to compare visual, refractive, and wavefront aberration outcomes of laser epithelial keratomileus... more to compare visual, refractive, and wavefront aberration outcomes of laser epithelial keratomileusis (LASEK), thin-flap LASIK (flap thickness 110 to 130 microm), and ultrathin-flap LASIK (flap thickness <110 microm) after excimer laser ablation with an aspheric ablation profile. a retrospective analysis of 97 eyes of 56 patients with myopia <6.00 diopters (D) sphere (30 eyes, alcohol-assisted LASEK; 30 eyes, LASIK 110; and 37 eyes, LASIK 130) was conducted. Surgery was performed using the SCHWIND ESIRIS Aberration-Free aspheric ablation profile and the Carriazo-Pendular microkeratome. groups were comparable preoperatively except for lower astigmatism and ocular trefoil (3,+3) in the LASIK 130 group and lower corneal thickness in the LASEK group. At 6 months postoperative, the groups were comparable for uncorrected and corrected distance visual acuity, efficacy index, safety, and refractive predictability. All groups demonstrated improved contrast sensitivity. All groups demonstrated a significant change in spherical aberration compared to preoperative levels. The induced spherical aberration was 0.057 microm/D in the LASEK group, 0.039 microm/D in the LASIK 110 group, and 0.044 microm/D in the LASIK 130 group. Other higher order aberrations did not show significant change except for a reduction in corneal trefoil (P=.034) in the LASEK group and increased ocular trefoil (P=.002) in the LASIK 110 group. The extent of change in higher order aberrations was not significantly different among groups. the aspheric ablation profile is safe, effective, and predictable and produces similar visual and refractive results with three different surgical approaches of LASEK, thin-flap LASIK, and ultrathin-flap LASIK. The ablation profile demonstrated a low induction rate of higher order aberrations regardless of surgical approach.
To evaluate the clinical outcomes of aspheric ocular wavefront ablation profiles in LASIK treatme... more To evaluate the clinical outcomes of aspheric ocular wavefront ablation profiles in LASIK treatments. Thirty eyes treated by ocular wavefront were retrospectively analyzed at 6-month follow-up. Custom Ablation Manager (CAM) software was used to plan wavefront-customized aspheric treatments, and the ESIRIS system was used to perform ablations (SCHWIND eye-tech-solutions). Outcomes were evaluated in terms of efficacy, predictability, refractive outcome, safety, and pre-and postoperative wavefront aberration analysis (SCHWIND Ocular Wavefront Analyzer). At 6 months postoperatively, 47% of eyes achieved uncorrected visual acuity 20/20 or better. Average defocus was reduced from -3.49+/-2.38 diopters (D) preoperatively (range: -10.63 to 0.00 D) to -0.14+/-0.31 D postoperatively (range: -1.75 to 0.00 D). Astigmatism was reduced from -0.81+/-1.15 D (range: -4.25 to 0.00 D) to -0.25+/-0.37 D (range: -1.25 to 0.00 D). Eighty-six percent of eyes were within +/- 0.50 D. Best spectacle-corrected visual acuity (logMAR) improved from +0.12+/-0.08 (range: 0.0 to +0.2) to -0.05+/-0.13 (range: -0.2 to +0.2) (P=.04). The treatment did not change coma or spherical aberration, and reduced the trefoil from 0.21+/-0.13 microm (range: 0.05 to 0.53 microm) to 0.08+/-0.13 microm (range: 0.01 to 0.39 microm) (P=.002). The study results indicate that the aspheric ocular wavefront customized CAM approach for planning ablation volumes is safe and effective.
The aim of this study is to evaluate the safety and effectiveness of riboflavin-ultraviolet type ... more The aim of this study is to evaluate the safety and effectiveness of riboflavin-ultraviolet type A (UV-A) light rays induced cross-linking of corneal collagen in improving visual acuity and in stabilizing the progression of keratoconic eyes. The method of corneal cross-linking using riboflavin and UV-A light is technically simple and less invasive than all other therapies proposed for keratoconus. It is the only treatment that treats not only the refractive effects of the condition but the underlying pathophysiology. In this prospective, nonrandomized clinical study, 20 eyes of 19 patients with keratoconus were treated by combined riboflavin UV-A collagen cross linking. The eyes were saturated with riboflavin solution and were subjected for 30 min under UV-A light with a dose parameter of 3 mW/cm(2). Safety and effectiveness of the treatment was assessed by measuring the uncorrected visual acuity, best corrected visual acuity, manifest cylinder/sphere, keratometry, pachymetry, posterior and anterior elevations from Pentacam and corneal aberrations at 6 months and 1 year post-treatment. Comparative analysis of the pre-operative and 1 year post-operative evaluation showed a mean gain of 4.15 lines of UCVA (P= 0.001) and 1.65 lines of BCVA (P= 0.002). The reduction in the average keratometry reading was 1.36 D (P= 0.0004) and 1.4 D (P= 0.001) at the apex. Manifest refraction sphere showed a mean reduction of 1.26 D (P= 0.033) and 1.25 D (0.0003) for manifest cylinder. Topo-aberrometric analysis showed improvement in corneal symmetry. Cross-linking was safe and an effective therapeutical option for progressive keratoconus.
