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Moderator
Kavitha R. Sivaraman, MD, ABO
Panelists
John F. Doane, MD, ABO; Denise Visco, MD, MBA, 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
Jiwon Jeong, MD
Purpose
To analyze the effect of laser parameter change to visual outcome in Visumax 800 KLEX surgery
Methods
This single center prospective randomized study was done in Fatima Eye Clinic at South Korea. Total 425 patients and 850 eyes were enrolled(all participants signed informed consent). KLEX procedure were done as usual manner. Laser Spot/Track distance were divided three group ( 4.3/3.0, 4.0/3.0, 3.7/3.0 ) and laser energy were also divided four group ( 85, 100, 115, 130nJ ) in each laser distance group. Visual acuity, refractive error, Objective scatter index (OSI, HD analyzer) were measured at preop, postop.1day, 1month, 3month. High order aberration also measured at postop. 1month, 3month.
Results
UDVA was very good in every group and there are no statistic differences. Refractive outcome were mre undercorrected in low energy group, and long spot/track distance group. However visual quality measured by OSI were better in lower energy group and longer spot/track distance group.
Conclusion
Energy level and spot/track distance influence to early visual recovery after KLEX operation. Low energy have better results than high energy setting. Also Longer spot/track distance have better results than short distance setting. However there are some possible variability on each devices. Cautions will be applied to using parameter change.
Presenting Author
Tulika Chauhan, MD, FRCOphth
Co-Authors
Garvita Dabas (MBBS, MS), Surveen Arneja (MBBS, MS), Akanksha Koul (MBBS, DNB)
Purpose
To compare visual and anatomical outcomes of Topography-Guided Custom Ablation Treatment (TCAT) and Topography-Guided Removal of Epithelium in Keratoconus (TREK) performed in eyes with different stages of keratoconus.
Methods
This prospective interventional series included 20 eyes of 20 patients with keratoconus. Ten eyes with mild to moderate keratoconus (Amsler-Krumeich stages I-II, thinnest pachymetry >430 µm) underwent TCAT followed by corneal cross-linking (CXL). Ten eyes with advanced keratoconus (stages III-IV, thinnest pachymetry <430 µm) underwent TREK (topography-guided epithelial removal with minimal or no stromal ablation) followed by accelerated CXL. Pre- and postoperative assessment included uncorrected and best-corrected visual acuity (UCVA, BCVA), manifest refraction, keratometry, and corneal topography at baseline, 1 month and 3 months.
Results
Both groups showed significant improvement in corneal regularity and visual function. Mean BCVA and mean maximum keratometry improved in both the groups. No sight-threatening complications, persistent haze, or progressive ectasia were observed during follow-up.
Conclusion
TCAT combined with CXL provides effective visual and topographic improvement in mild to moderate keratoconus, while TREK with CXL is a safe, tissue-sparing option in advanced disease where stromal ablation is contraindicated. Both approaches expand the surgical armamentarium for stage-appropriate keratoconus management.
Presenting Author
Mar�a Jos� Cosentino, MD
Co-Authors
Daniel Badoza (MD)
Purpose
To evaluate the long-term safety and effectiveness of photorefractive keratectomy (PRK) with excimer laser in corneas suspected of keratoconus.
Methods
Eighty-two eyes of patients with suspected keratoconus (44% female, 56% male) were analyzed. All underwent photorefractive keratectomy (PRK) with these excimer lasers: Technolas 217z (Bausch & Lomb, Rochester, NY, USA) and WaveLight EX500 (Alcon, Fort Worth, TX, USA). Mean follow-up was 16.5 ± 5.9 years, with a maximum of 23 years. The mean age of patients at surgery was 35.0 ± 3.1 years. Corneal topographies were obtained with Orbscan II (Bausch & Lomb, Rochester, NY, USA). Exclusion criteria included keratometry over 50 D, age under 32 years, and residual pachymetry less than 480 microns.
Results
Preoperatively, mean spherical equivalent (SE) was ?3.77 ± 1.17 D, cylinder ?1.43 ± 0.44 D, and best spectacle-corrected visual acuity (BSCVA) 0.82 ± 0.17. At the last follow-up visit, mean SE was ?0.46 ± 0.45 D, cylinder ?0.43 ± 0.37 D, and BSCVA 0.85 ± 0.23. Postoperative uncorrected visual acuity averaged 0.78 ± 0.14. Refraction remained stable throughout follow-up. We also analyzed gained and lost lines of BSCVA and keratometric evolution.
Conclusion
PRK with excimer laser in corneas suspected of keratoconus appears to be a safe and effective procedure, providing stable visual and refractive outcomes over very long-term follow-up (up to 23 years).
