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Moderator
Mark A. Kontos, MD, ABO
Panelists
James S. Bailey, MD, ABO, Lisa McIntire, MD, ABO
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
Wonseok Choi, MD
Purpose
To assess the effect of automated centration (Centrax) on outcomes of lenticule extraction with the ATOS femtosecond laser by comparing uncorrected distance visual acuity, refractive accuracy, and higher-order aberrations in eyes treated with and without Centrax.
Methods
This study included 80 eyes of 40 patients who underwent refractive lenticule extraction with the ATOS femtosecond laser. Patients were divided into two groups: Group 1 (20 patients, 40 eyes with Centrax automated centration) and Group 2 (20 patients, 40 eyes with manual centration). Postoperative evaluations were performed at 1 week, 1 month, and 3 months. Outcomes included uncorrected distance visual acuity (UDVA), refractive error, and higher-order aberrations (coma, trefoil). Intergroup comparisons were conducted to determine the impact of Centrax on visual performance and centration-related aberrations.
Results
Preoperatively, no significant intergroup differences were observed in visual acuity or higher-order aberrations, including coma, spherical aberration, and trefoil. Postoperatively, uncorrected distance visual acuity and refractive error were comparable between groups at all follow-up visits. At 1 week, significant differences were found only in vertical and horizontal coma measured at the 6.0-mm optical zone, while all parameters at the 3.0-mm zone showed no significant differences. At 1 and 3 months, vertical coma at the 6.0-mm zone remained significantly lower in the Centrax group, whereas horizontal coma and all other higher-order aberrations showed no significant intergroup differences.
Conclusion
Automated centration using Centrax allows more precise intraoperative centration during lenticule extraction. Although manual centration achieved excellent outcomes, Centrax further reduced coma at the 6.0-mm optical zone, which may contribute to maintaining night vision quality and minimizing night-time visual disturbances.
Presenting Author
Faruk Semiz, MD
Co-Authors
Ceren Ece Semiz (MD), Njomza H (MD), Fetih Furkan Arslan (MD)
Purpose
To evaluate the long-term efficacy, safety, and corneal morphological changes of fresh lenticule transplantation for hyperopic residual refraction and presbyopia following LASIK
Methods
This retrospective study included 84 eyes of 42 patients (32.9 ± 7.5 years) with post-LASIK hyperopic residual refraction (+1.00-+6.00 D) and cylinder (+0.75-+2.50 D). Inclusion required age >18, CDVA ?0.5 logMAR, and consent; exclusions were active infection, glaucoma, retinal detachment, cataracts, or predicted CCT >650 µm. Donor lenticules averaged 88.4 ± 28.1 µm thickness, ?4.42 ± 1.40 D power, and 660 ± 15 µm optical zone. In recipients, the LASIK flap was untouched, and a 140-µm intrastromal pocket was created for lenticule transplantation. Outcomes (UDVA, CDVA, slit-lamp, topography, pachymetry, AS-OCT) were evaluated over 5 years, with all patients completing follow-up.
Results
No cases of rejection, complications, or surgical revision occurred during follow-up. At 5 years, UDVA improved from 0.63 ± 0.21 to 0.03 ± 0.03 logMAR, UNVA from J7 to J2 (40 cm) and J6 to J3 (80 cm). Central corneal thickness increased from 490.0 ± 33.8 to 572.3 ± 27.1 µm, sphere decreased from +3.95 ± 1.40 to ?0.40 ± 0.13 D, K1 from 41.52 to 44.27 D, and K2 from 42.87 to 44.98 D. Q-value shifted from ?0.43 to ?0.79. All changes were significant (p < 0.001).
Conclusion
At 5 years, the procedure demonstrated long-term safety, stable corneal asphericity, and sustained improvements in both distance and near visual acuity.
Presenting Author
Geoffrey Nguyen, MD
Co-Authors
Paul Kang (MD), Amisha Dave (MD)
Purpose
To characterize the experiences of ophthalmology residents, fellows, and recently graduated ophthalmologists with refractive surgical procedures and identify deficiencies in refractive surgical education in residency.
