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Moderator
Kenneth J. Rosenthal, MD, FACS
Panelists
Scott M. MacRae, MD, ABO; Michael J. Taravella, 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
Michael Mimouni, MD
Co-Authors
Adir Sommer (MD), Margarita Safir (MD), Marcony Santhiago (MD, PhD), Waseem Nasser (MD, PhD), Dror Ben Ephraim Noyman (MD, BSc), Tzahi Sela (BScOptom), Gur Munzer (BA), Igor Kaiserman (MD), Eyal Cohen (MD)
Purpose
To compare the visual and refractive outcomes of breastfeeding versus non-breastfeeding women who underwent laser assisted in situ keratomileusis (LASIK) surgery.
Methods
A retrospective study was conducted at Care-Vision Laser Centers in Tel-Aviv, Israel. Medical records of women who underwent LASIK surgery between January 2013 and December 2023 were reviewed. Patients were divided into two groups: those who reported breastfeeding during their screening examination and those who did not. Preoperative, intraoperative, and postoperative parameters were compared between the groups.
Results
A total of 3,034 eyes from 1,595 women were included, with 161 eyes from breastfeeding women. The time between screening and surgery was similar for both groups (193.6±414.7 vs. 151.3±419.2 days, P=0.212). Breastfeeding women had worse preoperative UCVA (LogMAR 1.3±1.1 vs. 1.15±1.0, P=0.021) but achieved comparable postoperative outcomes, including UCVA (0.03±0.7 vs. 0.03±0.72, P=0.628), BCVA (0.03±0.72 vs. 0.02±0.77, P=0.370), spherical equivalent (SEQ) (-0.24±0.55 vs. -0.23±0.56 D, P=0.894), safety index (0.97±0.20 vs. 0.98±0.18, P=0.262), and efficacy index (0.96±0.21 vs. 0.98±0.20, P=0.490). There were no higher retreatment rates in breastfeeding women (P=0.23).
Conclusion
Six months after reporting active breastfeeding, women who underwent myopic LASIK surgery achieved visual and refractive outcomes comparable to non-breastfeeding women. These outcomes were assessed over a follow-up period of up to one year. LASIK provides excellent visual outcomes for both groups.
Presenting Author
Wonseok Choi, MD
Purpose
To evaluate the safety profile and anterior chamber inflammation following ICL implantation using a 2.2mm microincision compared to the standard 3.2mm incision.
Methods
A total of 80 eyes from 40 patients undergoing ICL implantation were enrolled. The microincision group (2.2mm) included 40 eyes from 20 patients, and the standard incision group (3.2mm) included 40 eyes from 20 patients. Postoperative assessments were performed at 1 day, 1 week, and 1 month. Intraocular pressure (IOP) and intraocular inflammation were measured at each time point. Intraocular inflammation was quantified using laser flare photometry.
Results
Anterior chamber inflammation increased significantly on postoperative day 1 in both groups compared to preoperative values (p < 0.05) and returned to near baseline by postoperative week 1. In the microincision group, flare values were 6.7 ± 3.5 preoperatively, 25.1 ± 15.2 at day 1, 7.8 ± 5.5 at week 1, and 7.1 ± 4.7 at 1 month. In the standard incision group, values were 5.9 ± 4.7, 31.7 ± 18.4, 7.0 ± 5.2, and 6.5 ± 4.5, respectively. No significant intergroup differences were observed at any time point.
Conclusion
Both incision techniques showed a transient postoperative inflammatory increase that normalized within one week, with no significant differences between groups. Microincision ICL implantation demonstrated a comparable inflammatory safety profile to the standard approach.
Presenting Author
Sang Yoon Hyun, MD
Co-Authors
Moonsun Jung (MD, PhD)
Purpose
We investigated the effects of lowering energy levels during Keratorefractive lenticule extraction (KLEx) surgery using the femtosecond laser ATOS (Schwind, Germany) on short-term surgical outcomes and corneal surface smoothness.
Methods
The study included 80 patients (160 eyes) who underwent KLEx surgery for myopia correction using ATOS at our clinic. Patients were divided into three groups based on energy intensity: a Conventional energy group (90nJ, C-group), a Low energy group (80nJ, L-group), and a Very Low energy group (75nJ, VL-group). Uncorrected visual acuity and mean spherical equivalent were compared at 1 day, 1 week, 1 month, and 3 months after surgery. The incidence of opaque bubble layer (OBL) and black areas was compared through intraoperative video analysis. The surface roughness of the extracted corneal lenticules was compared using scanning electron microscopy.
