx.0b013e3181d95217] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to examine the impact of different aberrations modes (e.g., coma, astigmatism, spherical aberration [SA]) and different aberration basis functions (Zernike or Seidel) on visual acuity (VA). METHODS Computational optics was used to generate retinal images degraded by either the Zernike or Seidel forms of second through fourth-order aberrations for an eye with a 5-mm pupil diameter. High contrast, photopic VA was measured using method of constant stimuli for letters displayed on a computer-controlled, linearized, quasimonochromatic (lambda = 556 nm) display. RESULTS Minimum angle of resolution (MAR) varied linearly with the magnitude (root mean square error) of all modes of aberration. The impact of individual Zernike lower- and higher-order aberrations (HOAs) varied significantly with mode, e.g., arc minutes of MAR per micrometer of root mean square slopes varied from 7 (spherical defocus) to 0.5 (quadrafoil). Seidel forms of these aberrations always had a smaller visual impact. Notably, Seidel SA had 1/17th the impact of Zernike SA with the same wavefront variance, and about 1/4th the impact of Zernike SA with matching levels of r wavefront error. With lower-order components removed, HOAs near the center of the Zernike pyramid do not have a large visual impact. CONCLUSIONS The majority of the visual impact of high levels of fourth-order Zernike aberrations can be attributed to the second-order terms within these polynomials. Therefore, the impact of SA can be minimized by balancing it with a defocus term that flattens the central wavefront (paraxial focus) or maximizes the area of the pupil with a flat wavefront. Over this wide range of aberration types and levels, image quality metrics based on the Point Spread Function (PSF) and Optical Transfer Function (OTF) can predict VA as reliably as VA measures can predict retests of VA, and, thus, such metrics may become valuable predictors of both VA and, via optimization, refractions.
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Affiliation(s)
- Xu Cheng
- School of Optometry, Indiana University, Bloomington, Indiana 47405, USA
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Tan G, Chen X, Xie RZ, He H, Liu Q, Guo Y, Liao A, Zhong X. Reverse geometry rigid gas permeable contact lens wear reduces high-order aberrations and the associated symptoms in post-LASIK patients. Curr Eye Res 2010; 35:9-16. [PMID: 20021249 DOI: 10.3109/02713680903421186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study evaluated the efficacy of custom-made reverse geometry rigid gas permeable (RGP) contact lenses in the control of symptoms related to increased wavefront aberrations after LASIK correction of myopia. MATERIALS AND METHODS Twenty-eight myopes treated with LASIK were assessed for post-LASIK symptoms (declined night vision, glare, halos and/or monocular diplopia) and corneal topography. A set of RGP contact lenses was selected as trial lenses based on the matching between the lens and the patient's corneal topography. If the fluorescein pattern between the trial lens and the corneal surface showed a central alignment, a mid-peripheral bearing and peripheral clearance and if the patient felt comfortable with the lens wear, a duplicated lens was ordered for the patient. Otherwise, a lens satisfied with corneal topography of the patient and clinical judgment was used. Visual acuity (VA) and wavefront aberrations were measured after the lens wear. RESULTS The custom-made lenses well matched the host cornea with no dislodgment in all subjects. The post-LASIK eyes showed an increase of 1 Snellen line in VA (from 0.90 +/- 0.33 to 1.11 +/- 0.24) and a significant improvement in all symptoms after the lens wear. The total higher-order aberration is significantly reduced after the lens wear with at least 70% reduction in either spherical aberration, coma, third or fourth aberration but only 33% reduction in the fifth aberration. CONCLUSIONS Reverse geometry RGP lenses with the design based on individual topographic data can improve visual performance of post-LASIK eyes by reducing higher order aberrations.