Methods
An anonymous online survey was emailed to ophthalmology residents, fellows, and recently graduated ophthalmologists (in practice for 5 years or less). Participants reported the number of presbyopia correcting IOLs implanted, femtosecond laser assisted cataract surgeries performed, and laser vision correction procedures performed during residency. Their confidence during residency in refractive surgical topics was assessed using a Likert scale. They were also asked about the biggest barriers to refractive surgical experiences in residency and if they would do a dedicated fellowship in cataract and refractive surgery if they were planning to offer refractive surgery at their practice.
Results
114 individuals responded. 58.8% had implanted 0 presbyopia correcting IOLs, 75.4% performed 0 femtosecond laser-assisted cataract surgeries, and 77.2% performed 0 laser vision correction procedures during residency. 65.8% of participants agreed that they were confident in their knowledge of optical biometry. Conversely, only 36.0% were confident in their knowledge of the latest refractive technologies available and only 25.4% were confident in their ability to manage post-refractive surgery patients. The cost of refractive surgical equipment was reported as the biggest barrier to refractive surgical education in residency (71.1%). 63.2% would do a dedicated fellowship in refractive surgery.
Conclusion
Although most participants surveyed agreed that refractive surgical education in residency was adequate, the majority reported low levels of confidence in performing refractive surgery. Measures to address the financial barrier of obtaining refractive surgical equipment should be investigated to increase exposure to refractive surgery in residency.
Presenting Author
Zoha N Mian, MD, MSc
Co-Authors
Max Liu (BSc), Ethan Driffill (BSc), Nick Mamalis (MD), Liliana Werner (MD, PhD)
Purpose
To evaluate two types of explanted hydrophilic acrylic phakic intraocular lenses (IOLs) for evidence of calcification: the Implantable Collamer Lens (ICL; copolymer of acrylic with porcine collagen; Staar; 34% water content), and the I-CARE (Corneal; 26% water content).
Methods
84 phakic lenses were analyzed, including 65 ICLs and 19 I-CARE lenses explanted 8.78 +/- 7.23 years and 12.99 +/- 5.34 years after implantation, respectively. Gross and light microscopic examination was performed on all lenses to assess for optical clarity, integrity, and presence of any surface and/or subsurface deposits. A subset of lenses underwent histochemical staining with 1% alizarin red to detect calcific deposits. Additional lenses were subjected to implant cytology and light transmission testing.
Results
Trace to mild pigmentary dispersion was observed in 36 ICLs (55.4%), and in 10 I-CARE lenses (52.6%). No evidence of opacification or calcification was detected on any lens under gross or light microscopy, including in peripheral areas of the haptic components. Histochemical analysis confirmed the absence of calcification, showing only nonspecific uptake of dye within the lens substance. Implant cytology revealed proteinaceous deposits without cellular elements. Light transmission in the visible spectrum was within normal range (93.7-97.4%) and effective ultraviolet blocking was shown for all lenses.
Conclusion
To the best of our knowledge, there is no reported case of calcification in relation to hydrophilic acrylic phakic IOLs, but this issue has not been thoroughly investigated in laboratorial analysis. This large series of explanted hydrophilic acrylic phakic lenses confirms no evidence of calcification, many years after implantation.
Presenting Author
Y Ralph Chu, MD
Co-Authors
James Paauw (MD), Mitch Jackson (MD), Mitchell Brigell (PhD), Konstantinos Charizanis (PhD, MBA), Jay Pepose (MD, PhD)
Purpose
To evaluate the efficacy of 0.75% phentolamine ophthalmic solution (POS) in improving mesopic low contrast vision (mLCVA) in post-keratorefractive surgery patients with nighttime photic complaints.
Methods
LYNX-2 was a multicenter, randomized, double-masked, placebo-controlled Phase 3 trial conducted at 25 U.S. sites. Subjects with prior keratorefractive surgery (>6 months), mesopic pupil diameter ?5 mm, and mLCVA ?30 ETDRS letters in at least one eye were enrolled. A total of 200 qualified subjects with symptoms of glare, halos, and starburst were randomized 1:1 to receive either 0.75% phentolamine ophthalmic solution or placebo nightly for 6 weeks. The primary endpoint was the percentage of subjects with ?3 lines (15 letters) of mLCVA improvement at Day 15. Tachyphylaxis of POS was evaluated at Week 6.
