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Moderator
Camille Bosc, MD
Panelists
Sung Min Kim, MD; Kendrick M. Wang, MD
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
Nicholas E Dudenhoefer, MD
Co-Authors
Gary Legault (MD), Samantha Rodgers (MD), Charisma Evangelista (MD), Jose Capo-Aponte (PhD, OD), Samuel Chen (BA), P. David Kohler (OD, MS)
Purpose
To compare six-month visual outcomes, higher-order aberrations (HOAs), and patient-reported symptoms between topography-guided LASIK using Contoura with Phorcides and wavefront-guided LASIK using iDesign 2.0 in a contralateral-eye, randomized, double-blind study.
Methods
Sixty-six subjects aged 21-50 years were enrolled and randomized to receive TG-LASIK in one eye and WFG-LASIK in the contralateral eye. Standard preoperative and postoperative assessments were conducted, including visual acuity, refraction, HOAs, Schirmer's test, and validated questionnaires (PROWL-SS and SPEED). Surgical procedures utilized the Zeiss VisuMax femtosecond laser for flap creation, followed by excimer laser ablation guided by either Contoura with Phorcides or iDesign 2.0. Outcomes were evaluated at multiple time points up to six months postoperatively.
Results
Sixty-three subjects completed the study. At six months, 54% of WFG-LASIK eyes and 46% of TG-LASIK eyes achieved UCVA of 20/16 or better (P = 0.476). TG-LASIK demonstrated a significantly higher efficacy index (1.08 vs. 1.02; P = 0.031) and better mean SEQ (0.04 D vs. 0.13 D; P = 0.042), while WFG-LASIK showed superior low-contrast CDVA at later time points. No significant differences were found in safety indices, residual HOAs, or dry eye symptoms. Both procedures significantly improved patient satisfaction and reduced visual disturbances compared to baseline.
Conclusion
Both treatments yielded excellent outcomes and safety. TG-LASIK showed advantages in refractive accuracy and efficacy, while WFG-LASIK provided better low-contrast visual acuity. These findings support the use of either platform for customized LASIK treatment, with selection potentially guided by individual patient needs and ocular characteristics.
Presenting Author
Seongjun Lee, MD, PhD
Purpose
To evaluate the impact of centration and cyclotorsion control aids on surgical outcomes following SMILE using VisuMax platforms with different levels of integration.
Methods
This retrospective study included 491 eyes of 247 myopic patients categorized into three groups: • Group 1 (n=244): VisuMax 800 integrated with both centration and cyclotorsion control aids (via IOLMaster 700) • Group 2 (n=126): VisuMax 800 integrated with centration control aid only • Group 3 (n=121): VisuMax 500 without centration or cyclotorsion control aids At 3 months postoperatively, visual outcomes, Alpins vector analysis, corneal higher-order aberrations, optical quality (OQAS), contrast sensitivity, and subjective satisfaction (QoV score) were assessed. Multiple linear regression was conducted to determine predictors of satisfaction.
Results
Group 1 achieved significantly better UDVA and lower residual astigmatism than Groups 2 and 3 (p<0.001). Vector analysis showed lower difference vector and angle of error in Group 1 (p<0.001, p=0.008). No significant differences were found between Groups 2 and 3 in visual or refractive outcomes. Induced horizontal and vertical coma were lower in Groups 1 and 2 than in Group 3 (p<0.001, p=0.014). OQAS and contrast sensitivity were comparable among groups. QoV scores were higher in Group 3 than in Group 2 (p=0.021), with no differences involving Group 1. Regression showed younger age and greater preoperative spherical aberration predicted higher satisfaction (p=0.001, p=0.027; Adj. R²=0.045).
Conclusion
Integration of both centration and cyclotorsion control aids in SMILE using VisuMax 800 led to superior visual and vector outcomes. While satisfaction was influenced by patient and optical factors, the combined use of alignment aids may improve overall refractive precision.