Presenting Author
David S. Oh, MD
Co-Authors
Sarah Rahman (MD), Kevin Everett (MD)
Purpose
What is the rate of lens exchange in patients with extended depth of focus Vivity intraocular lenses?
Methods
We conducted a retrospective chart review of patients who underwent implantation of a Vivity or Vivity Toric intraocular lens by a single surgeon at one institution from September 2020 through July 2024. We included eyes that had a history of any prior refractive or phototherapeutic surgery such as radial keratotomy, LASIK, PRK, or PTK. A total of 197 eyes were included, 147 of which did not have any prior refractive or phototherapeutic surgery. Primary outcome was lens exchange at any time in the postoperative period.
Results
1/197 eyes underwent lens exchange, yielding an overall rate of lens exchange of 0.51%. The rate of lens exchange in patients without prior refractive or phototherapeutic surgery was 0.68%, and the rate in patients with prior refractive or phototherapeutic surgery was 0% (p-value=0.556).
Conclusion
We find that the overall rate of lens exchange for Vivity or Vivity Toric intraocular lenses is less than 1%, and there is no statistically significant difference in lens exchange rates if a patient has had prior refractive or phototherapeutic surgery.
Presenting Author
Shima Dehghani, MD
Co-Authors
Mark Mifflin (MD), Daniel Savage (MD, PhD)
Purpose
Posthyperopic LASIK eyes pose challenges in IOL power calculation. Corneal spherical aberration (Z40), which decreases after hyperopic LASIK, may affect formula accuracy, yet its effect remains underexplored. This study aimed to assess the effect of corneal spherical aberration (Z40) on IOL power calculation accuracy in post-hyperopic LASIK eyes.
Methods
Retrospective study including 9 posthyperopic LASIK eyes(6 patients) that underwent phacoemulsification with implantation of SA60AT(Alcon) or MX60E(Bausch&Lomb) IOLs.Target refractions for each formula were calculated using 1month postoperative manifest refractions and the implanted IOL powers.Formulas used were Barrett Universal II, Cooke K6, EVO, Hill-RBF, Hoffer QST, Kane,and Pearl DGS with standard keratometry, and Barrett True-K and EVO with total keratometry (TK).Mean prediction error(MPE) and proportion of eyes (P) within ±0.50 D of target refraction were calculated for each formula.Pearson correlation assessed the effect of Z40 (-0.188 to 0.322 ?m, 6-mm pupil) on predictive accuracy.
Results
The formulas most and least impacted by Z40 were Hoffer QST (r = 0.563) and EVO TK (r = 0.072), respectively. EVO TK also showed high accuracy (MPE = 0.07 D; P = 0.56).
Conclusion
Overall, EVO TK was largely invariant to Z40 while having high accuracy, supporting its use for improved refractive outcomes.
Presenting Author
Shima Dehghani, MD
Co-Authors
Mark Mifflin (MD), Daniel Savage (MD, PhD)
Purpose
Intraocular lens(IOL)power calculations are less precise in post-hyperopic LASIK eyes compared to post-myopic LASIK eyes.Current literature favors Barrett True-K.However,reported outcomes vary widely between studies and formulae.This study assesses the accuracy of modern power calculation formulae in post-hyperopic LASIK eyes.
Methods
A retrospective study included 9 post-hyperopic LASIK eyes(6 patients)undergoing uncomplicated phacoemulsification with IOL implantation (SA60AT,Alcon;or MX60E,Bausch & Lomb).Manifest refraction was recorded at 1-month.IOL power was retrospectively calculated using Barrett Universal II,Cooke K6,EVO,Hill-RBF, Hoffer QST,Kane,and Pearl DGS with IOLMaster 700(Zeiss) standard keratometry. Barrett True-K and EVO with total keratometry(TK) were also applied (https://iolcalculator.escrs.org/).Mean prediction error (MPE), mean absolute error (MAE), and proportions within ±0.25 to ±1.00 D of target were calculated for each formula based on implanted IOLs. Proportions were compared with McNemar test.
Results
All formulae tended toward myopic refractions. Formulae utilizing TK were found to have the highest proportion of eyes within ±0.25?D, with 0.33 for Barrett True-K TK and 0.22 for EVO TK. Due to the small sample size, no statistically significant differences were found between any of the formulae within ±0.25?D of the target, but Barrett True-K TK and EVO TK trended toward significance. Of note, only Kane and Cooke K6 had all eyes within ±1.00?D of the target.