To compare measurements of ultrasound, Scheimpflug, and optical coherence pachymetric techniques ... more To compare measurements of ultrasound, Scheimpflug, and optical coherence pachymetric techniques to describe ablated depth after myopic astigmatic corneal laser refractive surgery and achieved refractive correction. Ninety-six myopic astigmatism treatments using LASIK or LASEK in 58 patients with 3-month followup were retrospectively analyzed. In all cases, standard examinations, pre-/postoperative corneal topography, ocular aberrometry, and pachymetry were performed. SCHWIND Custom Ablation Manager (CAM) software and the ESIRIS laser were used for planning treatments and performing ablations. Outcomes were evaluated in terms of predictability, safety, and wavefront aberration. Pachymetry was taken before treatment (ultrasound [DGH Pachette 2], Scheimpflug [Oculus Pentacam HR], and optical coherence pachymetry [OCP] [Heidelberg-Engineering OCP]), after lifting the flap (Pachette 2, OCP), immediately after finishing ablation (Pachette 2, OCP), and at 3-month follow-up (Pachette 2, Pentacam HR). At 3 months, 87 (91%) of eyes achieved 20/20 UCVA, and 89 (93%) of eyes were within +/-0.50 diopters (D). Postoperative mean spherical equivalent refraction was -0.15 +/- 0.30 D. Best spectacle-corrected visual acuity improved in 30 (31%) of eyes. Differential pachymetry correlated to intended central ablation depth for all techniques: r2 = 0.60, P < .0001, slope 0.81 for ultrasound; r2 = 0.75, P < .0001, slope 0.97 for Scheimpflug; and r2 = 0.76, P < .0001, slope 1.03 for OCR Relative differential pachymetry correlated only marginally to achieved refractive correction for ultrasound and OCP. Differential pachymetry is a metric useful for describing intended central ablation depth but not for achieved refractive correction. The rotating Scheimpflug technique offers the best estimation (closest slope to 1) and OCP offers the best correlation (closest r2 to 1) for describing intended central ablation depth achieved. The three techniques give different measurements for ablation depth, with OCP being substantially different from ultrasound and Scheimpflug. Only borderline correlations were obtained for achieved refractive correction with ultrasound and OCP.
Purpose: To evaluate postoperative clinical outcomes, and corneal High Order Aberrations, among e... more Purpose: To evaluate postoperative clinical outcomes, and corneal High Order Aberrations, among eyes with hyperopia up to +5 D of spherical equivalent, that have undergone LASIK treatments using the SCHWIND AMARIS laser system. Methods: At six-month follow-up, 100 eyes with preoperative hyperopia or hyperopic astigmatism up to +5 D of spherical equivalent were retrospectively analysed. Standard examinations, pre-and postoperative wavefront analysis with a corneal-wavefront-analyzer (OPTIKON Scout) were performed. Aberration-Free aspheric treatments were planned with Custom Ablation Manager software and ablations performed using the SCHWIND AMARIS fl ying-spot excimer laser system (both SCHWIND eye-tech-solutions). LASIK flaps were created using a LDV femtosecond laser (Ziemer Group) in all cases. Clinical outcomes were evaluated in terms of predictability, refractive outcome, safety, and wavefront aberration. Results: At six month, 90 % of eyes achieved ≥ 20/25 UCVA and 44 % achieved ≥ 20/16 UCVA. Seventy-four percent of eyes were within ± 0.25D of spherical equivalent and 89 % within ± 0.50D, with 94 % within 0.50D of astigmatism. Mean spherical equivalent was -0.12 ± 0.51D and 0.50 ± 0.51D for the astigmatism. Fifty-two percent of eyes improved BSCVA vs. only 19 % losing lines of BSCVA. Predictability slope for refraction was 1.03 and intercept +0.01 D. On average, negative corneal spherical aberrations were signifi cantly increased by the treatments, no other aberration terms changed from pre-to postoperative values. Conclusions: LASIK for hyperopia and hyperopic astigmatism with SCHWIND AMARIS yields very satisfactory visual outcomes. Preoperative refractions were postoperatively reduced to subclinical values with no clinically relevant induction of corneal HOA.