Presenting Author
Sean M. Cleary, MD
Co-Authors
Paramjit Bhullar (MD), Charisma Evangelista (MD), Jose Capo-Aponte (PhD, OD)
Purpose
This study aims to compare visual outcomes, refractive outcomes, and patient-reported symptoms in subjects undergoing contralateral laser-assisted in situ keratomileusis (LASIK) surgery using either the Wavelight Plus Sightmap (WLP) or wavefront-optimized (WFO) ablation profiles.
Methods
This three-month, single center, prospective, randomized, contralateral-eye study includes 53 subjects aged 21 to 50 years. Each underwent WLP-LASIK in one eye and WFO-LASIK in the other. Inclusion criteria included myopia between -2.00D and -8.00D and astigmatism ? 3.00D, with similar levels in both eyes. Subjects unsuitable for LASIK by standard measures were excluded. Post-operative month 1 (POM1) visual outcomes (i.e., uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), manifest refractive spherical equivalent (MRSE), and satisfaction with vision and visual symptoms using the Patient-Reported Outcomes with LASIK (PROWL) are reported.
Results
For the 18 subjects that have completed POM1 the UDVA was ?20/20 in 100% and 92.4% of eyes, and ?20/16 in 83.5% and 72.7% of eyes after WLP-LASIK and WFO-LASIK, respectively. The mean monocular UDVA was -0.11 ± 0.07 logarithm of the minimum angle of resolution (logMAR) and -0.09 ± 0.09 logMAR, and the monocular CDVA was -0.14 ± 0.05 logMAR and -0.13 ± 0.06 logMAR after WLP-LASIK and WFO-LASIK, respectively (P > 0.05). The mean MRSE was -0.05 ± 0.21 D after WLP-LASIK and -0.16 ± 0.23 D after WFO-LASIK (P = 0.039). PROWL overall satisfaction with vision score was better with WLP (P = 0.045).
Conclusion
Preliminary POM1 results suggest that WLP-LASIK may provide superior visual and refractive outcomes compared to WFO-LASIK. Patient-reported overall satisfaction with vision was also better for WLP-LASIK. Further analysis will continue to the six-month mark to confirm these findings.
Presenting Author
Avinoam Shye, MD, PhD
Co-Authors
Eyal Cohen (MD), Igor Kaiserman (MD), Gur Munzer (BA), Tzahi Sela (BScOptom), Michael Mimouni (MD), Asaf Friehmann (MD)
Purpose
To evaluate LASIK safety, efficacy, and refractive outcomes in hyperopic patients with very thick corneas (>600 µm) versus normal thickness (500-600 µm). Despite concerns, we assessed if thick corneas yield comparable results in UDVA, CDVA, refractive stability, safety, retreatment, and ectasia.
Methods
A retrospective analysis of 1475 hyperopic eyes (?12.0 D) treated with LASIK at Care-Vision Laser Centers, Tel Aviv (2010-2024), included patients aged 16-40 years. Eyes were divided by corneal thickness: 1421 eyes with 500-600 µm and 54 eyes with >600 µm. Preoperative, intraoperative, and postoperative parameters were assessed, including UDVA, CDVA, refraction, corneal curvature, optical zone, ablation depth, percent tissue ablated, residual stromal bed thickness, and retreatment and ectasia rates. Statistical adjustments were performed to control for confounding variables.
Results
The normal and thick cornea groups had similar demographics. Preoperatively, the thick cornea group had significantly greater corneal thickness (615±11 vs 543±25 µm, p<0.0001) and more hyperopic refractive error (SEQ: 2.38±2.2 vs 0.70±2.14 D, p<0.0001). Intraoperatively, RSB was greater (447 ± 27 vs 385±30 µm, p=0.7441), and percent of tissue ablated was lower (27.3 ± 4.0% vs 29.1 ± 3.9%, p < 0.0001). Postoperatively, there was a trend toward lower UDVA, CDVA, safety, and efficacy in the thick cornea group, though differences were not statistically significant (p > 0.05). Retreatment occurred in 1.3% of normal cornea cases but none in the thick cornea group. No ectasia was observed.
Conclusion
LASIK in hyperopic eyes with very thick corneas was safe and effective, though safety and efficacy indices trended lower than in normal corneas. No retreatments or ectasia occurred. This unique cohort, the largest of its kind, can support decision making in real life and highlights the need for larger studies to clarify outcomes.
