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Preoperative Distribution of Higher Order Aberrations in Patients Undergoing LASIK

Preoperative Distribution of Higher Order Aberrations in Patients Undergoing LASIK. Perry S. Binder, MS MD. Financial Disclosure . Abbott Medical Optics – A, B, C, E Allergan, Inc. – A, B, D,E Acufocus, Inc. – A, D, E UV X – A, D Ophthonix, Inc. – A Outocmes Analysis Software – P

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Preoperative Distribution of Higher Order Aberrations in Patients Undergoing LASIK

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  1. Preoperative Distribution of Higher Order Aberrations in Patients Undergoing LASIK Perry S. Binder, MS MD

  2. Financial Disclosure • Abbott Medical Optics – A, B, C, E • Allergan, Inc. – A, B, D,E • Acufocus, Inc. – A, D, E • UV X – A, D • Ophthonix, Inc. – A • Outocmes Analysis Software – P • RXVP - P

  3. Introduction • It has been suggested that Wavefront-guided treatments be considered only if the magnitude of preoperative root-mean-square (RMS) higher order aberrations is >0.30 microns. • The conclusions were based on the use of Tscherring aberrometry in fewer than 300 eyes

  4. Purpose • To determine the incidence and distribution of higher order aberrations (HOA) in patients undergoing LASIK and to compare the HOA root mean square (RMS) in patients who underwent wavefront aberrometry with either the CustomVue Wavescan (AMO) or the Allegretto LadarWave (Alcon) aberrometers.

  5. Methods • Retrospective analysis of a clinical database (Outcomes Analysis Software v 4.1, San Diego, CA) of 3,568 consecutive eyes undergoing LASIK performed by a single surgeon. • The CustomVue Wavescan aberrometer was used on 1,365 eyes • The Allergretto LadarWave was used on 2,194 eyes. • All aberrometry was performed by one of several technicians • A previous comparison of these aberrometers on a small number of eyes and plastics showed them to be equivalent (Warden et. al. J Refr. Surg. 24:188-196, 2008)

  6. HOA RMS: Eyes with more than 0.3 µm Total on Both Aberrometers Pre-op Post-op Preoperatively, 46.8% of eyes (1,670/3,568) had HOA RMS of 0.3 µm or greater Irrespective of pupil diameter

  7. HOA RMS: Pre-op by Aberrometer Custom Vue Ladar Wave • Preoperatively, mean HOA RMS was significantly greater in the LadarWave group • than in the CustomVue WaveScan group. • This difference was statistically significant (P<.001).

  8. Significantly Better Preop Defocus and SA with CustomVue WaveScan * ** ** *P=.0299; **P<.001

  9. Significantly Better Postop Defocus, Coma and SA with CustomVue WaveScan * * * *P<.001

  10. HOA RMS: Correlation Between Aberrometer and RMSm – No Difference Pre-op Post-op

  11. Conclusions • Using Hartman Shack aberrometers, many eyes (>40%) have a preoperative HOA RMS > 0.3 um for mesopic pupils >=6.00 mm • Both pre- and post-op, CustomVue Wavescan measured significantly less RMS HOA (P<.001) than the Allegretto LadarWave in myopic eyes, but both had > 45% of eyes with HOA RMS >0.3 um. • Both pre- and post-op, defocus and spherical aberration were less with CustomVue Wavescan than with the Allegretto LadarWave aberrometer, (P<.03 for defocus, P<.001 for SA).

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