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LADARVision4000 LADARVision4000 Vs Vs VISX VISX CustomVueCustomVue
CustomCorneaCustomCornea
A Comparison of Wavefront Guided A Comparison of Wavefront Guided
Refractive Surgery outcomes of LASIKRefractive Surgery outcomes of LASIKCapt J. Richard Townley, MDCapt J. Richard Townley, MDLt Col Charles D Reilly, MDLt Col Charles D Reilly, MD
STAR S4 IR Excimer Laser STAR S4 IR Excimer Laser SystemSystem
DisclaimerDisclaimer-This presentation does not reflect the official views of the US Army, Air -This presentation does not reflect the official views of the US Army, Air
Force, or governmentForce, or government-There are no financial ties to VISX or Alcon -There are no financial ties to VISX or Alcon
Among smallest-spot beam Among smallest-spot beam in industry in industry
Small-Spot (<1mm) Scanning
Minimized acoustic shockMinimized acoustic shock Depends on dilated pupil Depends on dilated pupil
and preoperative peri-and preoperative peri-limbal demarcation to limbal demarcation to account for intraoperative account for intraoperative cyclotorsioncyclotorsion
Differences between the two laser platformsLADARLADARVision Vision
CustomCornea SystemCustomCornea System
VISX CustomVueVISX CustomVue™™
STAR S4 IR Excimer Laser STAR S4 IR Excimer Laser SystemSystem
Combines advantages of Combines advantages of larger and smaller larger and smaller diameter beamsdiameter beams
Minimize volume of tissue Minimize volume of tissue removedremoved
Smooth ablationSmooth ablation Relies on iris registration Relies on iris registration
to account for proper to account for proper orientation of the orientation of the preoperative wavescan for preoperative wavescan for the intended treatmentthe intended treatment
Study DesignStudy DesignObjectives: To analyze the US Air Force Warfighter Refractory Surgery program to determine whether there was a difference in treatment outcomes between wavefront-guided LASIK performed with LADARVision4000 CustomCornea vs. VISX CustomVue. Methods: This study analyzed over 8,000 eyes that had undergone refractive surgery by the USAF over the past 8 yrs. Out of those 8000 eyes 936 had received custom Lasik treatments on either the VISX or LADAR4000 platforms. Since the vast majority of those eyes were treated with VISX, the 22 eyes that had been treated on LADAR were closely matched for age, gender, and pre-op refractive errors with those treated with VISX. All patients included in the study were operated on by the same surgeon and used the same keratome. Each of the eyes that were treated were followed up at 1, 3, and 6 months after surgery and the outcomes that were compared between the two laser platforms based on their uncorrected visual acuity (UCVa), best corrected visual acuity (BCVa), manifested refractions (MRx), and any documented complications.
Preoperative Patient Preoperative Patient CharacteristicsCharacteristics
CharacteristCharacteristicsics
LADARVisionLADARVision
CustomCorneaCustomCorneaVISX VISX
CustumvueCustumvueP ValueP Value
No. EyesNo. Eyes 2222 6060
Mean AgeMean Age 32.2 (22-43)32.2 (22-43) 34.11 (22-48)34.11 (22-48)
MalesMales 68%68% 66%66%
FemalesFemales 31%31% 33%33%
Mean Mean SphereSphere
-4.875 (-8.00 to -2.75)
-4.34-4.34
(-8.00 to -2.75)(-8.00 to -2.75)0.21730.2173
Mean CylMean Cyl 0.93 (0.0 to +3.50)
0.690.69
(0.0 to + 2.50)(0.0 to + 2.50)0.31370.3137
Mean SEMean SE -4.41 (-7.60 to -2.40)
-4.00-4.00
(-7.50 to -2.38)(-7.50 to -2.38)0.36100.3610
1 Month Results1 Month Results1 Month Uncorrected VA
0
10
20
30
40
50
60
70
80
90
100
20/15 or better 20/20 or better 20/25 or better 20/30 or better
Per
cen
t
LADARVision
VISX STAR 4
CharacteristicsCharacteristics LADARVision LADARVision CustomCorneaCustomCornea
VISX VISX
CustomvueCustomvueP ValueP Value
#Eyes at F/U#Eyes at F/U 22 4747
Mean SphereMean Sphere 0.166 +/- 0.33 -0.074 -0.074 +/- 0.39 0.01720.0172
Mean CylMean Cyl 0.222 +/- 0.33
0.2120.212 +/- 0.25 0.91370.9137
Mean SEMean SE 0.11 +/- 0.19
0.034 0.034 +/- 0.35
0.23070.2307
3 Months Results3 Months Results3 Months Uncorrected VA
0
10
20
30
40
50
60
70
80
90
100
20/15 orbetter
20/20 orbetter
20/25 orbetter
20/30 orbetter
20/50 orbetter
Per
cen
t
LADARVision
VISX STAR 4
CharacteristicsCharacteristics LADARVision LADARVision CustomCorneaCustomCornea
VISX VISX
CustomvueCustomvueP ValueP Value
#Eyes at F/U#Eyes at F/U 15 3636
Mean SphereMean Sphere 0.1875 +/- 0.73 -0.215 -0.215 +/- 0.43 0.17010.1701
Mean CylMean Cyl 0.0625 +/- 0.48 0.2150.215 +/- 0.24 0.40450.4045
Mean SEMean SE 0.047 +/- 0.13 -0.083 -0.083 +/- 0.33 0.61690.6169
