Moderator
Edward E. Manche, MD, ABO
Panelists
Sara K Sella, MD
Pooja Khamar, MD, PhD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Kurt Hanebrink, MD
Co-Authors
Ankur Parikh MD, Brigid Devine BA, Amar Shah MBA, MD
Purpose
Epithelial basement membrane dystrophy (EBMD) and Salzmann nodular degeneration (SND) are common indications for phototherapeutic keratectomy (PTK) before cataract surgery. This study evaluates how cryopreserved amniotic membrane graft (AMG) following PTK for EBMD/SND affects IOL selection, visual and refractive outcomes after cataract surgery.
Methods
A retrospective chart review of patients undergoing PTK for EBMD or SND prior to cataract surgery by a single surgeon at a single center in Cincinnati, Ohio between 2021-2024. Patients were separated into PTK with AMG and PTK without AMG prior to cataract surgery. Best-corrected visual acuity (BCVA) and tomographic data were collected for each eye prior to PTK between PTK and cataract surgery. and Tomographic metrics included K1, K2, steep axis, magnitude of cylinder, and higher order aberrations (HOA). Post-cataract surgery IOL, final BCVA, and refractive outcomes were analyzed.
Results
Sixty-three eyes of 38 patients underwent PTK for SND/EBMD without AMG placement (non-AMG group), and six eyes of 5 patients underwent PTK with AMG placement (AMG group). Mean higher-order aberrations (HOA) in the non-AMG group was 0.325 pre-PTK and 0.372 post-PTK; mean HOA in the AMG group was 0.423 pre-PTK and 0.694 post-PTK. In the non-AMG group, the mean post-phaco month 1 (POM1) BCVA was 0.070logMAR. The mean refractive error (RE) of -0.39+0.63 at 81 degrees with average spherical equivalent (SE) was -0.081 (predicted SE of -0.056). The POM1 post-phaco BCVA for AMG patients was 0.067logMAR. Mean RE was -0.95 +0.33 at 97 degrees with mean SE -0.79 compared with -0.92 predicted SE.
Conclusion
While AMG theoretically may improve epithelial healing, it did not clearly improve refractive outcomes or HOA in this limited study of patients who underwent PTK for EBMD/SND. Thirteen more eyes of 7 patients post-AMG for PTK are awaiting phaco and/or the postoperative period. Thus, a more robust conclusion may be obtained with more future data.
Presenting Author
Nader Nassiri, MD
Co-Authors
Kourosh Sheibani MD, MSc, Sara Kavousnezhad BSc
Purpose
To compare visual outcomes and contrast sensitivity after wavefront-optimized or conventional photorefractive keratectomy (PRK) in myopic patients with or without astigmatism.
Methods
Patients with low to moderate myopia with or without astigmatism were allocated into 2 groups. The study group was treated with wavefront-optimized PRK (Allegretto Wave Eye-Q software version 2.020 default treatment) and the control group, with conventional PRK (Technolas 217z). In all cases, treatments were bilateral and performed with the same device. Baseline and 3-month postoperative measures were uncorrected and corrected distance visual acuities, manifest refraction, and contrast sensitivity.
Results
Each group comprised 66 eyes. The mean preoperative spherical equivalent refraction improved from −2.99 diopters (D) ± 1.02 (SD) preoperatively to −0.08 ± 0.26 D 3 months postoperatively in the study group and from −2.66 ± 0.95 D to 0.01 ± 0.30 D, respectively, in the control group. In both groups, the postoperative mesopic and photopic contrast sensitivity decreased significantly at most spatial frequencies. The postoperative decrease in contrast sensitivity in both groups was comparable except at spatial frequencies of 3 cycles per degree (cpd) under mesopic conditions and 12 cpd under photopic conditions, frequencies at which the control group had a greater reduction.
Conclusion
Visual acuity and refractive error outcomes were similar in both treatment groups. After 3 months, mesopic and photopic contrast sensitivity were significantly decreased in both groups; the reduction in the 2 groups was almost comparable.