Presenting Author
Avinoam Shye, MD, PhD
Co-Authors
Igor Kaiserman (MD), Gur Munzer (BA), Tzahi Sela (BScOptom), Michael Mimouni (MD), Eyal Cohen (MD)
Purpose
To report the outcomes of LASIK in myopic older adult patients compared with a control group of patients aged 20-40 years.
Methods
Setting: A retrospective analysis of LASIK procedures performed at Care-Vision Laser Centers, a high-volume refractive surgery clinic in Tel Aviv, Israel, between January 2010 and June 2024. Methods: Retrospective cohort study of patients who were either 20 to 40 or 55 to 70 years old at the time of surgery, with myopia up to -12.0 diopters. Eyes were divided into two groups based on age. The adult group consisted of patients 20 to 40 years old, and the older adult group consisted of those 55 to 70 years old. Preoperative and intraoperative parameters as well as postoperative outcomes including retreatment and ectasia rates were compared between the two groups.
Results
We analyzed 29,047 hyperopic LASIK eyes: 28,740 adults and 307 older adults. Mean age was 28.4 vs 57.0 years (p<0.0001), with similar sex ratio, CT, and keratometry. Older adults had greater baseline myopia and astigmatism. Intraoperative parameters (optical zone, ablation depth, RSB, PTA) were comparable. At follow-up, adults achieved superior UDVA (0.99 vs 0.87, p<0.0001) and efficacy index (1.03 vs 0.94, p<0.0001), while safety index and retreatment rates (0.31% vs 0.29%) were similar. No cases of postoperative ectasia occurred.
Conclusion
LASIK in myopic older adults is safe and effective but shows slightly lower safety (CDVA loss) and significantly lower efficacy (UDVA gain) versus younger adults. Retreatment was higher in younger adults, likely due to greater willingness. No ectasia cases were observed.
Presenting Author
A. John Kanellopoulos, MD
Co-Authors
Filippos Vingopoulos (MD), Athanasios Zisimopoulos (MD, MSc)
Purpose
The relative efficacy and precision of these two leading refractive procedures. In doing so, it also explores whether the theoretical advantages of ray tracing-guided LASIK (wavelight plus-recently FDA approved) translate into potentially measurable clinical ascendency over SMILE Pro-with the upgraded femtosecond platform available outside the US.
Methods
This contralateral eye study included 120 eyes of 60 patients: one eye was treated with RayTracing LASIK (wavelight plus. Alcon/Wavelight, Erlagen Germany), while the fellow eye was treated with SMILE (SMILE pro, Visumax 800, Zeiss, Jena, Germany)) using the RayTracing calculated refraction (SightMap, Alcon/Wavelight). The following parameters were evaluated preoperatively and up to 3 months postoperatively: % of eyes with 1 line of vision gained in LogMAR, UDVA, CDVA, refractive error, spherical equivalent (SE), defocus equivalent (DE), high order aberrations (HOA): total: RMSh and spherical aberration, and contrast sensitivity,
Results
At 3 months 81.66% of the wavelight plus LASIK eyes gained one or more lines of UDVA compared to preop CDVA vs. 31.67% of the SMILE Pro eyes. Mean postop UDVA: -0.17 ± 0.06 LogMAR vs. -0.10 ± 0.04 LogMAR respectively. 20/20 UDVA 100% vs. 100%, 20/12.5 98.33% vs. 81.67%. Mean pre op VA was -0.10 ± 0.04 LogMAR in both groups. All eyes were within ±0.50 D of target refraction; both groups; within ±0.25 D of target refraction the wavelight plus LASIK group (100%) over the SMILE Pro group: 76.67% (P < 0.001). Mean pre op MRSE was equivalent nearly equivalent between both groups 4.19 ± 1.86 and -4.18 ± 1.87 for wavelight plus and SMILE Pro respectively
Conclusion
Ray-tracing LASIK (wavelight plus) appears to offer superior visual outcomes in lines of vision gained to Smile Pro. Whilst demonstrating lower defocus equivalent, lower reduction in mesopic contrast sensitivity and high order aberrations including spherical aberration
Presenting Author
Madhuvanthi Mohan, MS
Co-Authors
Sujatha Mohan (FRCS)
Purpose
To compare early visual recovery and short-term outcomes of Femtosecond LASIK (FS-LASIK) and Small Incision Lenticule Extraction (SMILE) in patients undergoing refractive surgery for myopia more than -5D at a tertiary eye care centre.