Results
Uncorrected visual acuity (LogMAR) improved across all energy levels, with lower energy levels showing greater improvement:at day 1 (C: 0.17?±?0.18, L: 0.05?±?0.09, VL: 0.00?±?0.09, p?
Conclusion
When performing KLEx surgery with the ATOS device, lowering the treatment dose led to faster early visual recovery and reduced intraoperative OBL occurrence. The smoothest lenticule surface was observed in the low energy group, while the very low energy group showed a tendency toward increased surface roughness.
Presenting Author
Rushad C. Shroff, MS
Co-Authors
Apoorva Agrawal (DNB)
Purpose
To evaluate visual outcomes including post-operative refractive error, corneal higher order aberrations, anterior and posterior corneal curvature changes after Smooth Incision Lenticular Keratomileusis (SILK) in low, moderate and high myopia.
Methods
This prospective interventional study included 110 eyes of 55 patients divided into three groups: low myopia (myopia <3D [diopters] spherical equivalent [SE]), moderate myopia (3D-5D) and high myopia (myopia >5D). The SILK procedure was performed. Pentacam HR (Oculus Optikgeräte, Germany) and Itrace (Tracey Technologies, Houston,USA) were used to measure the corneal asphericity, keratometry and higher order aberrations(HOA's). The Casia 2 Anterior segment OCT (Tomey, Nagoya, Japan) was used to assess changes in anterior and posterior corneal curvature at 3,5 and 7mm zones from center of the cornea 1 and 3 months postoperatively. Refractive outcomes were also studied post operatively.
Results
The total HOA's including spherical aberration did not show significant change after SILK (P=0.65). 95% eyes attained a UDVA of 20/25 or better on day one. 90% eyes were within 1 D of intended correction. There was no significant change in keratometric power in the 3,5 and 7 mm zones of the posterior corneal surface compared with its pre-SILK value in the mild (pre-operative [pre-op] - 6.10 + 0.23, post-operative [post-op] -6.06 + 0.22, P= 0.8) ,moderate (pre-op -6.06 + 0.16, post-op -6.05 +.18, P= 0.58), and high myopia group (pre-op -5.93 + 0.17, post-op -5.92. + 0.15, P=0.53). Asphericity (Q-value) of the posterior surface changed significantly (P <0.05) in all three groups
Conclusion
Lenticule Extraction with the ELITA Platform was found to be accurate, safe and effective. SILK does not induce significant changes in posterior keratometric power in low, moderate and high myopia. The asphericity of the posterior cornea did show a significant change however there was no change in higher order aberrations after the procedure.
Presenting Author
Rushad C. Shroff, MS
Co-Authors
Apoorva Agrawal (DNB)
Purpose
To determine the association between effective optical zone centration as well as its impact on visual outcomes, quality of vision and higher order aberrations (HOA's) in Smooth Incision Lenticular Keratomileusis (SILK) and laser in situ keratomileusis (LASIK).
Methods
Two hundred eyes of 100 patients treated with SILK (100 eyes) and LASIK (100 eyes) were included. The centration of the effective optical zone (EOZ) was evaluated on the tangential curvature difference map between the preoperative and 3-month postoperative scans using a superimposed set of concentric circles. The correlation between optical zone decentration and anterior keratometry values was evaluated. The effect of optical zone decentration on vector components of astigmatic correction and induction of higher-order aberrations (HOA) was assessed. Visual outcomes were also assessed.
Results
The mean decentration distance was 0.21 ± 0.11 mm for SILK and 0.20 ± 0.09 mm for LASIK (p = 0.808). There was a significant correlation between anterior keratometric astigmatism and decentration distance (r = 0.7, p = 0.05) for SILK. Mean EOZ was significantly larger(p=0.001) in the SILK group (5.35 + 0.22) than the LASIK group (4.88 +0.25).The total HOA's and spherical aberration was lower in the SILK group though it wasn't significant. Significant correlation was demonstrated between the decentration distance and the induced coma (SILK: r = 0.56, p = 0.04; LASIK: r = 0.59, p = 0.02). 95 % eyes attained a UDVA of 20/25 or better on day one. 90 % eyes were within 1 D of targeted correction
Conclusion
For the same planned optical zone, the EOZ after treatment was larger in SILK than in LASIK. There was lower induction of HOA's and spherical aberration in the SILK group. Subclinical decentration was associated with induction of coma but not with lower-order astigmatic correction. Both procedures were found to be safe, accurate and effective.