6 Months6 Months6 M onths Uncorrected VA
0
10
20
30
40
50
60
70
80
90
100
20/15 or better 20/20 or better 20/25 or better 20/30 or better
Pe
rce
nt
LADARVis ion
VISX STAR 4
CharacteristicsCharacteristics LADARVision LADARVision CustomCorneaCustomCornea
VISX VISX
CustomvueCustomvueP ValueP Value
#Eyes at F/U#Eyes at F/U 10 3636
Mean SphereMean Sphere 0.031 +/- 0.28 -0.076 -0.076 +/- 0.37 0.70740.7074
Mean CylMean Cyl 0.25 +/- 0.30 0.1810.181 +/- 0.22 0.55040.5504
Mean SEMean SE 0.156 +/- 0.27 -0.013 -0.013 +/- 0.37
0.23690.2369
Which Laser Platform Which Laser Platform Achieved the Attempted Achieved the Attempted
Treatment?Treatment?Surgical Correction of Refractive Error After 6 Months
y = 1.0641x + 0.4176
R2 = 0.9782
y = 1.0318x + 0.1323
R2 = 0.9266
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
-8-7-6-5-4-3-2-10Attempted SE (D)
Ach
ieve
d S
E (
D)
LADARVision
VISX STAR 4
Linear (LADARVision)
Linear (VISX STAR 4)
ConclusionsConclusions One patient treated with LADAR was noted to have a One patient treated with LADAR was noted to have a
small amount of micro striae post-op month three that small amount of micro striae post-op month three that spontaneously resolved by post-op month six. No other spontaneously resolved by post-op month six. No other complications were observed in either groupcomplications were observed in either group
This study illustrated that although the LADAR6000 was This study illustrated that although the LADAR6000 was pulled from the market due to residual central islands, pulled from the market due to residual central islands, wavefront-guided LASIK using the Visx CustomVue wavefront-guided LASIK using the Visx CustomVue system or LADARVision4000 were effective, predictable, system or LADARVision4000 were effective, predictable, and safe for correction of moderate to high myopic and safe for correction of moderate to high myopic refractive errors. refractive errors.
One of the only notable difference was that most LADAR One of the only notable difference was that most LADAR treatments resulted in plano to slightly hyperopic treatments resulted in plano to slightly hyperopic postoperative spherical equivalents while the VISX postoperative spherical equivalents while the VISX platform post-op SE had greater variation between platform post-op SE had greater variation between slightly myopic and hyperopic outcomes. However these slightly myopic and hyperopic outcomes. However these differences could be accounted for due to differences in differences could be accounted for due to differences in the sample sizes between the two groups.the sample sizes between the two groups.
Future StudiesFuture Studies Increased Sample SizeIncreased Sample Size
Prospective Randomized Control Prospective Randomized Control AnalysisAnalysis
Studies of Vision QualityStudies of Vision Quality Subjective Analysis with personal surveysSubjective Analysis with personal surveys Contrast Sensitivity ComparisonContrast Sensitivity Comparison Pre and Post Higher Order Aberration Pre and Post Higher Order Aberration
ComparisonComparison
ReferencesReferences Awwad ST et al. Wavefront-guided laser in situ keratomileusis with Alcon CustomCornea
and VISX CustomVue: three-month results. J Refract Surg. 2004; 20 606-613
Michael D. et.al. A Prospective Randomized Clinical Trial of Laser In Situ Keratomileusis With Two Different Lasers Am. J. Ophthalmol -01-AUG-2005; 140(2): 173.1-11
Michael S. et al. Comparison of LADARVision and Visx Star S3 laser in situ keratomileuisis outcomes in myopia and hyperopia. J Cataract Refract Surg 01-DEC 2003; 29: 2351-6
Raymond P. G. et.al. Comparison of LASIK outcomes with Alcon LADARVision4000 and the VISX STAR S2 Excimer Laser Using Optimized Nomograms. J Refract Surg. NOV 2005; 21: 683-690
Sale et. al. Contralateral comparison of Alcon CustomCornea and VISX CustomVue wavefront-guided laser in situ keratomileusis: one-month results. J Refract Surg. 2004; 20: 601-605
Shady T. et. al. Wavefront-Guided LASIK for Myopia Using the LADAR CustomCornea and the VISX CustomVue. J Refract Surg JAN 2007; 23: 26-38
Seiler T et al. Myopic photorefractive keratectomy with the excimer laser. One-year follow-up. Ophthalmology, 1991; 98:1156-1163
Seward MS et. al. Comparison of LADARVision and VISX Star S3 laser in situ keratomileusis outcomes in myopia and hyperopia. J Cataract Refract Surg. 2003; 292351-2357
Tobaigy FM. A control-matched comparison of laser epithelial keratomileusis and laser in situ keratomileusis for low to moderate myopia. Am J Ophthalmol - 01-DEC-2006; 142(6): 901-8
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