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Affiliation(s)
- Gang Tan
- Zhongshan Ophthalmic Center and State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
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Kashani S, Rajan M, Gartry D. Wavefront-guided retreatment after primary wavefront-guided laser in situ keratomileusis in myopes and hyperopes: long-term follow-up. Am J Ophthalmol 2009; 147:417-423.e2. [PMID: 19054497 DOI: 10.1016/j.ajo.2008.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 09/13/2008] [Accepted: 09/15/2008] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the long-term safety, predictability, and efficacy of wavefront-guided laser in situ keratomileusis (LASIK) retreatment in myopes and hyperopes following primary wavefront-guided LASIK. DESIGN Retrospective nonrandomized case series. METHODS Wavefront-guided retreatment was performed by a single surgeon (D.G.). A cohort of 63 eyes of 41 patients were studied, investigating refractive outcome, uncorrected visual acuity (UCVA), and best-corrected visual acuity before and after wavefront-guided LASIK retreatment. RESULTS The mean spherical equivalent (MSE) prior to primary LASIK in the myopic group (46 eyes) was -5.4 +/- 2.5 diopters (D) (range, -1 to -11.25 D). After the final retreatment the MSE was -0.08 +/- 0.45 D (range, +1.25 to -1.25) with 82.6% achieving +/-0.5 D and 95.6% +/-1 D of emmetropia. The initial MSE in the hyperopic group (17 eyes) was +1.91 +/- 1.13 D (range, +0.25 to +5.73 D). After the final retreatment the MSE was +0.23 +/- 0.43 D (range, -0.5 to +1.25) with 88.2% achieving +/-0.5 D and 100% +/-1 D of emmetropia. Logarithm of the minimal angle of resolution UCVA was 0.22 +/- 0.21 prior to primary LASIK and -0.06 +/- 0.13 after final retreatment for myopes and 0.14 +/- 0.15 prior to primary LASIK and 0.06 +/- 0.16 after final retreatment for hyperopes. The mean follow-up time after LASIK enhancement was 17.75 months in the myopic and 14.6 months in the hyperopic group. CONCLUSION Our results suggest that wavefront-guided retreatment following initial wavefront-guided treatment in myopes and hyperopes has favorable outcome with respect to safety, predictability, and efficacy.
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Affiliation(s)
- Shahram Kashani
- Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom.
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Wu L, Zhou X, Ouyang Z, Weng C, Chu R. Topography-guided treatment of decentered laser ablation using LaserSight's excimer laser. Eur J Ophthalmol 2008; 18:708-15. [PMID: 18850547 DOI: 10.1177/112067210801800508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the efficacy of topography-guided laser ablation for correction of previously decentered laser ablation using LaserSight's excimer laser. METHODS Re-treatment was performed to correct decentered ablation using LaserSight's excimer laser for 18 patients who previously underwent LASIK surgery for myopia correction in both eyes. For each patient, only the decentered eye was re-treated while the other asymptomatic eye forms a control group for this study. Measurements were conducted on ablation center, best spectacle-corrected visual acuity (BSCVA), contrast sensitivity and corneal aberrations pre- and post-operatively. RESULTS For the retreated 18 eyes, the mean decentration was significantly reduced from 1.32+/-0.28mm to 0.61+/-0.23mm post-operatively (t=16.24, p<0.001), and with a significant improvement in mean BSCVA from 0.08+/-0.09 logMAR to 0.01+/-0.11 logMAR (t=4.58, p<0.001). The post-operative contrast sensitivity at the spatial frequencies (SF) of 1.00 and 0.70 was significantly improved (p<0.05 for both SFs). Corneal higher-order aberrations (HOAs), including the coma-like aberrations and spherical aberration, were decreased. In comparing the measurements for the retreated group to those for the control group, no significant differencewas found either in decentration or in BSCVA, but the contrast sensitivity at 0.70 was lower and the level of corneal aberrations was higher. CONCLUSIONS Topography-guided ablation with LaserSight excimer laser is effective to correct decentered ablation. However, the re-treated eye is still inferior to the eye with originally centered ablation in corneal optical quality or visual performance.