Presenting Author
Rushad C. Shroff, MS
Purpose
To analyze refractive outcomes, contrast sensitivity, aberrations and tear film metrics using the ELITA Femtosecond platform for lenticule extraction (Johnson & Johnson, Inc) in the treatment of myopia. Setting: Tertairy Eye care cetre in North India
Methods
150 eyes of 75 patients who underwent Lenticule extraction using the ELITA platform (Johnson & Johnson) were included in this prospective interventional study. The Pentacam HR (Oculus Optikger�te GmbH, Wetzlar, Germany) and itrace (Tracey Technologies Corp., Houston, TX, USA) were used to measure the corneal and total aberrations. Tear film metrics were measured using the Keratograph (Oculus Optikger�te GmbH, Wetzlar, Germany)and Lipiview device (TearScience Inc., Morrisville, NC, USA) .Refractive visual outcomes were also studied at 1 month and 3 months post surgery
Results
Lenticule Extraction with the ELITA femtosecond laser Platform was found to be accurate, safe and effective. The total root mean square (RMS) and RMS of lower order aberrations did not show significant change after the procedure (P =0.65). None of the study subjects lost lines of Corrected Distance visual Acuity. 96 % eyes attained a UDVA of 20/20 or better. 90 percent eyes were within 1 D of targeted spherical and cylindrical correction. There was no significant change in MTF (P=0.23) demonstrating good preservation of contrast sensitivity. Non invasive BUT and Lipid layer thickness did not show significant deterioration post procedure. No adverse effect on the ocular surface was noted
Conclusion
Lenticule Extraction with the ELITA femtosecond laser Platform was found to be accurate, safe and effective with no significant deterioration in quality of vision as well as tear film metrics.
Presenting Author
Emily Y Ye, MD, MS
Co-Authors
Karolinne Rocha MD, PhD, Aline Hagui MD
Purpose
To evaluate refractive outcomes and changes in higher-order aberrations induced by implantable collamer lens placement with a central port design.
Methods
This retrospective study included healthy eyes undergoing surgery for implantable collamer lens (EVO ICL, STAAR Surgical) placement to correct myopia with or without astigmatism between December 2023 and August 2024. Horizontal corneal white to white (WTW) diameter was measured using scheimpflug tomography, swept-source OCT-based biometer (IOL master 700), and digital calipers. Manifest refraction spherical equivalent (MRSE), corrected and uncorrected distance visual acuity (CDVA, UDVA) were measured preoperatively and post-operatively. Higher-order aberrations were measured using a combined Scheimpflug and Hartman-Shack device (Pentacam Wave). Statistical analysis was performed with SPSS.
Results
13 eyes of 7 patients were included with average age of 35.29 ± 5.07 years at time of surgery. Average uncorrected distance visual acuity (UDVA) post-operatively was 0.003 ± 0.07 (logMAR). There was a statistically significant decrease in post-operative spherical aberrations for an optical zone of 5 mm (mean difference 0.032, P= 0.015, paired t-test) as well as a statistically significant post-operative decrease in coma aberrations for an optical zone of 5 mm (mean difference 0.06, P= 0.007, paired t-test). There were no statistically significant differences in post-operative change for trefoil aberrations, or coma and spherical aberrations at 3 mm optical zone.
Conclusion
A decrease in higher order aberrations were found for spherical and coma aberrations post-operatively. However, the study is still limited to small sample size. Overall, all patients included in the study achieved excellent visual outcomes.
Presenting Author
Azamat F. Yusupov, MD
Co-Authors
Nozim Zaynutdinov MD, Muyassar Karimova MD
Purpose
To assess clinical outcomes after phakic IOL implantation combined with laser-assisted in situ keratomileusis in patients with over high refractive errors.
Methods
In this retrospective, observational study, 41 eyes of 22 patients had been investigated after ICL implantation and laser-assisted in situ keratomileusis (LASIK) surgery. The main clinical outcomes of this study were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), ICL vault, intraocular pressure (IOP), keratometric value and central corneal thickness (CCT). All postoperative outcomes had been evaluated at 1 day, 1 week, 1, 3 and 6 months in postoperative period. The main indications for LASIK surgery in eyes were residual refractive outcomes after ICL implantation.
Results
Totally 41 eyes of 22 patients with over high refractive errors had underwent ICL implantation and Trans Epi method of LASIK surgery from 2020 to 2023. The mean age of patients was 26.25±2.75. The mean preop manifest spherical equivalent was -17.25±2.75 D and manifest cylinder was -2.75±0.50 D respectively (p≤0.001) and spherical refractive measures reduced to -0.5±0.25 D and cylinder measures reduced to -0.5±0.15 D postoperatively. After ICL implantation, the mean residual spherical equivalent was -2.5±0.75 D and corrected with using Trans Epi Lasik surgery on 1st month of postop period. The mean preoperative CCT value was 456±37 µm. The mean postop CCT was 408±23 µm respectively (p≤0.001).