Presenting Author
Sung Min Kim, MD
Purpose
To compare the 6-month clinical outcomes of lenticule extractions performed with the VisuMax 500 (Zeiss, SMILE), VisuMax 800 (Zeiss, SMILE Pro), ELITA (Johnson & Johnson, SILK), Z8 (Ziemer, CLEAR), and ATOS (Schwind, SmartSight).
Methods
This retrospective study analyzed 294 eyes of 148 patients who underwent lenticule extraction using the VisuMax 500 (Zeiss,80 eyes), VisuMax 800 (Zeiss,74 eyes), ELITA (Johnson & Johnson,48 eyes), Z8 (Ziemer,50 eyes), and ATOS (Schwind,42 eyes). Patients with hyperopia or mixed astigmatism, high myopia (>−9.0 D), high astigmatism (>−2.5 D), or preoperative best-corrected visual acuity (BCVA) <20/20 were excluded. Central corneal thickness (CCT), manifest refraction (MR), and higher-order aberrations (HoAs) were measured preoperatively. Uncorrected distance visual acuity (UDVA) and MR were evaluated at 1 week, 1 month, and 6 months postoperatively, while HoAs were assessed at 1 and 6 months.
Results
At 1 day postop, UDVA differed significantly among groups(p<0.05; SMILE, 1.04±0.19; SMILE Pro, 1.14±0.19; CLEAR, 0.94±0.15; SmartSight, 1.00±0.18; SILK, 1.04±0.16). At 1 month, UDVA improved in all groups, with significant differences(p<0.05; SMILE, 1.26±0.20; SMILE Pro, 1.36±0.18; CLEAR, 1.29±0.19; SmartSight, 1.32±0.24; SILK, 1.36±0.16). At 6 months, mean UDVA varied but was not statistically significant(SMILE, 1.29±0.20; SMILE Pro, 1.39±0.19; CLEAR, 1.33±0.18; SmartSight, 1.31±0.18; SILK, 1.39±0.15). Total HoAs were lowest in SILK, spherical aberration was lowest in SmartSight, and vertical coma was reduced in all newer platforms compared with VisuMax 500, with the lowest values in SILK.
Conclusion
All platforms showed favorable long-term visual outcomes, but newer platforms with enhanced functions achieved higher mean acuity than the VisuMax 500. Despite variations in aberrations due to device characteristics and lenticule design, newer platforms consistently outperformed the VisuMax 500, which lacks centration and cyclotorsion correction.
Presenting Author
Emily Y Ye, MD, MS
Co-Authors
Victoria Fernandes (MD), Karolinne Rocha (MD, PhD)
Purpose
We aimed to evaluate whether changes in higher-order aberrations (HOAs) and refractive outcomes differ between high and low myopes post-operatively.
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. Patients were categorized into high myopes (? - 6.0 D) and low myopes (<-6.0 D). Horizontal corneal white to white (WTW) diameter for each eye was assessed using Scheimpflug tomography, swept-source OCT-based biometer (IOL master 700), and digital calipers. Post-operative vault size was evaluated using anterior segment optical coherence tomography. HOAs were measured using a combined Scheimpflug and Hartman-Shack device (PentacamWave). Statistical analysis was performed using SPSS.
Results
Low myopes went from −4.4 ± 0.8 D to +0.01 ± 0.19 D postoperatively, and high myopes −8.0 ± 1.2 D to -0.11 ± 0.43 D postoperatively. At a 5-mm pupil, both low and high myopes showed minimal changes in total HOAs (0.195±0.059 to 0.200±0.045 µm, p=0.79; 0. 227±0.057 to 0.254±0.068, p=0.24), SA (0.098±0.026 to 0.084±0.036 µm, p=0.09; 0.136±0.049 to 0.120±0.039, p=0.06), and coma (0.104±0.038 to 0.102±0.041 µm, p = 0.90; 0.108±0.054 to 0.147±0.068, p=0.09). Post-operative total HOAs (p=0.026) and SA (p=0.04) were higher in high myopes vs. low myopes. While there was higher post-operative coma in high myopes vs. low myopes, it was not significant (p=0.09).