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Affiliation(s)
- L Wu
- Department of Ophthalmology, Jing-An District Center Hospital, Shanghai - China
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Relationship between preoperative aberrations and postoperative refractive error in enhancement of previous laser in situ keratomileusis with the LADARVision system. J Cataract Refract Surg 2008; 34:1267-72. [PMID: 18655975 DOI: 10.1016/j.jcrs.2008.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Accepted: 04/15/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify factors leading to inaccuracy of spherical correction in wavefront-guided enhancement treatments. SETTING Department of Ophthalmology, University of California, Irvine, California, USA. METHODS This retrospective outcomes analysis comprised 23 eyes (20 patients) having wavefront-guided flap-lift (19 eyes) or photorefractive keratectomy (4 eyes) enhancements after conventional non-wavefront-guided laser in situ keratomileusis (LASIK) for correction of residual myopia with a minimum follow-up of 1 month. Main outcomes measures were changes in lower-order aberrations and higher-order aberrations (HOAs) related to predictability of the refractive outcome. RESULTS The enhancement procedures reduced HOAs. Because of a hyperopic shift, however, uncorrected visual acuity (UCVA) improved 2 or more Snellen lines in 3 of 9 eyes (33.3%) treated without a surgeon offset compared with 9 of 14 (64.3%) when a surgeon offset was incorporated into the treatment plan. The quantitative amount of preoperative HOAs correlated with the amount of hyperopic shift, particularly strongly for spherical aberration (r(2) = 0.446, P = .0005). The amount of hyperopic shift was related in a linear manner to the amount of HOAs (for spherical aberrations, Y = 1.31X - 0.30, where Y is the postoperative manifest refraction spherical equivalent and X is the wavefront error in microns root mean square). CONCLUSIONS Wavefront-guided enhancements can reduce levels of HOAs. Although UCVA improved in many patients, some with high levels of preenhancement spherical aberration had worse UCVA. Adjusting the nomogram for the amount of preenhancement HOAs may improve the accuracy of the lower-order correction in wavefront-guided enhancements.
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Bababeygy SR, Zoumalan CI, Chien FY, Manche EE. Wavefront-guided laser in situ keratomileusis retreatment for consecutive hyperopia and compound hyperopic astigmatism. J Cataract Refract Surg 2008; 34:1260-6. [DOI: 10.1016/j.jcrs.2008.04.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Accepted: 03/23/2008] [Indexed: 11/25/2022]
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Corneal wavefront–guided enhancement for high levels of corneal coma aberration after laser in situ keratomileusis. J Cataract Refract Surg 2008; 34:222-31. [DOI: 10.1016/j.jcrs.2007.09.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 09/24/2007] [Indexed: 11/22/2022]
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Alió JL, Piñero D, Muftuoglu O. Corneal wavefront-guided retreatments for significant night vision symptoms after myopic laser refractive surgery. Am J Ophthalmol 2008; 145:65-74. [PMID: 17981258 DOI: 10.1016/j.ajo.2007.08.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 08/14/2007] [Accepted: 08/20/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the results of corneal wavefront (WF)-guided enhancements in patients with night vision symptoms and significantly high positive spherical aberration (SA) after myopic laser refractive surgery. DESIGN Noncomparative, interventional case series. METHODS Twenty-eight eyes of 20 patients with significant night vision symptoms and positive corneal SA (Z(4)(0)) higher than 0.5 microm after myopic laser refractive surgery were included in the study at Vissum-Instituto Oftalmologico de Alicante, Spain. Enhancement surgery was planned to remove residual refractive error and corneal SA (Z(4)(0)) in all cases. All patients underwent corneal WF-guided excimer laser retreatments using the ESIRIS/SCHWIND excimer laser system (Schwind Eye Tech Solutions, Kleinostham, Germany). The main outcome measures were visual symptoms, change in corneal SA (Z(4)(0)), and corneal asphericity (Q-value). RESULTS Subjective reports of night vision symptoms were improved in all patients. Mean corneal SA (Z(4)(0)) decreased from 0.75 +/- 0.19 microm before surgery to 0.43 +/- 0.42 microm after surgery (P < .001). Mean asphericity in the 4.5-mm zone significantly decreased from 1.02 +/- 1.07 before surgery to 0.52 +/- 0.88 after surgery (P = .008), and the mean asphericity in 8 mm did not change significantly (P = .362). The mean spherical equivalent significantly shifted to hyperopia from -0.22 +/- 1.14 diopters (D) before surgery to 0.33 +/- 0.54 D after surgery (P = .025). CONCLUSIONS Cornea wavefront-guided retreatment was effective in improving subjective night vision symptoms, reducing corneal SA, and decreasing asphericity in eyes that underwent myopic laser refractive surgery.
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Affiliation(s)
- Jorge L Alió
- Department of Refractive Surgery and Division of Ophthalmology, Instituto Oftalmológico de Alicante, Miguel Hernandez University, Alicante, Spain.