Methods
A prospective, consecutive case series was conducted between January and March 2025. Patients undergoing FS-LASIK (n?100 eyes) or SMILE (n?100 eyes) were included. Preoperative refraction, uncorrected distance visual acuity (UDVA) on postoperative day 1 (POD1), and at 1 month were analyzed. Primary outcomes were the proportion of eyes achieving UDVA ?6/6 at each timepoint and incidence of residual refractive error (<6/9). Astigmatism correction was assessed separately.
Results
On POD1, 82% of FS-LASIK eyes achieved UDVA ?6/6 compared to 68% of SMILE eyes, reflecting faster visual recovery in the LASIK group. By 1 month, outcomes were comparable, with 98% of FS-LASIK and 96% of SMILE eyes achieving UDVA ?6/6. Residual vision <6/9 persisted in 2% of FS-LASIK and 4% SMILE cases. Astigmatism correction was effective in both groups, with no significant difference in residual cylinder. No sight-threatening complications occurred.
Conclusion
Both FS-LASIK and SMILE provided excellent short-term outcomes in myopic patients, with FS-LASIK offering faster early recovery, while SMILE matched outcomes by 1 month. SMILE may offer additional biomechanical and dry-eye advantages, whereas FS-LASIK remains preferred where rapid visual rehabilitation is desired.
Presenting Author
Rafah Fairaq, MD
Co-Authors
Halah Bin Helayel (MBBS), Mohammed Almutlak (MD), Muhammad Ahad (FRCSEd, MRCOphth, PhD)
Purpose
To evaluate changes in corneal astigmatism after posterior chamber phakic intraocular lens implantation in patients with keratoconus and to compare the outcomes with myopic patients with normal corneas undergoing the same procedure.
Methods
Prospective two-armed cohort study including patients with keratoconus (Group 1) and myopic patients with normal corneas (Group 2) undergoing posterior chamber phakic intraocular lens implantation for refractive correction. Patients were selected based on clinical diagnosis and suitability for the procedure. Pre- and postoperative topographic astigmatism of anterior and posterior corneal surfaces was measured. The primary outcome was the change in corneal astigmatism from baseline to 3 months postoperatively in both groups.
Results
The study included 25 keratoconus patients (Group 1) and 27 myopic patients with normal corneas (Group 2). The mean preoperative anterior corneal astigmatism (ACA) was higher in Group 1 (2.83±0.50 diopters [D] vs 1.91±0.87 D, p=0.0079) as was the mean posterior corneal astigmatism (PCA, 0.63±0.27 D vs 0.44±0.19 D, p=0.0049). At 12 weeks postoperatively, the mean ACA was 2.71±1.4 D vs 2.0±1.0 D (p=0.1460) and the mean PCA 0.65±0.27 D vs 0.46±0.16 D (p=0.0366), with greater ACA changes in keratoconus while PCA remained stable in both groups.
Conclusion
Corneal astigmatism alterations following posterior chamber phakic intraocular lens implantation are more pronounced in biomechanically compromised corneas compared with normal corneas. These findings may influence predicted surgically induced astigmatism and should be integrated into preoperative planning.
Presenting Author
Avinoam Shye, MD, PhD
Co-Authors
Aya Wattad (MD), Igor Kaiserman (MD), Gur Munzer (BA), Tzahi Sela (BScOptom), Michael Mimouni (MD), Eyal Cohen (MD)
Purpose
PRK is widely used for myopia, preferred over LASIK in thin corneas or trauma risk. Its safety in teens remains debated due to stability, healing, and ectasia concerns. We analyzed 65,211 eyes to compare PRK outcomes in myopic teens (17-18) vs adults (19-40), assessing vision, efficacy, safety, retreatment, and ectasia.