Conclusion
ICL implantation provides excellent refractive outcomes in both low and high myopes. While there were higher total HOAs and spherical aberration in higher myopes post-operatively, our study showed that there was no statistical difference in higher order aberrations before and after ICL implantation in both high and low myopes.
Presenting Author
Karl G. Stonecipher, MD
Purpose
To assess visual outcomes and patient subjective outcomes in normal and dim lighting after wavelight plus LASIK.
Methods
This single site, single-arm, prospective, observational study assessed visual outcomes and patient subjective outcomes after successful bilateral wavelight plus LASIK surgery. A total of 100 eyes of 50 subjects at one site were targeted, and subjects were assessed 3 months post-operatively. Clinical evaluations included measurement of photopic and mesopic visual acuities, manifest refraction, and administration of a questionnaire containing selected and modified items from patient reported outcomes with LASIK (PROWL) questionnaire and low luminance questionnaire (LLQ-32).
Results
To date, 16 subjects (32 eyes) have completed the 3-month postoperative visit. At 3 months postoperative, mean binocular UDVA was -0.18 ± 0.09 logMAR under photopic conditions, and -0.17 ± 0.07 logMAR under mesopic conditions. In addition, 75% and 69% of subjects had UDVA 20/12.5 or better under photopic and mesopic conditions, respectively. On the questionnaire,100% of subjects were “Completely” or “Very” satisfied overall and 100% were under dim lighting conditions. Also on the questionnaire, 100% of subjects indicated they would have LASIK again and 100% of subjects would recommend LASIK to a friend or family member.
Conclusion
The WL+ laser creates ablations to create a 3 D eye model. The Sitemap acquires data and an ablation is created to compensate for laser ablation efficiency, epithelial remodeling, and biomechanical influence. Interim results suggest excellent visual outcomes under both photopic and mesopic conditions and high patient satisfaction with WL+ LASIK.
Presenting Author
Amulya G. Punati, MBBS, MS
Co-Authors
Naren Shetty (MS, PhD), Harsha Nagaraj (MS), Sneha Gupta (MBBS, MS)
Purpose
To evaluate the overall visual quality and determine the percentage of patients achieving better than 20/20 vision following customised LASIK ablation planning aimed at enhancing visual and optical outcomes.
Methods
Prospective interventional study of 50 patients (100 eyes) with myopia ? -6.0 D and astigmatism ? -4.0 D undergoing LASIK on the Wavelight EX500 using InnovEyes customized profiles. Pre-op diagnostics included wavefront, corneal tomography, and biometry via Sitemap. Outcomes assessed: UDVA, CDVA, HOAs, contrast sensitivity (Pelli-Robson), optical quality (I-Trace), defocus curve and epithelial mapping. Follow-up: day 1, 1 month, 3 months.
Results
At 3 months, 92% of eyes achieved UDVA ? 20/20, 58% ? 20/16. Mean CDVA improved by ? 1 Snellen line. Total HOAs reduced significantly (p < 0.01), with notable decrease in spherical aberration. Contrast sensitivity improved across all spatial frequencies. Defocus curves indicated superior depth of focus.
Conclusion
InnovEyes-guided ray-tracing LASIK demonstrated excellent refractive predictability, enhanced contrast sensitivity with 58% of patients achieving visual acuity better than 20/20, confirming its safety and efficacy in personalized laser vision correction.
Presenting Author
Daniil A. Myagkov, MD
Purpose
To assess the 12-month effect of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses on myopia progression in children and adolescents, focusing on axial length and spherical equivalent changes in real-world practice and analyzing differences by baseline myopia severity.
Methods
Prospective observational study including 63 children (7–14 years) with myopia −0.50 to −6.00 D. Exclusion: astigmatism >1.5 D, amblyopia, ocular pathology, prior therapy affecting eye growth. Full correction with DIMS lenses was prescribed; wear time ≥12 h/day and ≥90 min/day outdoors were recommended. Measurements: AL (optical biometry) and cycloplegic SE at baseline and 12 months. Statistics: Shapiro–Wilk, paired t-test or Wilcoxon, Pearson correlation (p<0.05). Stratification: mild (n=43) and moderate myopia (n=20).