Conclusion
The Barrett True-K formula with TK gave most precise refractive outcomes for post-hyperopic LASIK eyes.This finding is consistent with prior studies [Savage 2023].However,even using Barrett True-K TK,cataract surgeons should expect to have a relatively high variability of refractive outcomes tending toward myopia in post-hyperopic LASIK eyes.
Presenting Author
Jiwon Jeong, MD
Purpose
To evaluate the biomechanical effects of Small Incision Lenticule Extraction (SMILE) with and without corneal cross-linking (CXL) on corneal stiffness, using the Brillouin Optical Scanning System (BOSS) to assess localized changes in Brillouin modulus (BM).
Methods
This retrospective study analyzed 358 eyes (321 SMILE, 37 SMILE+CXL) from 180 patients, including unilateral and bilateral cases. Propensity score matching (PSM) balanced baseline characteristics using 10 variables (age, gender, ...), resulting in matched cohorts of 17 eyes each. BOSS measured BM( GPa) at 10 points preoperatively and at 1 and 3 months postoperatively. After PSM, BM values and changes (ΔBM, pre- to post-operative changes) were compared, including point-specific analyses, as well as mean, minimum, and maximum metrics. Changes were further grouped into categories based on ΔBM patterns .
Results
Preoperative BM values were stable and comparable between groups. Post-SMILE, overall decreases in stiffness were observed (ΔBM -0.034 GPa at 1 month, -0.024 GPa at 3 months), with partial recovery by 3 months but most values remaining below baseline levels, though BM4 and BM9 naturally recovered (ΔBM≥0 at 3 months). In contrast, SMILE+CXL preserved or enhanced stiffness in all 10 BM positions (mean ΔBM +0.002 GPa at 1 month, +0.004 GPa at 3 months). Pattern-based zone analysis identified four distinct categories: naturally recovered zone (2) resistant but vulnerable zone (3) strong effective zone (4) less effective zone
Conclusion
KLEX surgery with Modified epi-on crosslinking have good refractive results and promising biomechanical stability.
Presenting Author
Purendra Bhasin, MS
Purpose
Our case series reports the outcomes of phakic ICL implantation with monovision in early presbyopic myopes. We included 20 eyes of 10 patients (range –3.5 to –19.5 D) and evaluated binocular visual performance along with patient satisfaction.
Methods
The patients had a mean age of 46 years (40–52 years), with 4 males and 6 females. Follow-up ranged from 6 months to 3 years (average 14 months). In each case, the non-dominant eye was intentionally undercorrected by 1–1.75 D to provide useful near and intermediate vision. One patient required ICL re-dialing, but no other intra- or postoperative complications were noted.
Results
At 1 month post-op, binocular uncorrected distance visual acuity was 6/9 to 6/6, and near vision was N6–N8. Four patients required near glasses for fine print. All reported good satisfaction.
Conclusion
Phakic ICL with monovision is a safe and effective option for early presbyopic myopes seeking spectacle independence. Undercorrecting the non-dominant eye maintains both near and distance vision, offering a practical balance and a strong alternative to corneal laser procedures.
Presenting Author
Madhuvanthi Mohan, MS
Co-Authors
Sujatha Mohan (FRCS)
Purpose
To describe the demographics, refractive outcomes, and visual results of phakic intraocular lens (IOL) implantation performed at a tertiary eye care centre over an 18-month period.
Methods
A retrospective observational study was performed of all patients undergoing phakic IOL surgery between February 2024 and September 2025. Data collected included number of procedures, laterality, lens type (spherical vs toric), and trends in procedure volume over time. Outcome measures included pre- and postoperative refractive error (spherical equivalent, cylinder) and uncorrected/best-corrected distance visual acuity (UDVA/BCVA). Safety events such as lens explantation, infection, or endothelial complications were also noted.
Results
A total of 96 phakic IOL procedures were performed. Both spherical and toric phakic IOLs were implanted, with toric lenses accounting for a significant subset. At 3 months, the majority of patients achieved UDVA of 6/9 or better, with a high rate of refractive predictability (±0.50 D of target in most cases). Cylinder reduction was greater in the toric IOL group. No sight-threatening complications were observed; one explantation was documented. The majority of procedures were routine and uneventful.
Conclusion
Phakic IOL implantation is a safe and effective option for correction of high myopia, providing excellent refractive accuracy and visual outcomes. This observational study highlights increasing uptake of the procedure in an Indian tertiary center, with good safety and high patient satisfaction.
Presenting Author
Elise L Ma, MD, PhD
Co-Authors
Kevin Miller (MD)
Purpose
To evaluate the change in effective lens power following implantation of a HumanOptics artificial iris by passive sulcus fixation in pseudophakic patients.
