13 Optimized Prolate Ablations Using Ocular and Topographic Wavefront 6july06 (3.5 Megs)

7/29/2019 13 Optimized Prolate Ablations Using Ocular and Topographic Wavefront 6july06 (3.5 Megs)

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Jack T. Holladay, MD, MSEE, FACS 2006

Optomized PROLATE Topographic & Wavefront Guided Ablations Page 1 of 4

7/6/20067/6/2006 JTHJTH 11

Jack T. Holladay, MD, MSEE, FACSJack T. Holladay, MD, MSEE, FACS

Clinical Professor of OphthalmologyClinical Professor of Ophthalmology

Baylor College of MedicineBaylor College of Medicine

Houston, Texas, USAHouston, Texas, USA

Optimized Prolate

Ablations Using

Ocular and

Topographic Wavefront

Optimized Prolate

Ablations Using

OcularOcular andand

TopographicTopographic WavefrontWavefront

Learn from NatureLearn from Nature

Learn fromLearn fromNormal EyesNormal Eyeswithwith

excellentexcellent PerfomancePerfomancePrimates BinocularPrimates BinocularStereoStereo

Vision haveVision have ProlateProlateCorneasCorneas

Primates with BinocularPrimates with BinocularNonNon--

StereoStereo360360 Fields areFields are OblateOblate

ProlateProlate

s SSpherical AAberration forBEST CENTRAL VISIONBEST CENTRAL VISION

7/6/20067/6/2006 JTHJTH 5577

ProlateProlate Eagles, manEagles, man

QQavgavg == --0.260.26

Ref: May 1999 JCRSRef: May 1999 JCRS

Vol. 25 pp.663Vol. 25 pp.663--669669

QQnono SASA== --0.520.52

OblateOblate

s SSpherical AAberration but BEST PERIPHERAL VISIONBEST PERIPHERAL VISION

7/6/20067/6/2006 JTHJTH 7777

OblateOblateFrogs,Frogs,

Q = +0.25Q = +0.25


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Halos and Glare Today's CustomizedToday's CustomizedRefractive SurgeryRefractive Surgery

Requires Excellence inRequires Excellence in

Diagnostic MeasurementsDiagnostic Measurements

Surgical PlanningSurgical Planning

Surgical ProcedureSurgical Procedure

Laser AblationLaser Ablation

Ocular, Corneal &Ocular, Corneal &LenticularLenticular WFWF

Corneal AberrationsCorneal Aberrations

TopographyTopography

TomographyTomography PentacamPentacam

Ocular AberrationsOcular Aberrations

OPD Scan (D)OPD Scan (D) NidekNidek

ShackShack--Hartman (Hartman ())

TscherningTscherning (())

LenticularLenticularAberrationsAberrations

OcularOcular -- CornealCorneal

Measure Ocular and Topographical AberrationsMeasure Ocular and Topographical Aberrations

QuantitateQuantitate LenticularLenticular and Corneal Aberrationsand Corneal Aberrations

Corneal orCorneal or LenticularLenticular Surgery Best?Surgery Best?

Early Cataract orEarly Cataract or LenticularLenticular IrregularitiesIrregularities

Crystalline Lens RemovalCrystalline Lens Removal

match aspheric IOL tomatch aspheric IOL to cornealcorneal powerpower

andand shape (spherical aberration)shape (spherical aberration)(AMO(AMO TecnisTecnis IOL, Alcon HO, B&L WF)IOL, Alcon HO, B&L WF)

Surgical PlanningSurgical Planning

If Corneal ProcedureIf Corneal Procedure TREATTREAT Ocular: Refractive Error, SA, ComaOcular: Refractive Error, SA, Coma

Corneal: All HO AberrationsCorneal: All HO Aberrations

LenticularLenticularOnly SA & Coma, other HO aberrations areOnly SA & Coma, other HO aberrations are

unstable and unpredictableunstable and unpredictable

LenticularLenticular SASAs with agewith age

OverOver--correctcorrect SA (create ocular negative SA)SA (create ocular negative SA)

Negative SA Improves Near visionNegative SA Improves Near vision

(similar to Hyperopic Rx with negative SA)(similar to Hyperopic Rx with negative SA)

Surgical PlanningSurgical Planning Top View

Nodal Point

Visual AxisVisual Axis

OpticalAxisOpticalAxis

EE

Horizontal AngleHorizontal Angle == --5.25.2`

EE

FoveolaFoveola


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Center Procedure on Visual AxisCenter Procedure on Visual Axis