Results
Overall, AL increased by 0.16 ± 0.06 mm and SE by 0.31 ± 0.08 D (both p<0.001). Mild myopia: AL +0.16 ± 0.06 mm; SE +0.26 ± 0.09 D; moderate ΔAL–ΔSE correlation (r=0.372; p=0.0276). Moderate myopia: AL +0.19 ± 0.17 mm; SE +0.41 ± 0.15 D; no significant correlation (r=0.108; p=0.537). Tolerance was good; discontinuation in 28.6% was due to switching to defocus contact lenses or orthokeratology for greater daytime freedom (e.g., sports). No adverse events requiring cessation were recorded. Findings align with international evidence.
Conclusion
DIMS lenses slowed myopia progression over 12 months, showing lower axial elongation and SE shift compared with expected natural course. The effect was more evident in mild myopia, where AL–SE correlation persisted, underscoring the value of stratified and individualized management in pediatric myopia control.
Presenting Author
Ants Haavel, MD
Purpose
To assess whether extended bandage contact lens wear (6–7 days) after surface ablation reduces epithelial-related complications and postoperative haze compared with early lens removal (3–5 days), and to explore the underlying mechanisms of epithelial protection and controlled stromal oxygen exposure.
Methods
Prospective, comparative cohort study including consecutive surface ablation patients randomized to early (3–5 d) vs extended (6–7 d) bandage contact lens removal. Standardized excimer protocols were applied. Outcomes: epithelial healing, erosions, comfort scores, uncorrected visual acuity (UCVA) recovery, haze grading (Fantes scale) at 1, 3, and 6 mo. Mechanistic analysis examined whether prolonged epithelial coverage reduced eyelid-shear stress and moderated subepithelial oxygen tension, a factor implicated in keratocyte activation and haze induction.
Results
Preliminary data: 400 eyes (200 per group). Extended removal was associated with fewer epithelial erosions (1% vs 7%), lower 3-mo haze ≥grade 1 (2% vs 6%), higher comfort scores at 1 wk, and faster UCVA recovery (20/25 median by day 10 vs day 14). No significant differences in infection or delayed healing rates were observed. Statistical significance confirmed for all primary endpoints (p<0.05).
Conclusion
Extended bandage contact lens wear (6–7 d) after surface ablation improved epithelial integrity, reduced haze risk, and accelerated functional visual recovery compared with early removal. Prolonged epithelial protection and optimized stromal oxygen exposure may explain the benefit. Findings support revising postoperative protocols.
Presenting Author
Hady Yazbeck, MD
Co-Authors
Jad Assaf (MD), Shady Awwad (MD), Karen Asfar (MD)
Purpose
To introduce the Homogeneity score (H-score), an objective, quantitative measurement of lenticule interface homogeneity in keratorefractive lenticule extraction (KLEx), and correlate it with post-operative corrected distance visual acuity (CDVA) and Micro-Aberrations Scattering Index (MASI).
Methods
We retrospectively analyzed 246 eyes from 126 patients who underwent KLEx. Retroillumination images were captured pre- and post-operatively with a pyramidal aberrometer (PERAMIS, PERAMIS, Schwind Total Tech Solutions). Using Gray Level Co-occurrence Matrix (GLCM) texture analysis, H-scores were computed from those images to quantify interface homogeneity, with higher scores indicating a more homogenous interface. Linear regression was used to assess the correlation between changes in H-Score and changes in CDVA (logMAR) and MASI from baseline to postoperative day one (?HS_d1, ?CDVA_d1, ?MASI_d1) and to postoperative week one (?HS_w1, ?CDVA_w1, ?MASI_w1).
