Laser Refractive Surgery Outcomes in > 13 000 Eyes

1. Laser Refractive Surgery Outcomes in > 13 000 Eyes Arthur Cummings, Richard Corkin Wellington Eye Clinic UPMC Beacon Hospital, Dublin ICO Cavan, 12th May 2011

2. 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

3. 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

4. SAFETY – Myopia (IK vs. EK)

5. SAFETY – Myopia > -8.00 (IK vs. EK)

6. High Myopia > -8.00: Stability LASEK 12 Months LASIK 12 Months

8. Microkeratomes vs. Femtosecond lasers

9. Numbers of Eyes & Flap Thickness

10. Intra-Operative Complications

11. UCVA at 3 Months

12. BCVA at 3 Months

13. SAFETY

14. PREDICTABILITY AT 3 MONTHS

15. VECTORGRAM AT 3 MONTHS

16. Comparing Lasers of Different Speeds: 200, 400 & 500 Hz

18. UCVA, BCVA, PREDICTABILITY

19. 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

20. LASIK: Primary vs. Secondary 7.2% of Myopic LASIK eyes lose 1 or more lines of BCVA while 15.7% 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) Enhancements 6 Months LASIK 6 Months

21. ASA: Primary vs. Secondary 6.9% of Myopic LASEK eyes lose 1 or more lines of BCVA while 9.8% 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) LASEK 6 Months Enhancements 6 Months

22. 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

23. Primary Treatments • 85% receive WFO treatments • 15% receive customized treatments • How do they compare?

24. Primary Treatments • Compare 4 profiles across all refractive errors • WFO • WFG • T-CAT • Custom-Q

25. Comparing 4 Ablation Profiles WFG WFO Custom-Q Topography-Guided

26. 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

27. SAFETY at 3 Months WFO WFG WFG WFO RT Topography-Guided T-CAT RT

28. Secondary Treatments • 75% receive WFO treatments • 25% receive customized treatments • How do they compare? • RT not used in this cohort in this study

29. WFO enhancement WFG enhancement WFO enhancement WFG enhancement SAFETY Custom Q enhancement T-CAT enhancement Custom Q enhancement T-CAT enhancement

30. 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”

31. Thank You for Your Attention