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The author has a financial interest in the matter under presentation Dr. Rupal Shah, New Vision Laser Centers, India. Results of All-in-One ( AiO ) Femtosecond Laser Surgery for Correction of Myopia and Myopic Astigmatism. All-In-One Femtosecond LASIK. - PowerPoint PPT Presentation
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The author has a financial interest in the matter under presentationDr. Rupal Shah, New Vision Laser Centers, India
Uses only the femtosecond laser for completing the entire LASIK procedure
No need for an excimer laserPossible only with the VisuMax Laser
from Carl ZeissTwo Procedures
FLEx=Femtosecond Lenticule Extraction SMILE=Small Incision Lenticule Extraction
All-Femto Lasik Integrated Solution
Benefits and Advantages
Advantages for the patient
Vision correction w/o corneal ablation• Result quality independent of external conditions• High refractive correction with less induced aberration
Fast single-step treatment• Short period of stress and fear• No need to change stations
Potential for minimal-invasive procedure• Better and faster healing (small incisions)• Preserved biomechanical stability of the cornea• Potential for correction of higher myopes• Lower incidence of Dry-Eye syndrome
(to be proven)
Advantages for the surgeon Differentiation from other LVC providers• Uniqueness of AIO procedure (marketing, positioning)
Workflow improvements• Fast bilateral treatment w/o need to change to excimer
higher patient throughput• Less space requirement
Increased profitability • Premium procedure provides higher margin potential
(ex.: Intralase, Wavefront)• Minimal-invasive treatment may increase demand• Only one laser, with the investment, consumables and
service costs for only laser
683 eyes treated between Aug 2008 and February 2010
Includes eyes treated with both FLEx and SMILE
All consecutive eyes- All eyes treated have been included
Video Illustrates technique of All in One (AiO) Femtosecond Laser Refractive Surgery
Subject Demographics
Mean Range
Age 25 y 18 y to 50y
MR SEQ -4.56 D ± 2.04 D -0.75 D to -10.38 D
MR Sphere -4.22 D ± 1.95 D -0.50 D to -10.00 D
MR Cylinder -0.68 D ± 0.72 D up to -4.50 D
Pre-operative: 683 eligible eyes (339 OD, 344 OS)
429 female eyes, 254 male eyes
Postoperative Results
Mean Range
MR SEQ 0.00 D ± 0.26 D 1.00 D to -1.25 D
MR Sphere 0.00 D ± 0.21 D 1.00 D to -1.25 D
MR Cylinder -0.10 D ± 0.26 D up to -1.75 D
6 month 423 eyes
AiO Safety Change in CDVA
Change in CDVA
13%
54%
8%6%
1%
18%
4%
17%
4%2%
25%
64%
1%4%
33%
57%
11%
<1%2%
31%
58%
8%7%2%2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
lost > 2 lost 2 lost 1 unchanged gained 1 gained 2 gained > 2
Per
cen
tag
e E
yes
[%]
0.25 (638) 1 (558) 3 (502) 6 (423) 12 (109)month (eye)
@3 month 92% unchanged/gained
AiO Stability Achieved correction (MR SEQ) over time
Time
-4.49
0.12 0.08 0.04 0.05 0.03
110423502558639683-7.00
-6.00
-5.00
-4.00
-3.00
-2.00
-1.00
0.00
1.00
pre op 1 w 1 m 3 m 6 m 1 y
Highly stable refraction over time!
R2 = 0.97
0
1
2
3
4
5
6
7
8
9
10
11
12
0 1 2 3 4 5 6 7 8 9 10 11 12
Attempted delta SR equiv. [D]
Achieved [D]
overcorrected
undercorrected
R2 = 0.98
0
1
2
3
4
5
6
7
8
9
10
11
12
0 1 2 3 4 5 6 7 8 9 10 11 12
Attempted delta SR equiv. [D]
Achieved [D]
overcorrected
undercorrected
AiO Refractive Outcome MR SEQ Percent within Attempted@1w and @6m
1 week (639) 6 month (423)
High predictability for early and late follow-ups!
Refractive outcome - Percentage within Attempted
2%
90%
7%3%
93%
4%
94%
3%<1% 2% 2%2%
97%
1%1%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
-1.01 to -2.00 -0.51 to -1.00 +- 0.50 +0.51 to +1.00 +1.01 to +2.00
1 w (639) 1 m (558) 3 m (502) 6 m (423) 1 y (110)
AiO Refractive Outcome MR SEQ Percent within Attempted
@1w 99% ± 1.00 D@3m100% ± 1.00 D
preOP CDVA vs. postOP UDVA - Percentage
67% 69%
43%
22%
44%
<1%
94%
84%
65%
99%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
20/16 orbetter
20/20 orbetter
20/25 orbetter
20/32 orbetter
20/40 orbetter
20/50 orbetter
20/63 orworse
preSCVA (575) 1 d (572) 1 w (537)
month (eyes)
Only 94% are 20/25 or better preOP
AiO-Astigmatism CorrectionNormalized Double Angle Minus Cylinder – Scatter Plot ►only eyes with myopic astigmatism
preOP (485 eyes with myopic astigmatism)
High predictability in cylinder correction after 1 week!
-5
-4
-3
-2
-1
-0
-1
-2
-3
-4
-5
-5 -4 -3 -2 -1 -0 -1 -2 -3 -4 -5
Mean Cyl -0.95 @ 0.0°CZM-Applikation Gehmlich
0°
45°
90°
135°
1 week (460 eyes with myopic astigmatism)
-5
-4
-3
-2
-1
-0
-1
-2
-3
-4
-5
-5 -4 -3 -2 -1 -0 -1 -2 -3 -4 -5
Mean Cyl -0.02@ 167.2°CZM-Applikation Gehmlich
0°
45°
90°
135°