Comparison of a new implantable collamer lens formula to standards formulas using spectral domain optical coherence tomography.

PURPOSE: To use spectral-domain optical coherence tomography (SD-OCT) data to develop a new implantable collamer lens (ICL) sizing formula and compare vault outcomes with the Online Calculation and Ordering System™ (OCOS) and the NK2 formula. METHODS: Consecutive eyes (n = 237) were evaluated that had undergone ICL/toric ICL implantation. Actual ICL vaults were measured, and a what-if analysis was performed to predict vault values with the NK2 formula using SD-OCT data. To develop a new formula (EPB), multiple regression analysis was performed with different parameters than the NK2 formula. Predicted vaults with NK2 and EPB formulas were compared to the actual vaults. RESULTS: Parameters that were correlated with optimal ICL size were white-to-white, anterior chamber width, lens rise and desired refractive correction. The mean postoperative vault was 489 ± 258 µm. At last visit, 94.5% of eyes were within the manufacturer's acceptable vault range. Predicted vaults in the acceptable range were 74 and 87% with the NK2 and EPB formulas, respectively. Six percent had a predicted vault less than 100 µm with the EPB formula compared to 1% for actual outcomes. The NK2 formula resulted in a shift toward higher predicted vaults while the EPB formula was similar to the actual postoperative vaults but with slightly more cases with extremely low and high vaults. CONCLUSION: SD-OCT data with OCOS result in good postoperative vaults. Further refinement is required to the NK2 for use with SD-OCT data. Although the EPB formula provides acceptable predicted vaults, further refinement with a larger sample size is needed.

Small optical zones with aspheric profiles in laser refractive surgery for myopia: a surgical outcome and patient satisfaction study.

PURPOSE: To assess the outcomes of small optical zone (OZ) ablations used in conjunction with large transition zones (TZ) and a highly aspheric treatment profile. METHODS: Interventional case series of 39 consecutive patients with myopia or myopic astigmatism. Patient data included pre and postoperative refraction and visual acuities, laser treatment settings and pre and postoperative corneal topography as well as questionnaire responses about the use of glasses and the quality of vision postoperatively. RESULTS: The mean preoperative spherical equivalent was -4.50±2.11 dioptres (D) and the mean OZ and TZ diameters were 4.5±0.5mm and 8.1±0.4mm, respectively. The mean patient age was 40.7±10.4 years. Manifest spherical refraction was within ±0.5D in 87% of patients (±1.0D in 99%) and cylindrical refraction within 0.5D in 79% (≤1.0D in 95%). The need to wear distance glasses postoperatively was associated with dissatisfaction with the quality of daytime vision (p=0.05) and unhappiness with night vision was associated with symptoms of halos (p=0.03) and starbursts (p=0.02). The proportion of patients reporting symptoms of dysphotopsias included: ghosting 0%; glare 2%; halos 10%; and starbursts 15%. There was a significant difference in the measured mean effective OZ diameter (4.8±0.3mm) compared to the mean programmed OZ (4.5±0.5mm, p=0.00). CONCLUSIONS: Small ablation zones, when used in conjunction with a large diameter TZ, do not lead to a greater incidence of unwanted visual phenomena over that reported by many studies with larger OZs.

A contralateral, randomized comparison of optimized prolate ablation and conventional LASIK for myopia with the NIDEK excimer laser platform.

PURPOSE: To compare the refractive, visual acuity, topographic, and spherical aberration outcomes of LASIK using the Quest excimer laser platform with the optimized prolate ablation (OPA) profile (NIDEK Co Ltd) in one eye and conventional ablation profile in the fellow eye of the same patient. METHODS: Thirty-seven myopic patients underwent LASIK bilaterally, with one eye randomized to receive OPA ablation (-3.88±1.42 diopters [D], range: -1.53 to -7.50 D) and the fellow eye to receive conventional ablation (-3.89±1.37 D, range: -1.75 to -7.00 D). Independent and paired t tests were used for testing differences between groups at last postoperative follow-up (6 or 12 months). RESULTS: Postoperatively, 97% (32/33) of OPA eyes and 94% (31/33) of conventional eyes saw 20/20 or better without correction (P>.05). No eyes lost 2 or more lines of distance corrected visual acuity. Manifest refraction spherical equivalent was -0.16 D in the OPA group and -0.05 D in the conventional group (P>.05). Ocular spherical aberration was -0.003 µm in the OPA group and +0.102 µm in the conventional group (P<.05). Corneal asphericity was statistically lower after OPA (0.07±0.26) compared to conventional ablation (0.30±0.26) (P<.001). The mean programmed optical zone and achieved postoperative horizontal diameter of the effective optical zone were statistically significantly larger in the OPA group (P<.05). CONCLUSIONS: Postoperative visual acuity and refractive outcomes were similar between groups. Laser in situ keratomileusis using the OPA profile for the correction of myopia induced significantly less corneal and ocular spherical aberration, resulted in normal postoperative asphericity in 94% of eyes, and larger horizontal diameter of the effective optical zone compared to the conventional profile.