Results
Means±Standard deviations (SD) are reported with p-values relative to pre-operative baseline. At post-operative day one, the H-Score deteriorated from 0.83±0.02 pre-operatively to 0.74±0.04, CDVA from -0.02±0.05 to 0.07±0.18, and MASI from 15.31±5.84 to 28.19±8.99 (all P<0.001). ?HS_d1 was negatively correlated with both ?CDVA_d1 (Pearson r = -0.29, P<0.001), and ?MASI_d1 (Pearson r = -0.41, P=0.008). At post-operative week one, the H-Score improved to 0.77±0.03, CDVA to 0.02±0.14, and MASI to 25.21±9.09 (all P<0.001). ?HS_w1 was negatively correlated with both ?CDVA_w1 (Pearson r = -0.20, P=0.01) and ?MASI_w1 (Pearson r = -0.51, P<0.001).
Conclusion
The H-Score significantly correlates with visual outcomes at post-operative day one and week one, as measured by CDVA and MASI. The H-score may serve as a clinically objective endpoint to assess lenticule interface and post-operative vision quality following KLEx.
Presenting Author
Rafah Fairaq, MD
Co-Authors
Halah Bin Helayel (MBBS), Mohammed Almutlak (MD)
Purpose
To evaluate patient-reported outcomes and satisfaction in myopic patients undergoing a hybrid approach for anisometropia, with implantable collamer lens in one eye and laser vision correction in the fellow eye, assessing its impact on visual function, patient experience, and perceived benefit.
Methods
This prospective study with retrospective data included 15 patients (30 eyes) aged ?18 years who underwent a hybrid procedure, with implantable collamer lens implantation in one eye and laser vision correction in the fellow eye, between June 2014 and November 2022. Exclusion criteria were pregnancy, age <18 years, keratoconus, prior keratoplasty, post-LASIK ectasia, and amblyopia. Comprehensive ophthalmic evaluation included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, and keratometry. Patient-reported outcomes were assessed using the validated Arabic NEI RQL-42 ?2 months postoperatively. Statistical analysis used the Mann-Whitney U test (p<0.05).
Results
Fifteen patients (30 eyes) underwent hybrid correction with ICL in one eye and LVC in the fellow eye. Mean baseline anisometropia was 5.57 D (±2.82). Preoperative SE was -9.82 D (±2.57) in ICL eyes and -4.07 D (±1.11) in LVC eyes (p<0.001). UCVA was worse in ICL eyes (1.38±0.22 vs 0.77±0.30 logMAR, p<0.001), with slightly lower BCVA (0.14±0.16 vs 0.03±0.07, p=0.021). At final follow-up, both groups achieved comparable outcomes with mean SE -0.46 D and UCVA 0.13 logMAR. Patient-reported outcomes demonstrated high NEI RQL-42 scores for clarity, near and far vision, and satisfaction, with lower scores for expectations and appearance.
Conclusion
The hybrid ICL-LVC approach demonstrated stable refractive outcomes, improved visual performance, and high patient-reported satisfaction in anisometropia. This technique may offer a clinically effective, cost-efficient alternative, although larger studies with baseline patient-reported outcomes are warranted.
Presenting Author
Yazeed Alhaqbani, MD
Co-Authors
Fatimah Alzaher (MD), Mohammed Aljasir (MBBS), Almoayad Makrami (MD), Khalid Alanazi (MD), Abdulaziz Alsomali (MD)
Purpose
To evaluate the long-term efficacy and safety of Toric Implantable Collamer Lens (TICL) V4c implantation for correcting high residual ametropia after penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK).
Methods
A retrospective cohort study of 41 phakic eyes (36 patients) implanted with TICL V4c following keratoplasty (26 DALK, 15 PKP) at a tertiary center. Outcomes included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refractive error, intraocular pressure (IOP), safety index, efficacy index, and complications over a 7-year follow-up period.
Results
UDVA improved from 0.98 ± 0.41 logMAR preoperatively to 0.19 ± 0.18 at 6 months (p<0.001) and remained 0.37 ± 0.16 at 6-7 years. Cylinder decreased from ?4.15 ± 1.65 D to ?1.25 ± 1.54 D at 6 months (p<0.001), regressing to ?2.52 ± 1.86 D at 6-7 years. SE improved from ?7.66 ± 4.35 D to ?0.58 ± 0.98 D at 6 months and 1.14 ± 1.45 D at 6-7 years (p<0.001). Postoperatively, 59.4% and 68.8% of eyes were within ±0.50 D and ±1.00 D of target SE. Vector analysis showed residual J0 and J45 not different from zero (p>0.05). Safety and efficacy indices were 1.37 and 1.32; IOP stable (p=0.009); no graft failures.