Results
The primary endpoint was met, with 17% of subjects in the phentolamine group achieving ?15-letter mLCVA improvement at Day 15 vs. 9% in the placebo group (p<0.05). A statistically significant difference was also seen at Day 8 (16% vs. 8%, p<0.05). The 90% confidence interval in change from baseline in mean mLCVA between Day 3 (best response) and Week 6 in the POS arm did not include the prespecified 5 letter loss, demonstrating no tachyphylaxis. Treatment was well tolerated, and no treatment related serious ocular adverse events were reported.
Conclusion
Phentolamine ophthalmic solution significantly improved mLCVA in post-keratorefractive surgery subjects with reduced mesopic low contrast vision and may represent a potential therapeutic option for this underserved population.
Presenting Author
Ants Haavel, MD
Purpose
To determine the incidence of post-refractive corneal ectasia after surface-ablation procedures (PRK, LASEK, transepithelial PRK, epi-K) performed at a high-volume center over two decades, and to contextualize findings against contemporary ectasia rates reported for flap-based laser vision correction.
Methods
Retrospective registry review (2005–2025) including all consecutive surface-ablation cases for myopia/myopic astigmatism. Ectasia was defined as progressive tomographic/keratometric steepening with thinning and loss of CDVA consistent with post-refractive ectasia, with/without need for cross-linking. Case ascertainment used EMR search, imaging archives, and cross-linking referral logs. Incidence proportion with exact 95% CI calculated; when zero events, rule-of-three upper bound (3/n) reported.
Results
Across 20 years, 50,000 surface-ablation procedures were performed. Zero ectasia cases were identified via EMR search, imaging archive review, and regional cross-linking referral logs. Incidence: 0% (exact 95% CI upper bound 0.006%; ≤6 per 100,000 procedures). Findings were consistent across procedure subtypes.
Conclusion
In a high-volume center with standardized ectasia screening, surface ablation showed an extremely low observed risk, with an upper 95% bound ≤6 per 100,000. Alongside published rates higher for flap-based procedures, these data support surface ablation as a highly safe option in properly screened candidates.
Presenting Author
Sumitha Muthu, MS
Co-Authors
Rohit Shetty (FRCS), Pratibha Panmand (DNB), Swaminathan Sethu (PhD), Arkasubhra Ghosh (PhD)
Purpose
To explore whether progressive myopia is associated with ocular surface inflammation, corneal nerve changes, and dopamine alterations. We investigated tear biomarkers, in vivo confocal microscopy findings, and dopamine receptor status to identify potential inflammatory-neurochemical pathways in myopia progression.
Methods
Progressive myopes (n=70) along with stable myopes (n=25), emmetropes (n=15) were included in the study. Tear fluids were used to measure inflammatory biomarker (IL-1?, IL-6,TNF?, MMP9, ICAM1, etc.,) levels. In vivo confocal microscopy was performed in a subset of patients to assess the status of corneal nerves, dendritic cells, and T cells. Tear fluid dopamine and conjunctival impression cytology-based assessment of dopamine receptors expression was performed in subset of the study subjects and validated in vitro. Data from progressive myopes were compared with stable myopes, and emmetropes to evaluate correlations between inflammation, nerve changes, and dopaminergic pathways in myopia
Results
Higher levels of IL-1?, IL-6, TNF?, MMP9, and ICAM1 were observed in a subset of progressors. Tear dopamine was reduced in progressive myopes, with lower levels correlating with greater progression risk. In vitro assays indicated that inflammation impaired dopamine receptor function. Confocal microscopy revealed reduced corneal nerve density, presence of dendritic cells, and T lymphocytes in progressive myopes, a change that is correlated with elevated inflammatory markers and reduced dopamine
Conclusion
Progressive myopia shows features of subclinical ocular surface inflammation, immune activation, and dopaminergic downregulation. Targeted immunomodulation and dopamine pathway support could represent novel strategies for early stabilization of myopia.
Presenting Author
Dhiresh Bandaru, BSc
Co-Authors
Amisha Dave (MD), Dagny Zhu (MD)
Purpose
To characterize LASIK discourse in r/lasik (2/2/2024-8/25/2025) by quantifying procedures, topics, and symptoms; classifying experience sentiment and would/wouldn't recommend statements in posts and comments; estimating how often comments advise professional care; and assessing authorship concentration.