Conclusion
Visian ICL implantation is a safe, effective and alternative refractive surgery for correction of over high refractive errors. Residual spheric equivalent might be corrected with using Trans Epi method of LASIK surgery. This method is safe and could be used to reach high postop visual results.
Presenting Author
Azamat F. Yusupov, MD
Co-Authors
Nozim Zaynutdinov MD, Muyassar Karimova MD
Purpose
To evaluate clinical outcomes after ICL implantation in high myopic patients with narrow anterior chamber depth.
Methods
In this retrospective and observational study, we aimed to evaluate the results of 32 high myopic eyes of 21 patients who had been undergone ICL implantation from 2020 to 2024. In all stages of investigation, the main clinical outcomes of this study were uncorrected visual acuity, best corrected visual acuity, ICL vault, intraocular pressure, anterior chamber depth and development of any kind postoperative complications. Clinical outcomes have been evaluated at 1 day, 1 week, 1,3 and 12 months in postoperative period. Especially, we gave an attention to the anterior chamber depth and intraocular pressure after phakic IOL implantation during postoperative follow-up period.
Results
The mean age of 21 patients was 26.21±3.56. Ten men (47.6%) and eleven (52.4%) were women patients. The mean preoperative manifest spherical equivalent was -11.50±3.72 D and manifest cylinder was -1.25±0.3 D, which postoperative spherical refractive measures reduced to -0.5±0.25 D and cylinder measures reduced to -0.5±0.12 D respectively (p≤0.001). The mean IOP was 13.7±1.45 mmHg preoperatively. The mean IOP has changed until 15.44±1.76 mmHg during twelve months in postoperative period. Preoperatively the mean anterior chamber depth was 2.43±0.15 mm. The mean anterior chamber depth was 2.18±0.17 mm and the mean ICL vault was 124±46 µm. Any complications weren`t revealed in postop period.
Conclusion
ICL implantation is safe, effective and alternative method of refractive surgery. Even anterior chamber depth is less than required parameters; surgeon could implant ICL and get best postop results. However, in these cases all patients should be accurately prepared for planned surgery and must be followed up periodically IOP and ICL vault.
Presenting Author
John F. Doane, MD, ABO
Purpose
To report and compare the refractive and visual outcomes of small-incision lenticule extraction (SMILE) for myopia and myopic astigmatism using the VisuMax femtosecond laser (Carl Zeiss Meditec) before and after implementing a VISULYZE (Carl Zeiss Meditec) generated treatment nomogram.
Methods
This was a retrospective, single site clinical study evaluating eyes that underwent routine SMILE for myopia and myopic astigmatism by one experienced surgeon between August 2023 and December 2023. Inclusion criteria were patients 18 years or older with sphere from -1.00 to -10.00D, cylinder up to 3.00D, a preoperative CDVA of ?20/25 Snellen, and completed a 1-month postoperative visit. Preoperative, operative, and postoperative data was collected, and standard outcomes analysis was performed.
Results
A total of 206 eyes met the inclusion criteria; 109 eyes treated before the nomogram (BV group) and the first 97 eyes treated after implementing the nomogram (AV group). Mean attempted SEQ was -3.82±1.90 (-0.88 to -9.13D) in the BV group and 3.85±1.8 ( 0.75 to -8.63D) in the AV group. Postop SEQ was within ±0.50D in 91.7% of eyes in the BV group and 97.9% of eyes in the AV group. UDVA was 20/20 or better in 85% of eyes in the BV group 90% of eyes in the AV group. Astigmatism analysis showed 90.8% of eyes in the BV group and 93.8% of eyes in the AV group had ≤0.50 of postop refractive cylinder
Conclusion
Implementation of a VISULYZE generated treatment nomogram improved the refractive accuracy of the treatment, resulting in better visual outcomes compared to eyes treated before the new nomogram was in use. Further, large population studies are needed to confirm these initial results
Presenting Author
Kerry D. Solomon, MD
Co-Authors
Jeffrey Whitman MD, Stephen Wexler MD, Francis Price MD, Ronald Krueger MSE, MD
Purpose
To evaluate patient-reported outcomes of ray tracing–based LASIK surgery for the correction of myopia in eyes with and without astigmatism
Methods
Included were patients ≥21 years-old with myopia ≤−11.0 D, with or without astigmatism ≤−4.5 D. For each eye, a virtual 3D model and individualized ablation profile was developed using data collected from the InnovEyes™ Sightmap and processed by the wavelight plus ray-tracing algorithm. Factors including visual and dry eye symptoms, satisfaction with treatment, visual symptoms (double images, halos, glare, and starbursts), and ocular surface disease index (OSDI) were assessed via Patient-Reported Outcomes With LASIK (PROWL) questionnaire, administered via electronic clinical outcome assessment tablets at study visits.