Methods
We retrospectively analyzed pseudophakic patients who underwent artificial iris implantation by passive sulcus fixation. Preoperative and postoperative manifest refractions were recorded, and spherical equivalents (SE) were calculated using the standard formula (sphere + � cylinder). Paired comparisons were performed to assess change in SE. The primary outcome was mean difference in SE before and after artificial iris implantation. Statistical significance was evaluated using a one-sample t-test with significance set at p < 0.05.
Results
Twelve pseudophakic eyes were included. The mean change in SE was 0.98 ± 0.29 D (SE), with a 95% CI of 0.34 to 1.62 D. The direction of change reflected a consistent hyperopic shift. A one-sample t-test demonstrated that this change was statistically significant (t(11) = 3.37, p = 0.006).
Conclusion
Artificial iris implantation by passive sulcus fixation in pseudophakic eyes results in significant hyperopic shift. These findings highlight the importance of accounting for refractive change when counseling patients and planning combined procedures.
Presenting Author
Rohit Shetty, FRCS
Co-Authors
Pooja Khamar (MD, PhD), Swaminathan Sethu (PhD), Nimisha Kumar (MSc, PhD), Arkasubhra Ghosh (PhD)
Purpose
To compare ultraviolet (UV-FS) and infrared (IR-FS) femtosecond laser platforms in KLEx surgery, focusing on molecular wound healing, ocular surface inflammation, immune response, corneal nerve recovery, and clinical visual outcomes.
Methods
Prospective, randomized, contralateral-eye trial in 19 patients (38 eyes) undergoing KLEx for myopia. One eye was treated with UV-FS, the fellow with IR-FS. Analyses included lenticule gene expression (wound healing, apoptosis, ECM remodeling), tear cytokine multiplex (8 markers), ocular wash immune phenotyping (9 subsets), and in vivo confocal microscopy (nerve and keratocyte parameters). Standard clinical exams included slit-lamp, visual acuity (UCVA/CDVA), refraction, and tomography at baseline, 1 week, 1 month, 3 months, and 6 months.
Results
Thirty-eight eyes completed 6 months. UV-FS lenticules showed higher MMP9/TIMP1 ratio (P=0.04) and lower Lumican (P=0.02), suggesting active remodeling. Tear cytokines and immune cell subsets showed no group differences across visits. IVCM showed early nerve loss in both groups, with less reduction in UV-FS eyes (CNFD P<0.001, CNFL P=0.02, CNBD P=0.003). By 6 months, UDVA ?20/25 in 100% of eyes; ?20/20 in 100% IR-FS vs 63% UV-FS. MRSE within ±0.50 D: 96% IR-FS vs 68% UV-FS.
Conclusion
Both lasers achieved safe, effective KLEx with similar inflammation and immune responses. UV-FS promoted more favorable nerve preservation and molecular remodeling, while IR-FS yielded greater refractive accuracy. Laser choice may be tailored to balance nerve recovery and precision.
Presenting Author
Tsung-Hsien Tsai, MD, MPH
Purpose
To investigate the impact of preoperative anterior topographic parameters on the morphology of postoperative effective optical zone (EOZ) in patients undergoing keratorefractive lenticule extraction (KLEx) and wavefrontguided LASIK (WG-LASIK) surgeries.
Methods
This retrospective study included 310 eyes from patients who underwent KLEx with small incision lenticule extraction (171 eyes) or WG-LASIK (139 eyes). Patients were stratified into subgroups based on median values of spherical equivalent (SE) and anterior topographic parameters. Postoperative EOZ parameters were measured one month after surgery and compared between subgroups. Correlation and multivariable regression analysis were performed to explore the correlations between preoperative anterior topographic parameters and EOZ parameters.
Results
In the KLEx cohort, multivariable regression showed that SE (β=0.027, 95% CI: 0.022–0.032, p<0.001), mean keratometry (Km; β=0.009, 95% CI: 0.002–0.016, p=0.014), and anterior corneal astigmatism (β=0.031, 95% CI: 0.013–0.049, p<0.001) were significant predictors of the postoperative optical-zone reduction ratio (RR = EOZ / planned optical zone × 100%; R²=0.456, p<0.001). In the WG-LASIK cohort, SE (β=0.015, 95% CI: 0.007–0.023, p<0.001) and anterior corneal astigmatism (β=0.029, 95% CI: 0.012–0.047, p=0.001) were identified as independent predictors of RR (R²=0.121, p<0.001).
Conclusion
Preoperative anterior topographic parameters, especially anterior corneal astigmatism, significantly influence postoperative EOZ morphology in both KLEx and WG-LASIK. Km is an additional predictor of EOZ reduction in KLEx surgery.