Conclusion
TICL V4c implantation provides effective, predictable, and safe correction of post-keratoplasty ametropia over a 7-year period, with sustained visual improvement and minimal complications. It represents a viable alternative for patients with intolerance to hard contact lenses or those unsuitable for corneal refractive surgery.
Presenting Author
David Sung Yong Kang, MD
Co-Authors
Tae-im Kim (MD, PhD), Byunghoon Chung (MD), Kangyoon Kim (MD), Samuel Arba Mosquera (PhD)
Purpose
To compare corneal higher-order aberrations (HOAs) in pupil centered and vertex centered measurements and their correlation with visual outcomes.
Methods
Total of 300 patients (600 eyes) who had undergone Keratorefractive lenticule extraction treatment. Based on the the preoperative pupil o?set all patients were divided into two groups: group I (pupil o?set ? 0.20 mm) and group II (pupil o?set > 0.40 mm). All of the eyes had low to high myopia with or without astigmatism. Uncorrected distance visual acuity, corrected distance visual acuity, MRSE, pupil o?set, corneal HOAs and Strehl ratio were measured and compared.
Results
At 6 months postoperatively, mean uncorrected distance visual acuity (UDVA) was ?0.01±0.06 in Group I and 0.02±0.05 in Group II. The average pupil offset was 0.18±0.12 in Group I and 0.42±0.18 in Group II. In Group II (significant pupil offset), there were marked differences in aberrations when measured at different reference points. Total HOAs were 0.59±0.18 at the vertex center versus 0.72±0.15 at the pupil center. Similarly, coma was 0.32±0.15 vs. 0.58±0.17, and spherical aberrations were 0.16±0.13 vs. 0.32±0.14. Overall, the correlation between visual outcomes and corneal aberrations was stronger when aberrations were measured at the corneal vertex center compared to the pupil center.
Conclusion
For patients with a significant pupil offset, corneal aberrations measured at the corneal vertex center better predict visual outcomes than those measured at the pupil center. This suggests that the corneal vertex is a more effective reference point for evaluating visual quality after keratorefractive surgery.
Presenting Author
David Smadja, MD
Co-Authors
Michael Mimouni (MD), Nir Sorkin (MD), Eliya Levinger (MD), Shmuel Levinger (MD), Irit Bahar (MD, MHA), Itay Lavy (MD), Sara Sella (MD)
Purpose
To compare visual and refractive efficacy and safety of PRK versus femtosecond LASIK in a nationwide cohort of 18,706 myopic or myopic-astigmatic eyes.
Methods
Multicenter national registry of consecutive primary laser vision corrections for myopia and/or myopic astigmatism. Preoperative, 1,3,6 and 12-month outcomes were collected: Uncorrected Distance visual Acuity, Corrected Distance Visual Acuity, manifest refraction (MRSE), efficacy and safety indices. Adverse events such as ectasia, epithelial-related events, flap-related events, stromal haze, and loss of ?2 lines CDVA were collected and compared between both groups. Comparative analyses used multivariable adjustment and propensity-score matching for baseline age, MRSE, Corneal thickness, Keratometry, and residual stromal bed; significance at p<0.05.
Results
The PRK cohort was significantly younger (25.6 vs 32.1 years) and more myopic (-4.55D vs -2.65D) than the FS-LASIK group (P < 0.001). FS-LASIK demonstrated superior early efficacy, with 88.5% of eyes achieving an MRSE within ±0.50D vs. 78.5% for PRK, P < 0.001, and 66.6% achieving UDVA 20/20 or better (vs. 46.2% for PRK, P < 0.001) (Table 1). Regarding safety, significantly more PRK eyes experienced vision loss (≥2 lines CDVA) with 0.32% in FS-LASIK and 0.48% in PRK (P = 0.005). The overall rate of adverse events was significantly lower in the FS-LASIK, 1.13% than in PRK eyes, 2.23% (p <0.001).
Conclusion
An epithelial ablation factor based on experimentally measured epithelial ablation rates enabled individualized adjustment during transPRK. Accounting for a 21% lower effective epithelial ablation enables high refractive accuracy. At 12 months, outcomes showed high predictability, excellent visual acuity, and high safety profile.
