Intraoperative Aberrometry

Mark Packer, MD, FACSClinical Associate Professor

Oregon Health & Sciences University

Mark Packer, MD

Financial Disclosure

(*stock options)

Abbott Medical Optics, Inc.

Advanced Vision Science, Inc.

Bausch & Lomb Surgical, Inc.

Carl Zeiss Surgical, Inc.

Celgene, Inc.

GE Healthcare

Haag-Streit USA

Ista Pharmaceuticals

LensAR, Inc.*

Rayner Intraocular Lenses, Ltd.

Surgiview LLC*

Transcend Medical, Inc.*

TrueVision Systems, Inc.*

WaveTec Vision Systems*April 1, 2010

Purpose

• To determine the effect of intraoperative wavefront-guided enhancement of limbal relaxing incisions on the rate of postoperative excimer laser enhancement

ORange Aberrometer

• Talbot moire interferometry

• Fourier transform

• Calculation of spectacle correction

Methods• Retrospective chart review

• Patients having limbal relaxing incisions (LRIs) at the time of cataract or RLE surgery

• May 2007 to June 2009

• August 2008 ORange– WaveTec, Inc., Aliso Viejo, CA

Methods• Standardized LRI technique

– Sim Ks (EyeSys, Tracey, Inc)– Nichamin nomogram– After IOL insertion (IOP ≥ 25 mm Hg)– 10 mm OZ– Ruminson Astigmatic Gauge and Marker (Rhein

Medical, Tampa, FL) – 90% depth

• Cornea Gage Plus (Sonogage, Cleveland, OH)• Stealth Triamond (Mastel Precision, Rapid City, SD)

Methods

• Enhancement by extending arcs

– measured axis ± 15º of expected • (SIA + 0.5 D @ 90º)

– residual cylinder ≥ 1.0 D.

Results - Total• 67 eyes of 48 patients

– 62.6 ± 9.0 years– Mean pre op ∆K = 1.4– Mean steep axis = 85º– Mean 10 mm pachy = 674 µ

• Post op MR Cyl at 29 days (n = 66) = 0.42 D

• Post op MR Cyl at 7 months (n = 34) = 0.59 D

Results – Group 1• 37 eyes of 27 patients • Not measured with intraoperative aberrometry

– 63.5 ± 9.0 years– Mean pre op ∆K = 1.5 D (0.51 – 2.64) – Mean steep axis = 83º– Mean pre op 10 mm pachy = 679 µ

• Post op MR Cyl at 33 days (n =36 ) = 0.48 D

• Post op MR Cyl at 9 months (n = 20) = 0.53 D

Results – Group 2 Total• 30 eyes of 21 patients• Measured with intraoperative aberrometry

– 61.5 ± 9.1 years – Mean pre op ∆K = 1.28 D (0.52 – 3.25)– Mean steep axis = 87º– Mean pre op 10 mm pachy = 668 µ

• Post op MR Cyl at 24 days (n = 28) = 0.37 D

• Post op MR Cyl at 5 months (n = 14) = 0.41 D

Mean Preoperative Characteristics

Group 1 Group 2 p-value

Age, years 63.5 61.5 0.34

∆K, D 1.5 1.28 0.40

Axis, º 83 87 0.21

Pachy, µ 679 668 0.42

Postoperative CharacteristicsGroup 1 Group 2

Mean Sphere -0.27 -0.33Mean MRSE +0.0 -0.15Median UCVA 20/25 20/25MR Cyl 0.48 0.37 ≥ 0.75 D 10 (27%) 7 (23%) ≥ 1.00 D 9 (24%) 2 (6.6%) ≥ 1.25 D 4 (11%) 1 (3.3%)

NON ORange

0.00

0.50

1.00

1.50

2.00

2.50

3.00

0 0.5 1 1.5 2 2.5 3 3.5

Pre Op Delta K

Po

st O

p M

R C

yl

Group 1: ∆K v MR Cyl

ORange

0

0.5

1

1.5

2

2.5

3

0 0.5 1 1.5 2 2.5 3 3.5

Pre Op Delta K

Po

st O

p M

R C

yl

Group 2: ∆K v MR Cyl

Results – Group 2 Enhanced• 8 eyes of 6 patients• Enhanced with extended LRIs

– 62.2 ± 12.5 years– Mean pre op ∆K = 1.75 D (0.87 – 3.25) – Mean steep axis = 82º– Mean pre op 10 mm pachy at steep axis = 655 µ

• Post op MR Cyl at 29 days (n = 8) = 0.31 D

• Post op MR Cyl at 6 months (n = 3) = 0.42 D

ORange LRI-ENH

0.00

0.50

1.00

1.50

2.00

2.50

3.00

0 0.5 1 1.5 2 2.5 3 3.5

Pre Op Delta K

Po

st O

p M

R C

ylGroup 2 (LRI enhanced):

∆K v MR Cyl

Results – Laser Enhanced

• 7 eyes of 5 patients (7/67 = 10.5%)

Results – Laser EnhancedWithout aberrometry (Group 1) 6/37 = 16.2%

59.8 ± 3.7 yearsMean pre op ∆K = 1.70 D (0.76 – 2.32)Mean steep axis = 95ºMean 10 mm pachy at steep axis = 664

µ

Before excimer at 2 - 11 months MRSE = -0.39 D (-1.1 – 0.38)MR Cyl = 1.45 D (1.0 – 2.5)

Results – Laser EnhancedWith aberrometry (Group 2) 1/30 = 3.3%

– 58 years– Pre op ∆K = 2.61 D– Steep axis = 78º– Pre op 10 mm pachy at steep axis = 658 µ

Before excimer (1 month)MRSE = -0.50 DMR Cyl = 1.00 D

Laser enhanced: ∆K v MR Cyl

Laser Enhancements

0

0.5

1

1.5

2

2.5

3

0 0.5 1 1.5 2 2.5 3 3.5

Pre Op Delta K

MR

Cyl

Bef

ore

Las

er

Comparison of Enhanced Eyes

Non-ORange w/LASIK enh

n = 6/37 (16.2%)

ORange

w/LASIK enh

n = 1/30 (3.3%)

ORange

w/LRI enh

n = 8/30 (26.7%)

Age: Mean, SD 59.8 + 3.7 58 62.2 + 12.5

Pre-Op Delta K1.70 D

(0.76 - 2.32)

2.61 D 1.75 D

(0.87 - 3.25)

Steep Axis 95º 78º 82º

Pre-op 10mm Pachymetry

664 microns 658 microns 655 microns

Post LRI

1.45 D

(1.0 - 2.5)

1 month

(n = 6)

1.00 D

1 month

(n = 1)

0.31 D

(0.00 – 1.00)

1 month

(n = 8)

Post LASIK0.95 + 0.29D

7-16 months (n = 6)

0.42D

6 months (n = 3)

Conclusion

• Intraoperative wavefront guided enhancement of LRIs reduced the rate of postoperative excimer laser enhancement from 16.2% to 3.3%, an odds ratio of 5.71 (p=0.12).

Conclusion

• Small case-control study indicates a trend

• Further research (prospective, randomized) indicated to validate effect