Methods
We conducted a retrospective cross-sectional study of public r/lasik using the Python Reddit API Wrapper. All content dated 2/2/2024-8/25/2025 was retrieved (posts N=846; comments N=6,070); analytic subsets required the token "lasik" (posts n=553; comments n=2,173). A predefined refractive-surgery lexicon tagged procedures, themes, and symptoms. Rule-based models labeled experience sentiment and identified 'would/wouldn't-recommend' language; comments were also coded for explicit professional care advice. We summarized category frequencies and author-level contribution concentration (most-active, top-10, top-10%). A parallel r/lasiksupport analysis is planned.
Results
Among posts (n=553), co-mentions included PRK 28.4%, ICL 18.6%, SMILE 15.2%. Posts most often described drops/meds/bandage lens (58.6%), vision quality (57.5%), recovery (55.3%), return to activities (53.5%), surgeon choice (44.3%), and candidacy (40.9%). Symptoms: dry eye 44.8%, pain/burning 44.3%, halos 30.7%, flap-related 22.8%. Sentiment: neutral/mixed 58.0%, positive 26.2%, negative 15.7%. Comments (n=2,173; 570 authors): vision quality 17.1% and recovery 16.3% led; 29.1% advised professional care. Enhancement/revision noted in 6.6% of comments. Comment authorship was moderate, top author 2.1%, top-10 12.8%, top 10% 39.4%. Post authorship had little repetition.
Conclusion
r/lasik discussions emphasize peri-operative care, vision quality, and recovery; dry eye and night-vision phenomena recur. Comments are largely neutral and often direct peers to care; authorship is moderately concentrated. These insights can guide counseling and digital patient education; final statistical analysis is pending.
Presenting Author
Gilad Fainberg, MD
Co-Authors
Michael Mimouni (MD), Gur Munzer (BA)
Purpose
To characterize vertical gas breakthrough (VGB) during femtosecond LASIK (FS-LASIK) by frequency, location, management, and early visual outcomes.
Methods
All FS-LASIK procedures (June 2020-January 2023) were reviewed. Cases with an uncut area during flap creation were identified; VGB was confirmed on intraoperative video as gas breaching the lamellar plane with subepithelial accumulation. Management was classified as proceed, manual completion (crescent/keratome), conversion to PRK, or procedure abortion. Primary outcomes were UDVA and CDVA at the last postoperative refraction visit; postoperative day (POD) was summarized, and complications recorded.
Results
Among 7,746 eyes, uncut areas 79 (1.0%) and VGB 23 (0.3%). Age 36±12; 14/23 female. VGB peripheral 21/23 (91.3%); crossing visual axis 2/23 (8.7%). Management: proceed 11 (47.8%), manual completion 5 (21.7%), PRK 5 (21.7%; 3 primary, 2 after failed lift), abortion 2 (8.7%). Endpoint POD 70±44 (median 62 [58-78], range 7-184). Postop UDVA 0.96±0.21; CDVA 1.03±0.09 (n=21). 82.6%/91.3% within ±0.50/±1.00 D. Attempted-achieved: y=0.9058x+0.2608 (R�=0.9071); mean diff +0.03 D. Astig ?0.50 D in 86.4%; ?1.50 D fell 4.3%?0%. Complications: buttonholes 2/21 (9.5%), PRK haze grade-1 1/21 (4.7%).
Conclusion
VGB was uncommon, usually peripheral, and manageable with surgeon-directed adjustments. Early postoperative visual outcomes at the last refraction visit were favorable and similar across management strategies.
Presenting Author
Jacklyn Vainshtein, BSc
Co-Authors
Arya Davari (BSc), Victoria Wang (MD, MS), Dagny Zhu (MD)
Purpose
Vitreous opacities have been shown to significantly degrade visual quality in patients post-cataract surgery. This study aimed to evaluate quantitative contrast sensitivity and visual outcomes after YAG laser vitreolysis treatment in pseudophakic eyes with visually significant vitreous opacities after cataract surgery.
Methods
A prospective study evaluating pseudophakic eyes that underwent YAG laser vitreolysis for the treatment of visually significant vitreous opacities after femtosecond laser-assisted cataract or refractive lens exchange surgery was conducted. Eyes requiring simultaneous YAG laser treatment for significant posterior capsular opacities or other underlying pathology were excluded. Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCDVA), quantitative contrast sensitivity function qCSF (adaptive sensory technology), and a Vitreous Floaters Functional Questionnaire (VFFQ) were evaluated at baseline, 1 week, and 4 weeks.