Methods
This retrospective cohort study analyzed 65,211 eyes that underwent PRK at Care-Vision Laser Centers, Tel Aviv, between January 2010 and June 2024. Patients aged 17-40 years with myopia up to -12.0 D were divided into teens (17-18) and adults (19-40). Preoperative parameters such as corneal thickness, keratometry, and refraction, as well as intraoperative details including optical zone size, ablation depth, and residual stromal bed, were compared. Postoperative outcomes, including uncorrected and corrected distance visual acuity, efficacy, safety, retreatment rates, and ectasia incidence, were assessed with adjustments for confounders.
Results
Preoperatively, teens had thicker corneas (536.8 ± 32.7 vs. 528.3 ± 33.7 ?m, p < 0.0001) and lower keratometry values. Postoperatively, UDVA was slightly better in teens (0.9646 ± 0.1072 vs. 0.9507 ± 0.1289, p = 0.0815), with a higher efficacy index (1.022 ± 0.1126 vs. 1.015 ± 0.1339, p = 0.0497). No significant differences were found in subjective refraction or corrected distance visual acuity. Retreatment rates (0.41% in both groups, p = 0.7987) and ectasia rates (0.024% vs. 0.026%, p = 0.5778) were similar. These findings suggest that PRK in teens achieves comparable or slightly better visual outcomes without increased risk
Conclusion
PRK in myopic teens is safe and effective, with outcomes comparable or slightly better than adults. Teens showed higher efficacy without increased retreatments or ectasia, suggesting age should not limit candidacy. This large study provides strong evidence supporting PRK as a viable option in selected teens.
Presenting Author
O?uzhan Karabulut, MD
Co-Authors
Sibel Ahmet (FEBO, FRCSEd, MD), Ahmet Kirgiz (FEBO), Nilay kandemir Besek (MD), Gülay Yalç?nkaya çak?r (FEBO)
Purpose
To evaluate and compare the effect of ocular residual astigmatism (ORA) on the refractive outcomes in eyes with astigmatism after femtosecond laser-assisted in situ keratomileusis (F-LASIK) and keratorefractive lenticule extraction (KLEx).
Methods
This retrospective study included patients who underwent F-LASIK or KLEx for myopia (0 to ?9.00 D) and astigmatism (?0.25 to ?2.00 D) with 1-year follow-up. Astigmatic changes were assessed using Alpins' vector analysis. Outcomes were compared by ORA/MRC (manifest refractive cylinder) ratio. Eyes were grouped by ORA/MRC cutoff value of 0.5. For both surgical techniques, intergroup comparisons were performed for keratometry (K1 and K2), anterior corneal astigmatism (ACA), safety and efficacy indexes (SI and EI), index of success (IOS), difference vector (DV), target and surgically induced astigmatism (TIA and SIA), correction and flattening indexes (CI and FI), and magnitude of error (ME).
Results
In the F-LASIK group, eyes with a high ORA/MRC ratio had significantly higher ORA (p=0.01) and ME (p=0.001), while ACA (p=0.03), DV (p<0.001), and TIA (p<0.001) were significantly lower compared with the low-ratio group. In the KLEx group, eyes with a high ORA/MRC ratio showed significantly higher ORA (p=0.008), K1 (p<0.001), and K2 (p=0.003), but lower ACA (p=0.007), DV (p=0.02), TIA (p<0.001), and ME (p=0.002). No significant intergroup differences were observed for SI, EI, SIA, CI, FI, CCT, or IOS (p>0.05).
Conclusion
The ORA/MRC ratio affected astigmatic parameters differently in F-LASIK and KLEx. High ratios were linked to greater residual astigmatism, while corneal and vector responses varied by technique. However, safety, efficacy, and surgical success remained unaffected. ORA/MRC may guide astigmatic prediction, though its visual impact appears limited.