To compare the clinical outcomes of aberration-free ablation profiles based on the normal corneal... more To compare the clinical outcomes of aberration-free ablation profiles based on the normal corneal vertex (CV) and the pupil center (PC) in relation to laser in situ keratomileusis. Aberration-free aspheric ablation treatments were performed in all cases. METHODS. Two myopic astigmatism groups (CV centered using the offset between pupil center and normal corneal vertex and PC centered using the pupil center) comprising 24 and 29 eyes (16 and 19 patients), respectively, with a 6-month follow-up, were included. All enrolled eyes had Ͻ0.65 m RMS-higher order aberration (HOA) for 6.00 mm analysis diameter and pupillary offset Ͼ200 m. In all cases, standard examinations, and preoperative and postoperative wavefront analysis were performed. Custom ablation software was used to plan aberration-free aspheric treatments and a flying spot excimer laser system was used to perform ablations. The clinical outcomes were evaluated for predictability, refractive outcome, safety, ocular wavefront aberration, and asphericity. RESULTS. Of the CV eyes, 38% had improved best spectaclecorrected visual acuity (BSCVA) compared with 24% of the PC eyes (comparison CV/PC P ϭ 0.38). Induced ocular coma was on average 0.17 m in the CV group and 0.26 m in the PC group (comparison CV/PC P ϭ 0.01 favoring CV). Induced ocular spherical aberration was on average ϩ0.01 m in the CV group and ϩ0.07 m in the PC group (comparison CV/PC P ϭ 0.05 favoring CV). Change in asphericity was on average ϩ0.56 in the CV group and ϩ0.76 in the PC group (comparison CV/PC P ϭ 0.05 favoring CV). No significant shift was observed in the pupillary offset after treatments. CONCLUSIONS. In myopic eyes with moderate to large pupillary offset, CV-centered treatments performed better in terms of induced ocular aberrations and asphericity, but both centrations were identical in photopic visual acuity. (Invest Ophthalmol Vis Sci. 2008;49:5287-5294)
To evaluate the clinical outcomes of LASIK using optimized &a... more To evaluate the clinical outcomes of LASIK using optimized "aberration neutral" ablation profiles. Laser in situ keratomileusis was performed in 231 eyes (120 patients) with a mean spherical equivalent refraction of -4.12+/-2.26 diopters (D) (range: -0.37 to -9.50 D) using a SCHWIND Pendular microkeratome with a 130-microm cutting head and the SCHWIND ESIRIS excimer laser. In all cases, pre- and postoperative autorefractor measurements, manifest refraction, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), topography and corneal wavefront analysis, and ocular wavefront analysis as well as complications were analyzed. Ablations were calculated using the ORK-CAM software. Clinical outcomes were evaluated in terms of efficacy, predictability, stability, refractive outcome, safety, and wavefront aberrations. At 3 months, mean spherical equivalent refraction was -0.10+/-0.33 D (range: +0.86 to -1.18 D). Of 231 eyes, 201 (87%) were within +/-0.50 D of attempted correction. Uncorrected visual acuity was 20/16 or better in 71% (164 eyes), 20/20 or better in 92% (213 eyes), and 20/32 or better in 100%. Average root-mean-square higher order aberrations increased 0.05 microm after treatment, mean spherical aberration increased 0.08 microm after treatment, and mean coma increased 0.04 microm after treatment (all for 6.0-mm analysis diameter). Our results show that non-customized "aberration neutral" ablation profiles derived from wavefront analysis are able to minimize the amount of induced aberrations of both the cornea and the eye.
PURPOSE: To evaluate the postoperative clinical outcomes and higher-order aberrations (HOAs) in e... more PURPOSE: To evaluate the postoperative clinical outcomes and higher-order aberrations (HOAs) in eyes with astigmatism greater than 2.00 diopters (D) that had laser in situ keratomileusis (LASIK) using a non-wavefront-guided aberration-free ablation profile.
Purpose: To evaluate the clinical outcomes of aspheric corneal wavefront (CW) ablation profiles ... more Purpose: To evaluate the clinical outcomes of aspheric corneal wavefront (CW) ablation profiles in LASIK treatments.Methods: Thirty eyes treated with CW ablation profiles were included after a follow-up of 6 months. In all cases, standard examinations including preoperative and postoperative wavefront analysis with a CW topographer (Optikon Keratron Scout) were performed. Custom Ablation Manager (CAM) software was used to plan corneal wavefront customized aspheric treatments, and the ESIRIS flying spot excimer laser system was used to perform the ablations (both SCHWIND eye-tech-solutions, Kleinhostheim, Germany). Clinical outcomes were evaluated in terms of predictability, refractive outcome, safety, and wavefront aberration.Results: In general, the postoperative uncorrected visual acuity and the best corrected visual acuity improved (p < 0.001). In particular, the trefoil, coma, and spherical aberrations, as well as the total root-mean-square values of higher order aberrations, were significantly reduced (p < 0.05) when the pre-existing aberrations were greater than the repeatability and the biological noise.Conclusions: The study results indicate that the aspheric corneal wavefront customized CAM approach for planning ablation volumes yields visual, optical, and refractive results comparable to those of other wavefront-guided customized techniques for correction of myopia and myopic astigmatism. The CW customized approach shows its strength in cases where abnormal optical systems are expected. Apart from the risk of additional ablation of corneal tissue, systematic wavefront-customized corneal ablation can be considered as a safe and beneficial method.