Presenting Author
Julian D. Stevens, FRCS, FRCOphth, DO, BM BCh
Purpose
To develop a simple, accurate and repeatable technique at the slit-lamp to measure the vault of a Visian ICL phakic lens implant with a CentraFlow hole at the centre of the lens optic.
Methods
The slit-lamp beam is moved horizontally so that the inner rim of the shadow seen on the anterior surface of the crystalline lens is coincident with the rim of the ICL central hole. The shadow is then displaced exactly 0.36mm and the vault is easily calculated using the formula: Vault = 0.36mm×tan(angle of the slit-lamp beam) The vault of 100 consecutive eyes with ICL implants were measured with this shadow displacement technique and then anterior segment OCT was performed and vault measured. The vault at the slit-lamp was then compared to the OCT measurement.
Results
100 consecutive eyes were assessed by slit-lamp (SL) and OCT and the vault range by SL ranged from 83 to 989 µm and by OCT from 90 to 1,095 µm. The mean vault by SL was 337 µm and by OCT was 383 µm. The mean difference between methods was 46 µm with standard deviation of 34 µm. Low vaults <250 µm measured by OCT had a mean error of 36 µm and higher vaults >400 µm had a mean error of 62 µm.
Conclusion
This simple slit-lamp technique which is performed within a few seconds enables accurate and repeatable ICL vault measurement without requiring time consuming and often unavailable anterior segment OCT. It enables rapid assessment of ICL vault per-op using a portable slit-lamp or microscope slit-beam and post-op in the clinic.
Presenting Author
Ivan Gabric, MD
Co-Authors
Samuel Arba Mosquera (PhD)
Purpose
This study analyzed 115 eyes to assess how femtosecond laser dose (mJ/cm�) and pulse energy (nJ) influence uncorrected distance visual acuity (UDVA) at POD1 and one month. We examined whether "low" settings yield superior early vision and if such benefits persist or diminish by one month.
Methods
Laser settings and clinical outcomes were retrospectively analyzed. Dose thresholds of approximately 333-666mJ/cm� were compared against higher doses, and pulse energy cutoffs around 78-85nJ were similarly evaluated. Mean UDVA outcomes at POD1 and one month were assessed using t-tests, F-tests, chi-square, and effect size estimates (Cohen's d). Dose and pulse energy were examined for correlation with treatment date to account for any learning-curve effects.
Results
At POD1, lower-dose treatments (e.g., below 555mJ/cm�) and lower pulse energies (e.g., below 78nJ) correlated with significantly better UDVA, as confirmed by multiple statistical tests (p<0.05). Differences were especially pronounced for certain intermediate dose ranges, with negative effect sizes indicating a clear advantage for "low" settings. By one month, most UDVA disparities disappeared, although doses below ~380mJ/cm� continued to show modestly better results. Dose showed a stronger and more consistent impact than pulse energy.
Conclusion
Lower femtosecond laser doses and energies improved early UDVA, especially at POD1, but benefits faded by one month. Dose showed the strongest effect, though both trended favorably when reduced. As dose/energy correlated with treatment date, learning-curve effects cannot be excluded. Optimizing laser settings may aid short-term recovery.
Presenting Author
Erik A Navas Villar, MD
Co-Authors
Arturo Chayet (MD), Ivonne Curiel Arce (MD)
Purpose
To evaluate the accuracy of an artificial intelligence-based model for vault prediction in patients undergoing Implantable Collamer Lens (ICL) implantation using preoperative Anterior Segment Swept-Source OCT (Anterion, Heidelberg Engineering)
Methods
A retrospective observational study was conducted including 75 eyes of 42 patients who underwent ICL implantation between January 2023 and December 2024. Predicted vault values were obtained from the AI model, and postoperative vault was measured at 6 weeks. Agreement between predicted and actual values was analyzed using mean prediction error (bias), mean absolute error (MAE), root mean square error (RMSE), and the percentage of eyes within predefined error ranges (±250, ±500, ±750 ?m).
Results
The mean prediction error was -99.98 ± 239.23 ?m. The MAE was 192.15 ?m and the RMSE was 257.76 ?m. A total of 67.1%, 93.2%, and 100% of eyes were within ±250 ?m, ±500 ?m, and ±750 ?m of the predicted vault, respectively. Correlation between predicted and real vault was r = 0.48, p =0.001.
Conclusion
The artificial intelligence model demonstrated moderate correlation with postoperative vault and provided clinically useful accuracy for ICL sizing, with the majority of eyes falling within ±250 ?m of the actual vault, but with an underestimation of approximately 100 µm
