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MYOPIA, ASTIGMATISM, HYPEROPIA…. PERSONALIZED TREATMENT Bernard Mathys, MD Secretary-general of the Belgian Society of Cataract & Refractive Surgery. Refractive surgery in 2004. Today we use mostly PRK (surface treatment) and Lasik to perform surgery and our desire is to improve our results.
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MYOPIA, ASTIGMATISM, HYPEROPIA… PERSONALIZED TREATMENT Bernard Mathys, MD Secretary-general of the Belgian Society of Cataract & Refractive Surgery
Refractive surgery in 2004 Today we use mostly PRK (surface treatment) and Lasik to perform surgery and our desire is to improve our results How can we do this? Better instruments, new lasers, well-trained surgeons, improvement of post-op treatments… and new algorithms?
Algorithm factor • Improve the treatment itself: -3 of X is not necessarily -3 of Y • Personalize treatment =>Improve quality of vision • Possibility to help people with thin corneas, large pupils, high ametropia Different steps are needed:
Zyoptix: the name of the system The laser custom treatment
Lasik The intervention - making the flap
Lasik Closing the flap
Wavefront analyse Reconstruction of wavefront by CCD-image> Zernike coefficient CCD-Image
Lenslet CCD Wave Aberration Array Array Spot Array Hartmann-Shack WavefrontMeasurement Perfect Eye Aberrated Eye
The shape of the wavefront is depicted in Zernike coefficient, each shape describes a deformation
Conventional Refraction radial order 2nd Zernike Modes defocus astigmatism astigmatism Higher Order Aberrations 3rd coma coma trefoil trefoil 4th quadrafoil astigmatism astigmatism spherical quadrafoil secondary secondary 5th coma pentafoil trefoil coma secondary pentafoil secondary secondary secondary trefoil
Point Spread Function (PSF) Point Spread Function: is the representation of an optical system of a punctual and distant light source ( star in the sky) Airy Disc
Perfect eye (diffraction limited) MRB GYY MAK Each eye has different patternsof High Order Aberrations. Wave Aberration 5.7 mm pupil Pointspread Function Retinal Image
NEW SCALE ? • VA is a less sensitive measure of the correction of high-order aberrations • Increase the quality of the retinal image • We need to assess quality of vision in true-life conditions: Contrast & low-contrast sensitivity Different lightning conditions Color vision Glare & haloes
Custom treatment: the future ? • Aberrometry • Topography • Linked to the laser, to achieve personal treatment • Must improve our actual results in all cases • Must be safe • Not a higher complication rate
THANK YOU FOR YOUR ATTENTION • Bernard Mathys, MD • Secretary-general of the Belgian Society of Cataract & Refractive Surgery