Presenting Author
Gulce Kayikci, FEBO
Co-Authors
Nilay kandemir Besek (MD), Sibel Ahmet (FEBO, FRCSEd, MD), Metehan Simsek (MD), Gülay Yalç?nkaya çak?r (FEBO)
Purpose
To evaluate the impact of preoperative keratometry profile (steep vs normal-range) on postoperative visual, keratometric, and aberrometric outcomes after SMILE in moderately myopic eyes.
Methods
Records of patients who underwent SMILE for moderate myopia (?3.0 to ?6.0 D) between 2017 and 2024 were retrospectively reviewed. Based on preoperative corneal topography (Sirius; CSO, Florence, Italy), eyes with K2 of 42-46 D were classified as the normal-range keratometry group (NRK, n=60) and eyes with K2 >46 D as the steep keratometry group (S, n=60). Six-month changes (?) from baseline were compared for best-corrected visual acuity (BCVA, logMAR), keratometry (K1, K2, Kmax, mean K), and higher-order aberrations (total RMS, astigmatism, coma, trefoil, spherical aberration (SA)) at 4?mm and 6?mm pupil diameters.
Results
120 eyes analyzed. Spherical equivalent improved from ?4.54±0.56 D to ?0.29±0.33 D; cylinder from ?0.27±0.27 D to ?0.16±0.19 D (p<0.001, p=0.012). At 6 months BCVA was similar between groups (p=0.967). Visual acuity gain was greater in NRK (?BCVA: S ?1.27±0.34 vs NRK ?1.56±0.29; p=0.001). Kmax flattening was more pronounced in NRK (S ?2.26±2.42 D vs ?4.12±2.39 D; p=0.015). changes in K1, K2, and mean K were similar (all p>0.30). At 6 mm, SA decreased more in NRK (S ?0.055±0.104 vs ?0.119±0.125; p=0.034). At 4 mm, it increased in S but decreased in NRK (+0.023±0.049 vs ?0.009±0.034; p=0.022). No group differences in total RMS, astigmatism, coma, or trefoil (all p>0.13).
Conclusion
In moderate myopia, SMILE produced greater BCVA gain and Kmax flattening in eyes with NRK versus steep keratometry. SA decreased more at 6 mm and did not increase at 4 mm in the NRK group. Total RMS, astigmatism, coma, and trefoil were comparable. In steep corneas, perioperative planning should prioritize SA control and precise centration.
Presenting Author
Stephen A. LoBue, MD
Co-Authors
Fatma Shakarchi (MD, MSc), Ayorinde Cooley (MD, PhD), Curtis Martin (MD), Traeson Brandenburg (BSc), Nicolas Zaunbrecher (MD), Christopher Shelby (MD), Wyche Coleman (MD)
Purpose
To compare epithelial ingrowth rates following femtosecond LASIK enhancement when proparacaine versus tetracaine was applied to the stromal bed before flap repositioning.
Methods
We retrospectively reviewed 148 eyes undergoing secondary LASIK enhancement by a single surgeon (2021-2024). Flaps were lifted and ablations performed with an EX500 excimer laser. After ablation, either a proparacaine- or tetracaine-soaked weck-cel was applied to the stromal bed before flap repositioning. Patients were monitored ?3 months postoperatively. Primary outcomes included rate of epithelial cells detected post-flap lift and rate of clinically significant epithelial ingrowth requiring removal.
Results
The proparacaine group included 34 eyes (40 lifts) and the tetracaine group 106 eyes (108 lifts). Mean interval from primary LASIK was 7.3 years vs 9.5 years (p=0.08). Epithelial cells were detected in 9% of proparacaine cases vs 13% tetracaine (p>0.05). Clinically significant ingrowth occurred in 0% of proparacaine vs 11% of tetracaine eyes (p=0.04). Most ingrowth cases (75%) occurred >3 years after primary LASIK (mean 8.7 years, p<0.05). No recurrence occurred after ingrowth removal in the tetracaine group.
Conclusion
Relifting LASIK flaps >3 years after primary surgery increases ingrowth risk. Proparacaine use on the stromal bed may reduce clinically significant ingrowth, while tetracaine may help prevent recurrence after removal. Careful anesthetic selection could optimize outcomes during long-term LASIK enhancements.