Results
Of 168 patients (336 eyes) enrolled, 161 patients (322 eyes) completed the study. Reports of visual symptoms decreased postoperatively compared to preoperatively, with 97.5% of subjects satisfied with their vision. 91.4% of subjects reported no longer using glasses or contact lenses at 12 months. Mean OSDI scores showed a reduction in dry eye symptoms by -6.48 at 3 months and remained stable at 12 months.
Conclusion
PROWL data of wavelight plus LASIK treatment correcting myopia in individuals with and without astigmatism demonstrated good patient-reported symptoms and satisfaction with the procedure.
Presenting Author
Steven J. Dell, MD, ABO
Purpose
To report the outcomes of SMILE for myopia and myopic astigmatism using the VISUMAX 800 femtosecond laser (Carl Zeiss Meditec) during the learning curve of a new SMILE surgeon.
Methods
This is a retrospective analysis of the first 50 consecutive eyes treated with SMILE for myopia and myopic astigmatism at Dell Laser Consultants, Austin, TX from June 2024 to Dec 2024. Inclusion criteria are patients 21 years of age with sphere from -1.00 to -10.00D, cylinder up to 3.00D, and will have completed at least a 1-month postoperative visit. Preoperative, operative, and postoperative data including UDVA, manifest refraction, and CDVA will be collected from eyes that meet the inclusion criteria. Standard outcomes analysis will be performed.
Results
Outcomes reported will be based on the standard nine graphs for reporting refractive surgery including: mean attempted SEQ, postoperative SEQ within 0.50D and within 1.00D, attempted vs achieved SEQ, cumulative percentage of eyes with UDVA 20/20 or better and 20/25 or better, change in postoperative CDVA compared to preoperative CDVA, and additional astigmatism analysis including percentage of eyes with a postoperative refractive cylinder ?0.50D and ?1.00D, SIA vs TIA, and angle of error distribution.
Conclusion
A summary of the outcomes will be provided, and any key take away messages from the learning curve experience with the VISUMAX 800 for a new SMILE surgeon will be discussed.
Presenting Author
Erik A Navas Villar, MD
Co-Authors
Erick Navarro MD, Ivonne Curiel Arce MD, Arturo Chayet MD
Purpose
To evaluate the effect of surgically induced astigmatism (SIA) on refractive outcomes in patients undergoing toric EVO Visian Implantable Collamer Lens (ICL) implantation by STAAR Surgical.
Methods
One - year, non - randomized, prospective study of 26 eyes myopic eyes of 15 patients were SIA was assessed with the implantation of a toric EVO Visian Implantable Collamer Lens (ICL) implantation by STAAR Surgical. ICL power calculations were performed using the manufacturer’s (STAAR Surgical Company) online calculation tool. ICL sizing was based on the corneal horizontal white-to-white (WTW) distance, measured with the Anterion (Heidelberg, Germany). All corneal incisions were made temporally using a 2.8 mm clear corneal approach, with all procedures performed by the same experienced surgeon. Patients underwent two evaluations: one 24 hours post-surgery and another 6 weeks later.
Results
Average age was 30 years ± 6.4. Using a 2.8 temporal clear corneal incision the SIA average was 0.44 D ± 0.23 with the rule. Predicted refractive cylinder was -0.40 D @ 171° and the obtained refractive cylinder was -0.50 @ 153°. A double angle plot graph would be summitted.
Conclusion
The ICL online formula of STAAR surgical needs to be updated to include the SIA factor and by this means enhance refractive results in this group of patients. What
Presenting Author
Michael Mimouni, MD
Co-Authors
Waseem Nasser MD, PhD, Adir Sommer MD, Margarita Safir MD, Dror Ben Ephraim Noyman MD, BSc, Gur Munzer BA, Eyal Cohen MD, Tzahi Sela BScOptom, Igor Kaiserman MD
Purpose
To compare the postoperative outcomes of patients who underwent myopic photorefractive keratectomy (PRK) with a postoperative corneal curvature below 34 diopters (D) versus those with a curvature above 34 D.
