FEMTO-LASIK and BEYOND - Carl Zeiss, Inc.

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12 Ophthalmology WORLD REPORT a patient where the measured wavefronts revealed an angle kappa and showed the calculated point spread function from the vertex of centered wavefront. “Subjective point spread function correlates with the vertex point spread function and not pupil point spread function,” he said. “In clinical practice, patients see aberration relative to the vertex which is in approximation to the visual axis,” he added. He showed the published myopic, hyperopic, and emmetropic results where a Hansatome was used for treatment and the results were not as good as with the femtosecond laser. Safety and efficacy: “On the safety front, shockingly we found that patients who started with very high stereo, only 1 in 20 lost one patch,” he said, to show that there was a statistically significant change in stereo acuity by this procedure. For efficacy he said, “About two-thirds of the patients had 100 seconds of stereo and 90% of them had 200 seconds of stereo uncorrected.” The post-op uncorrected stereo acuity was thus lower than the pre-op near-corrected. Summary: He summarized the non-linear aspheric micromonovision. “We have a procedure which is based on LASIK, which corrects pure presbyopia, wide range of refractive errors (+5D to -9D), does a simultaneous accurate correction of cylinder, is centered perfectly by an eye tracker, allows a minimal compromise to contrast sensitivity and night vision disturbances, is well tolerated by more than 95% patients, maintains a functional stereo acuity and is performed as a 10 minute bilateral procedure that heals in 3 hours,” he said. This according to him was actually the solution. Future of VisuMax: Prof Reinstein spoke about the unsurpassed future potential of VisuMax which he referred to as “the new horizon of femtosecond technology in ophthalmology”. According to him, the VisuMax is designed to become the corneal surgery workstation for a large spectrum of procedures. ReLEx flex and ReLEx smile have undoubtedly added unprecedented accuracy in corneal incision. Prof Zhou Xingtau on “Clinical and Research Experience of Femto-LASIK and ReLEx using VisuMax in China” “ReLEx appears to be a safe and promising corneal refractive procedure for correcting high myopia.” Experience with ReLEx: Prof Zhou has been doing Femto-LASIK procedures since 2008. He presented the preliminary 5-month results of a recent prospective study for femtosecond lenticule extraction in correction of high myopia. He then discussed his clinical experiences with patients ranging from 32 to more than 45 years of age. “ReLEx recovery may be slower than the excimer laser LASIK but the outcome in general is very good,” he said. VisuMax Femto-LASIK: Prof Zhou showed the results of the first 60 cases of high myopia (SE of -8.05D) who underwent Femto-LASIK with VisuMax femtosecond laser. He then showed comparative results of the femtosecond flap to the microkeratome, where the predictability of femtosecond was much better. According to him, the patients were satisfied with -0.34D and the cylinder was -0.3D. He also showed the good topography outcomes in cases of hyperopic patients. He shared that recently he has been choosing to do flaps of only 85-90 μm and discussed the results of the post-corneal aberration of Femto-LASIK for high myopia. CXL Research with VisuMax: “With VisuMax, we not only do Femto-LASIK, not only do ReLEx, but we can also do some research,” he said, and shared the procedure of intrastromal pocket creation in animal eyes. The stromal pocket was apparently visible shortly after the operation and disappeared within 2 weeks normally. In 8 of 10 cases, a demarcation line-like change in the stroma, indicating the cross linking was visible as early as 2 weeks after crosslinking treatment. The reflection density of the crosslinking stroma slightly decreased at 1 month postoperatively.“Crosslinking with femtosecond laser appears to be a safe approach. The demarcation line may be a potential tool to monitor the depth of effective crosslinking with the femtosecond laser in the early phase postoperatively,” he concluded. Prof Muhaya Mohammad on “LASIK and Character Building” “The VisuMax femto energy is regular and smooth. Every step is smooth. Post-LASIK discomfort is less.” LASIK and Character Building: Prof Mohammad shared her observations about the use of VisuMax. According to her the VisuMax femtosecond energy is very regular and smooth and the post-LASIK discomfort is less. Every step is gorgeous. She believes in deep breathing and meditation and reassures her patients through talking. She specified that intention, attention and no tension were the secrets of attaining the desired results. She then supported a positive mental attitude as a prerequisite to success. She has even done VisuMax Femto-LASIK on her daughter.
June 2012 Supplement Ophthalmology WORLD REPORT 13 Continued from P11 >> Dr Donald Tan on “Preliminary Results of ReLEx in SNEC: As good as LASIK, or better?” “The future of this technology lies in ReLEx smile, which is a major advance over LASIK with no flap, minimal ocular surface disturbance, or dry eye. It is a quantum leap. Another advantage is the potential reversibility of ReLEx, which is a new concept of long-term lenticule storage for patients. Lenticules may be re-implanted back at a later stage, in the event of keratectasia, refractive shift or even to restore myopia for presbyopic correction.” taking more of peripheral tissue out and creating a mechanical flattening at the center of the cornea in these highly myopic eyes.” Explaining the ablation depth for the new profile, he said that “we are taking it much more efficiently from where it has to go.” And where it has to go from is actually measured at the stromal level with ultrasound. Sharing an example of RST planning, he spoke of how in a -11D, with 509 μm in pachymetry, treating with VisuMax with flap thickness of 80 μm and an ablation depth of 135 μm, one can still leave around 300 μm residual stromal thickness. Outcomes: “I am sure femtosecond lasers will take over in high myopic treatments,” said Prof Reinstein. He discussed the results in 220 eyes with a 1-year follow-up and myopic spherical equivalent of up to -14.5D. The myopia maximum meridian was -10.18 ± 1.48D -8D, up to -16D and the cylinder went up to -6.25D. Around 45% eyes were treated with staged procedures. The enhancement rate for the non two-stage was 35%. According to him, the advantages of the two-stage procedure were an increased safety, more accurate results, and lower patient expectations. “If after the first stage, someone had a main issue of night vision disturbances, we had the option of using the remaining tissue for topography-guided expansion instead of further myopic corrections.” Femtosecond lasers: Dr Tan enlisted the femtosecond lasers currently available. He then discussed the results of femtosecond laser-assisted sutureless ALK in 12 eyes with anterior corneal scarring using the IntraLase.“Only 58% improved visual acuity and about 33% had 20/50 or better,” he said. Further, he shared results of a study published in 2009 for DALK with femtosecond laser (IntraLase ALK with zigzag incisions) where a poor stromal bed quality was reported and good lenticules were not obtained. Dr Tan presented the results of their 2008 study comparing the ALTK microkeratome (R2=0.24, with a wide scatter) with the femtosecond laser (R2=0.93, more statistically significant). “So we know that the femtosecond laser is much more predictable than the microkeratome for depth,” he confirmed. Showing pictures of the rim cuts, he said, “There is not much collateral damage.” He also specified the minimal morphological damage to endothelium. VisuMax: Dr Tan discussed the “very precise vertical ablations” with “minimal collateral endothelial damage” and “reasonably smooth lamellar bed” with VisuMax 200 kHz and showed how the atomic force microscopy pictures with deep stromal lamellar dissection (400 μm) improved with the 500 kHz VisuMax than with the 200 kHz VisuMax and the 40 kHz FEMTEC. He shared pic- Monocular efficacy (Excluding eyes not intended plano) MEL 80 High myopia: Safety - BSCVA Continued on P15 >>
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