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Kanellopoulos AJ, Binder PS. Collagen cross-linking (CCL) with sequential topography-guided PRK: a temporizing alternative for keratoconus to penetrating keratoplasty. Cornea 2007; 26:891-5. [PMID: 17667633 DOI: 10.1097/ico.0b013e318074e424] [Citation(s) in RCA: 200] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the effectiveness of ultraviolet A (UVA) irradiation-induced collagen cross-linking (CCL) on keratoconus (KC) progression. METHODS A patient with bilateral, progressive KC underwent UVA irradiation (3 mW/cm for 30 minutes) after topical 0.1% riboflavin drops over a deepithelialized cornea. Twelve months later, a topography-guided penetrating keratoplasty (PRK; wavelight 400 Hz Eye-Q excimer) was performed in 1 eye for a refractive error of -3.50 -4.00 x 155 by using an attempted treatment of -2.50 -3.00 x 155. At all postoperative follow-up visits to 18 months, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), pachymetry, and topography were performed. RESULTS In the treated left eye, the UCVA after the UVA CCL improved from 20/100 to 20/80, and the BSCVA improved from 20/50 to 20/40. Eighteen months after the topography-guided PRK, the UCVA was 20/20, and the BSCVA was 20/15, with a refractive error of Plano -0.50 x 150. The cornea was clear, and the endothelial cell count remained unchanged. The untreated right mate eye continued to progress during the same period. CONCLUSIONS The significant clinical improvement and the apparent stability of more than a year after UVA CCL, and subsequent PRK compared with the untreated mate eye, seems to validate this treatment approach for KC. An adjusted nomogram may be considered in the ablation of cross-linked cornea tissue to avoid overcorrections.
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Bibliography. Current world literature. Curr Opin Ophthalmol 2007; 18:342-50. [PMID: 17568213 DOI: 10.1097/icu.0b013e3282887e1e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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O’Brien TP, Ide T. Update on customized wavefront-guided versus wavefront-optimized excimer laser ablation: next steps in the quest for perfect vision. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.3.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Carones F, Vigo L, Scandola E. Wavefront-guided Treatment of Symptomatic Eyes Using the LADAR6000 Excimer Laser. J Refract Surg 2006; 22:S983-9. [PMID: 17124902 DOI: 10.3928/1081-597x-20061101-30] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the clinical results of wavefront-guided customized treatment of eyes that underwent previous keratorefractive surgery with clinically significant visual symptoms related to the presence of higher order aberrations, with or without defocus/astigmatism. METHODS Twenty-eight consecutive eyes of 19 symptomatic patients underwent wavefront-guided custom photorefractive keratectomy (PRK with mitomycin C) to correct low and high order aberrations, using the LADAR-Vision platform. All eyes had manifest refractive spherical equivalent (MRSE) error from 0.00 to -4.25 diopters (D), and high order aberrations root-mean-square (RMS) values >0.80 microm for a 6.0-mm measurement diameter (mean: 1.18 microm). Eyes were examined at 1, 3, and 6 months postoperatively. Uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), MRSE, wavefront measurement of high order aberrations, and patient subjective evaluation were the parameters used to assess the treatment. RESULTS Six months after treatment, all 28 eyes had an improvement in UCVA compared to preoperative values. Seventeen (60.7%) eyes gained lines of BSCVA (1 to 3 lines) whereas 1 eye lost 1 line. Although the amount of positive defocus was intentionally and empirically undercorrected in this study, MRSE was slightly hyperopic (mean +0.65 D, range: -0.25 to +1.75 D). All eyes showed a reduction in pre-existing high order aberrations, with a mean reduction of 47% (0.62 microm). Spherical aberration reduced the most (mean 60%), coma was reduced by a mean 29%, and all other terms were reduced by a mean 42% compared to preoperative values. Subjectively, all patients but 1 (both eyes treated) noticed a reduction in their pre-existing visual symptoms. Overall, the treatment was considered satisfactory by the patients in terms of visual quality gain. CONCLUSIONS This series of consecutive treatments of symptomatic eyes indicates wavefront-guided custom ablation is an effective surgical option to reduce visually impairing high order aberrations and related visual symptoms. To avoid the resulting hyperopic shift, some significant nomogram adjustments are necessary, most often when pre-existing positive spherical aberration is present.
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Laser literature watch. Photomed Laser Surg 2006; 24:537-71. [PMID: 16942439 DOI: 10.1089/pho.2006.24.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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