Methods
This retrospective study included 17,019 eyes that underwent myopic PRK at Care Vision Laser Centers with 183 eyes (1.08%) classified as having a flat postoperative cornea (average keratometry <34 D). Baseline and intraoperative characteristics were compared between the flat cornea group and a control group (average keratometry ≥34 D). Postoperative outcomes, including uncorrected visual acuity (UCVA), spherical equivalent (SEQ), and other refractive and visual parameters, were analyzed both before and after adjusting for differences in baseline and intraoperative variables.
Results
The flat cornea group had greater preoperative myopia (SEQ: -10.2±2.3 D vs. -4.9±2.6 D, p<0.001), and exhibited thicker minimal corneal thickness (540.7±33.5 µm vs. 530.2±33.6 µm, p<0.001). Intraoperatively, they received a higher spherical correction (8.9±1.5 D vs. 4.8±2.2 D, p<0.001) and deeper maximum ablation depth (131.7±17.2 µm vs. 82.8±36.2 µm, p<0.001). Unadjusted postoperative outcomes indicated worse UCVA (logMAR: 0.06±0.11 vs. 0.03±0.07, p<0.001). After adjusting for baseline and intraoperative differences, no significant differences were observed in UCVA (logMAR: 0.03 vs. 0.03, p=1.00) or other key refractive outcomes between the groups.
Conclusion
Although patients with flat postoperative corneas (34D) had worse postoperative visual outcomes, these differences were not significant after adjusting for baseline and intraoperative variables. It is probable that inferior outcomes in this group is the result of an aggressive treatment rather than an excessively flattened cornea.
Presenting Author
Ivan Gabric, MD
Purpose
JJSV has developed a new femtosecond laser (aka ELITA). This clinical trial evaluated the ease of lenticule removal and visual outcomes for myopic refractive correction with or without astigmatism, across various optical zones. Results are presented up to 3-months post-operatively.
Methods
Fifty myopic eyes were treated using the ELITA system, with varying optical zone (OZ) sizes: 7 eyes with 6.0 mm OZ, 12 with 6.5 mm OZ, 9 with 6.7 mm OZ and 22 with 7.0 mm OZ. Main outcomes included an assessment of ease of lenticule removal, uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) across different optical zones (6.0, 6.5, 6.7 and 7.0 mm), evaluated up to the 3 month follow-up visit
Results
50 eyes at 1D and 1W post op, 48 at 1M and 42 at 3M across different optical zones were analyzed. Surgeons reported 93% favorable lenticule removal (no/mild dissection) with 13.3%, 20%, 20% and 40% from 6.0, 6.5, 6.7 and 7.0 OZ respectively. Moderate dissection was reported in 2.2% for OZs of 6.0, 6.5 and 7.0 mm, and no cases of difficult dissection were reported. UCVA of 20/20 or better by OZ was: 1W - 74% for 6.0 OZ, 92% for6.5 OZ, 92% for 6.7 OZ, and 73% for7.0 OZ; and at 3M - 93% in 6.0 OZ, 100% in 6.5 OZ, 89% in 6.7 OZ, and 94% in 7.0 OZ. BCVA of 20/20 or better was achieved in 100% of eyes at the 3M f/u
Conclusion
These results demonstrate that ease of lenticule removal is successfully achieved across multiple optical zones and excellent visual outcomes are achieved with the new ELITA femtosecond laser, concluding that the ELITA femtosecond laser effectively generates lenticules with diverse optical zones
Presenting Author
Rohit Shetty, FRCS
Co-Authors
Pooja Khamar MD, PhD, Matthias Maus MD
Purpose
The purpose of this study was to evaluate the safety and performance of a new femtosecond laser (Ultra-short wavelength) for creation of corneal flaps for LASIK.
Methods
This was a prospective, interventional, nonrandomized, open label, multicenter, single arm, single eye study. Subjects?18 years-old undergoing routine myopia correcting refractive surgery underwent flap creation with the Ultra-short wavelength laser prior to LASIK. Efficacy and safety were evaluated for up to six months.
Results
Fifty-nine subjects were treated and completed the study. The mean (SD) difference between the achieved average central flap thickness and intended flap thickness at 1 month postoperative was -0.73 (11.984) �m (90% CI [-3.34, 1.87]). Postoperative UCDVA and MRSE demonstrated favorable visual outcomes from all eyes with mean UCDVA of -0.071 logMAR and MRSE of -0.0948 D at 6 months. There were no intraoperative or postoperative ocular AEs related to flap creation or treatment. No serious AEs or ADEs were reported.
Conclusion
Overall, the Ultra-short wavelength Femtosecond Laser demonstrated the ability to accurately and safely cut corneal flaps as part of myopia correcting LASIK procedures.
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