Compensation ofCompensation ofRadial Energy LossRadial Energy Loss

Function ofFunction of

Distance fromDistance fromvertex normalvertex normal perpendicularperpendicular

Curvature of CorneaCurvature of Cornea steep or flat Curvaturesteep or flat Curvature

Asymmetric due to Angle KappaAsymmetric due to Angle Kappa

Different for Right and Left EyesDifferent for Right and Left Eyes

Surgical ProcedureSurgical Procedure

LOS Alignment

Visual AxisLOS

VisualVisualAxisAxisAlignmentAlignment

The only Reference Axis is the Visual AxisThe only Reference Axis is the Visual Axis

Time to move away from pupil center!Time to move away from pupil center!

Avoid INDUCING ComaAvoid INDUCING Coma

Reference: Visual AxisReference: Visual Axis

LOSLOSAlignmentAlignment

NO YES

Radial Energy CompensationRadial Energy Compensation

nasaltemporal ODtemporal OS

Differences between Intended vs. AchievedDifferences between Intended vs. AchievedAblationAblation There is noThere is noone size fits allone size fits allcompensation matrixcompensation matrix

Radial energy fall off is not symmetricalRadial energy fall off is not symmetrical

Needs to be different for OD and OSNeeds to be different for OD and OS

Needs to be different for steep and flat eyesNeeds to be different for steep and flat eyes

Results so farResults so far

Surgeon: MohamedSurgeon: MohamedAlaaAlaa ElEl DanasouryDanasoury, MD, MD

JeddaJedda, Saudi Arabia, Saudi Arabia

Diagnostics: OPD ScanDiagnostics: OPD Scan

Laser: NIDEK ECLaser: NIDEK EC--5000 LASER5000 LASER

8 patients will be presented at ASCRS 20068 patients will be presented at ASCRS 2006

PreOPPreOP DataData

OPAS (OptimizedOPAS (Optimized ProlateProlateAblation System) on RIGHT EYEAblation System) on RIGHT EYE

A.A. Best Final Refraction @Best Final Refraction @VTXVTX = 14 mm= 14 mm

OD:OD: --6.506.50 --1.25 x 180 = 20/20+2 (1.2)1.25 x 180 = 20/20+2 (1.2)

OS:OS: --6.506.50 --1.00 x 180 = 20/20+1 (1.2)1.00 x 180 = 20/20+1 (1.2)

B.B. Target Refraction:Target Refraction: planoplano

C.C. Pach'sPach's OD: 558OD: 558 OS: 559 micronsOS: 559 microns

D.D. ScotopicScotopic Pupil Size:Pupil Size: OD: 7.31mOD: 7.31m OS: 7.07 mmOS: 7.07 mm

Treatment OZ Right Eye =Treatment OZ Right Eye = 7.3 mm7.3 mm and blend to 9.0 mmand blend to 9.0 mm..

PRE-OPERATIVE OD

12 MO POST-OPERATIVE Prolate RX

Instantaneous Refractive Wavefront


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PRE-OPERATIVE OS

12 MO POST-OPERATIVE Standard RX

Instantaneous Refractive WavefrontSummarySummary

All RXsAll RXs will ultimately usewill ultimately use TopographyTopography

andand Ocular WavefrontOcular Wavefront ... The latter... The latter mustmust

in Resolutionin ResolutionAll cornealAll corneal andand some lenticularsome lenticular

aberrationsaberrations will bewill be treatedtreated andand

anticipated (SA)anticipated (SA)

RXs will beRXs will be centered on Visual Axiscentered on Visual Axis toto

avoid INDUCING aberrations (Coma,avoid INDUCING aberrations (Coma,

Tilt)Tilt)

SummarySummary

Iris registrationIris registration will become thewill become the

standard of carestandard of care

Asymmetric Radial CompesationAsymmetric Radial Compesation

Functions unique to patientFunctions unique to patient and willand will

improve, so that theimprove, so that the IntendedIntended andand

ActualActual areare equalequal..

MakeMake

Eagles!Eagles!

NotNot

Frogs!Frogs!Ribbit

&

Thank you !

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13 Optimized Prolate Ablations Using Ocular and Topographic Wavefront 6july06 (3.5 Megs)