Results
Preliminary results (7 eyes in 6 patients) found no significant change in visual acuity after vitreolysis (logMAR UDVA 0.03 ± 0.01 D and 0.075 ± 0.01 D at 1 and 4 weeks, respectively, logMAR BCDVA 0.0 ± 0 D and 0.06 ± 0.07 D at 1 and 4 weeks, respectively). There was no significant difference overall in qCSF (0.31 ± 0.8 dB and 1.69 ± 0.07 dB at 1 and 4 weeks, respectively, P>0.05). VFFQ scores significantly improved after treatment indicating better visual function (-2.9 ± 0.85, P<0.05 and 1.5 ± 0.55, P>0.05 at 1 and 4 weeks, respectively). 100% of patients noted some or marked improvement (2.4 ± 0.89, P<0.05 and 1.6 ± 0.89, P<0.05 at 1 and 4 weeks, respectively). No adverse events occurred.
Conclusion
This preliminary report demonstrates that YAG vitreolysis is a safe and effective treatment method for visually significant vitreous opacities in pseudophakic eyes. Repeat treatments may be needed to in some cases to maintain benefits.
Presenting Author
Ali Nowrouzi, MD, FEBO, FACS
Purpose
To evaluate the effectiveness and safety of systemic corticosteroids in reducing postoperative pain following photorefractive keratectomy (PRK) compared to standard topical therapy.
Methods
In a prospective, randomized controlled trial, 43 patients aged 18–35 with myopia or myopic astigmatism underwent PRK and were randomized into two treatment groups. Group 1 received standard pain management, while Group 2 received the same regimen plus oral Deflazacort, initiated two hours preoperatively and tapered over six days. A third group of 42 eyes treated with Laser-assisted in situ keratomileusis LASIK served as a control for visual outcomes. Pain scores, visual acuity, and complications were assessed over a six-month period.
Results
Group 2 reported significantly lower pain scores than Group 1 on Day 1 (3.36 vs. 7.96, p < 0.0001) and Day 2 (1.56 vs. 4.20, p < 0.0001). Visual outcomes were comparable between PRK and LASIK groups. No systemic or ocular complications were attributed to Deflazacort.
Conclusion
Oral Deflazacort significantly improves early postoperative comfort following PRK without compromising safety or visual outcomes, supporting its use as an adjunct to standard pain management.
Presenting Author
Rohit Shetty, FRCS
Co-Authors
Pooja Khamar (MD, PhD), Abhijit Roy (PhD), Rahul Patil (MSc), Raghav Narasimhan (None)
Purpose
To present the Narayana Epithelium Evaluation Display (NEED), a next-generation platform for comprehensive visualization and quantitative analysis of corneal sublayer thickness, designed to enhance diagnostic accuracy and clinical decision-making in corneal disorders
Methods
Corneal scans from 120 eyes (healthy and keratoconus each) were acquired on Pentacam OCT (1 µm resolution). Each eye underwent 3 repeats. Raw B-scans were processed with a custom edge-detection algorithm to delineate tear film, epithelium, Bowman's layer, and anterior stroma. Sublayer thickness maps were computed and visualized on NEED. An ETDRS grid (2/5/7 mm zones, 8 sectors) was applied. Sectoral mean thicknesses across repeats were compared, and intra-class correlation coefficients (ICC) calculated to assess repeatability.
Results
Tear film showed moderate repeatability (ICC: 0.83 healthy, 0.79 KC), reflecting variability. Bowman's layer and epithelium demonstrated excellent repeatability. Central 2 mm mean Bowman's thickness was 15.69 ± 1.58 µm (healthy) vs 12.57 ± 0.45 µm (KC). Central epithelium measured 49.57 ± 3.55 µm (healthy) vs 45.04 ± 1.83 µm (KC). ICC values were 0.99 for Bowman's and 0.97 for epithelium, confirming robust measurement reliability using NEED.
Conclusion
NEED, integrated with ultra-high-resolution Pentacam OCT, enables precise and repeatable evaluation of corneal sublayers. While tear film showed variability, Bowman's layer and epithelium demonstrated excellent repeatability, highlighting NEED's potential for reliable clinical assessment and keratoconus monitoring.