Comparison of corneal and total ocular aberrations before and after myopic LASIK.

PURPOSE: To assess the compensation of total ocular and corneal wavefront aberrations after conventional myopic LASIK. METHODS: This study comprised 57 eyes of 57 patients. Total and corneal aberrations were measured preoperatively and 3 months postoperatively using the OPD-Scan (NIDEK Co Ltd) aberrometer. Total and corneal aberrations root-mean-square (RMS) was calculated out to the 6th Zernike order for a 6.0-mm pupil diameter. The percentage increase postoperatively was defined by the ratio of RMS pre- and postoperatively for each corneal and total eye group. The compensation between corneal and internal aberrations for a given aberration group was defined as: (corneal aberration group RMS - total eye aberration group RMS)/corneal aberration group RMS. RESULTS: Postoperatively, higher order aberrations increased by a factor of 1.77+/-1.26 (total) and 2.47+/-2.25 (corneal) (P<.05). Coma aberration increased by a factor of 2.43+/-2.61 (total) and 2.56+/-2.66 (corneal). Spherical aberration increased by a factor of 1.46+/-1.83 (total) and 2.64+/-2.24 (corneal). The values of the ratio of compensation did not change significantly before and after LASIK for individual aberrations (P>.05). CONCLUSIONS: Although myopic LASIK induced significant corneal aberrations, the level of partial compensation of corneal aberrations by internal structures remained unchanged. These results suggest that the previously described emmetropization that is effective during development may also be effective with acquired variations in corneal shape.

Laser in situ keratomileusis for hyperopia and hyperopic astigmatism using the Meditec MEL 70 spot scanner.

PURPOSE: To evaluate safety, predictability, efficacy, and stability of laser in situ keratomileusis (LASIK) for spherical hyperopia and hyperopia with astigmatism. METHODS: In this retrospective study we analyzed the results of 23 eyes of 23 patients who had LASIK for spherical hyperopia (preoperative cylinder < or = 0.75 D) and 44 eyes of 44 patients who had LASIK for hyperopia with astigmatism; (Bausch & Lomb Hansatome microkeratome with a 180-microm plate and a suction ring for a 9.5-mm flap diameter; Asclepion-Meditec MEL 70 G-scan flying spot laser with a 1.8-mm Gaussian beam). RESULTS: In Group 1 (spherical hyperopia), mean preoperative spherical equivalent refraction was +4.88 +/- 2.13 D (range +2.13 to +9.63 D); in Group 2 (hyperopic astigmatism), +4.33 +/- 2.15 D (range +0.50 to +9.50 D). One year after LASIK, mean spherical equivalent refraction was +0.30 +/- 0.90 D (range -0.75 to +2.50 D) in Group 1 and +0.29 +/- 1.27 D (range -3.25 to +3.25 D) in Group 2. In Group 1, 78%, and in Group 2, 42% were within +/- 0.50 D. In Group 1, no eyes lost two or more lines, and one eye (6%) lost one line of best spectacle-corrected visual acuity at 1 year. In Group 2, one eye (4%) lost one line and one eye (4%) lost more than two lines at 1 year. Uncorrected visual acuity of 20/40 or better was achieved in 83% (Group 1) vs. 62% (Group 2) at 1 year; these values improved to 100% vs. 71% for corrections up to +6.00 D. CONCLUSIONS: LASIK with the Meditec MEL 70 G-Scan flying spot laser seemed to be safe and effective for hyperopia and hyperopia with astigmatism for corrections up to +6.00 D. Large flap diameters are necessary to avoid epithelial ingrowth.

Comparison of laser in situ keratomileusis outcomes with the Nidek EC-5000 and Meditec Mel 70 excimer lasers.

PURPOSE: To report refractive outcomes of laser in situ keratomileusis (LASIK) for myopia with and without astigmatism using the Nidek EC-5000 and Meditec Mel 70 excimer laser systems. METHODS: A retrospective analysis of refractive outcomes with each laser was conducted. Approximately 5700 eyes treated for myopia and myopic astigmatism were analyzed. Preoperative sphere ranged from -0.25 to -15.50 D and cylinder ranged from -0.75 to -5.50 D. All statistical analyses were performed by Datagraph med version 2.8 refractive analysis software. RESULTS: With the Nidek EC-5000 at 6 months after LASIK, mean spherical equivalent refraction was -0.24 D with 72% of eyes within +/- 0.50 D. In the Meditec cohort, the mean spherical equivalent was -0.54 D with 55% of eyes +/- 0.50 D. CONCLUSION: Eyes treated for myopia and astigmatism with either of these lasers showed early refractive stability and similar efficacy. Higher incidences of epithelial ingrowth and haze were present in the Meditec treated eyes.