Comparison of topography guided (TGL) to standard LASIK (SL) for hyperopia. How important is adjustment for angle kappa?

ASCRS 08

A. John Kanellopoulos, MD Associate Professor NYU, New York Director, Laservision.gr, Athens, Greece www.brilliantvision.com

We have reported our topo-guided experience in LASIK utilizing the Wavelight-platform

(Kanellopoulos-JRS Sept05)

• The software feeds 8 high quality topographies (Oculus) and offers surgeon adjustment for final ablation for: 1-sphere 2-Cylinder 3-Axis 4-Q value (asphericity) angle-kappa adjustment is done by default. So the ablation is decentered to target the visual axis www.brilliantvision.com

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We have reported our experience with LASIK for treating hyperopia with the standard Wavelight platform Kanellopoulos-JRS 2006 Initial topography guided Hyperopic and Hyperopic Astigmatism LASIK Experience with the WaveLight ALLEGRETTO WAVE excimer laser in 120 Consecutive Eyes ARVO 2006-JRS 2006

Is Angle kappa significant in hyperopes?

• We published the study:

Measurement of angle kappa with synoptophore and Orbscan II in a normal population

Hikmet Basmak, MD 1 ; Afsun Sahin, MD 2 ; Nilgun Yildirim, MD 3 ; Thanos D. Papakostas, MD 4,5 ; and A. John Kanellopoulos, MD 4,5 2007 J Refract Surg • We showed as previous investigators have that there is a significant correlation between positive refractive errors and large positive angle kappa values. Refractive surgeons must take into account angle kappa especially in hyperopic patients in order to avoid complications related to decent ration of ablation zone.

4/27/2020 www.brilliantvision.com

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Purpose-why really use topo-guided for hyperopia?

• We evaluated the Safety and efficacy of Topo Guided LASIK (that compensates for angle kappa) versus standard hyperopic LASIK • Compare to previous data from previous published standard treatments(including ours) • Can we safely and effectively compensate for angle-kappa by using this platform?

www.brilliantvision.com

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An example of a topo-guided hyperopic correction (1 is after, 2 is pre-op and 1 minus 2 the difference showing that the ablation is decentered when referenced to the pupil): Treatment axis is centered on the visual axis and not pupil center

METHODS:

SETTING: Laservision.gr Institute, Athens, Greece. 35 patients treated with TGL in one eye, SL in the other. • The Wavelight and Intralase systems were used. • Refraction, UCVA, BSCVA, angle kappa; effective ablation diameter (EAD), wavefront analysis (WA) and contrast sensitivity (CS) were evaluated with 18 months follow-up.

www.brilliantvision.com

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How is Angle kappa adjusted with topo-link

These figures depict the same planned excimer profile for the correction of hyperopic astigmatism on the left: centered on the pupillary center and on the right :adjusted by topography to take into consideration and adjust for angle kappa 4/27/2020 www.brilliantvision.com

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A LASIK flap with a microkeratome needs to be de-centered as well to accommodate the de-centered ablation this may be Challenging for the surgeon. The Intralase offers a better option to customise the flap cnetration 4/27/2020 www.brilliantvision.com

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Results

• Mean pre-op sphere for both groups • +3.08 (SD+/- 1.56) D. • Cylinder: +1.80 (SD+/- 1.01 D). • Post-op: Mean post-values Topo guided compared tp Standard • UCVA: 20/20 to 20/23. • Regression: + 0.32 to +0.55. • Cylinder: + 0.25 to +0.54. • Ablation diameter: 6.8 to 6.2 mm, • Wavefront: 0.25 to 0.37.

• Contrast sensitivity: +40% to + 15%.

www.brilliantvision.com

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A head on comparison of the post hyperopic LASIK Pentacam map in the same patient The topo-guided eye on the left and standard on the right 4/27/2020 www.brilliantvision.com

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Conclusions

• Topo Guided LASIK and Standard LASIK with the Intralase and the Wavelight laser appear to be safe and effective for hyperopia. • Topo-guided appears be superior in regard to regression, residual astigmatism, Contrast and ablation diameter • This platform achieves superior visual axis centration with a smaller re-treatment rate compared to our previously published series.

• It reduces the chance of a surgeon-related de centration error .

• Oculyzer-link maybe faster and more-accurate 4/27/2020 www.brilliantvision.com

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