to compare visual, refractive, and wavefront aberration outcomes of laser epithelial keratomileus... more to compare visual, refractive, and wavefront aberration outcomes of laser epithelial keratomileusis (LASEK), thin-flap LASIK (flap thickness 110 to 130 microm), and ultrathin-flap LASIK (flap thickness &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;110 microm) after excimer laser ablation with an aspheric ablation profile. a retrospective analysis of 97 eyes of 56 patients with myopia &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6.00 diopters (D) sphere (30 eyes, alcohol-assisted LASEK; 30 eyes, LASIK 110; and 37 eyes, LASIK 130) was conducted. Surgery was performed using the SCHWIND ESIRIS Aberration-Free aspheric ablation profile and the Carriazo-Pendular microkeratome. groups were comparable preoperatively except for lower astigmatism and ocular trefoil (3,+3) in the LASIK 130 group and lower corneal thickness in the LASEK group. At 6 months postoperative, the groups were comparable for uncorrected and corrected distance visual acuity, efficacy index, safety, and refractive predictability. All groups demonstrated improved contrast sensitivity. All groups demonstrated a significant change in spherical aberration compared to preoperative levels. The induced spherical aberration was 0.057 microm/D in the LASEK group, 0.039 microm/D in the LASIK 110 group, and 0.044 microm/D in the LASIK 130 group. Other higher order aberrations did not show significant change except for a reduction in corneal trefoil (P=.034) in the LASEK group and increased ocular trefoil (P=.002) in the LASIK 110 group. The extent of change in higher order aberrations was not significantly different among groups. the aspheric ablation profile is safe, effective, and predictable and produces similar visual and refractive results with three different surgical approaches of LASEK, thin-flap LASIK, and ultrathin-flap LASIK. The ablation profile demonstrated a low induction rate of higher order aberrations regardless of surgical approach.
To evaluate the clinical outcomes of aspheric ocular wavefront ablation profiles in LASIK treatme... more To evaluate the clinical outcomes of aspheric ocular wavefront ablation profiles in LASIK treatments. Thirty eyes treated by ocular wavefront were retrospectively analyzed at 6-month follow-up. Custom Ablation Manager (CAM) software was used to plan wavefront-customized aspheric treatments, and the ESIRIS system was used to perform ablations (SCHWIND eye-tech-solutions). Outcomes were evaluated in terms of efficacy, predictability, refractive outcome, safety, and pre-and postoperative wavefront aberration analysis (SCHWIND Ocular Wavefront Analyzer). At 6 months postoperatively, 47% of eyes achieved uncorrected visual acuity 20/20 or better. Average defocus was reduced from -3.49+/-2.38 diopters (D) preoperatively (range: -10.63 to 0.00 D) to -0.14+/-0.31 D postoperatively (range: -1.75 to 0.00 D). Astigmatism was reduced from -0.81+/-1.15 D (range: -4.25 to 0.00 D) to -0.25+/-0.37 D (range: -1.25 to 0.00 D). Eighty-six percent of eyes were within +/- 0.50 D. Best spectacle-corrected visual acuity (logMAR) improved from +0.12+/-0.08 (range: 0.0 to +0.2) to -0.05+/-0.13 (range: -0.2 to +0.2) (P=.04). The treatment did not change coma or spherical aberration, and reduced the trefoil from 0.21+/-0.13 microm (range: 0.05 to 0.53 microm) to 0.08+/-0.13 microm (range: 0.01 to 0.39 microm) (P=.002). The study results indicate that the aspheric ocular wavefront customized CAM approach for planning ablation volumes is safe and effective.
The aim of this study is to evaluate the safety and effectiveness of riboflavin-ultraviolet type ... more The aim of this study is to evaluate the safety and effectiveness of riboflavin-ultraviolet type A (UV-A) light rays induced cross-linking of corneal collagen in improving visual acuity and in stabilizing the progression of keratoconic eyes. The method of corneal cross-linking using riboflavin and UV-A light is technically simple and less invasive than all other therapies proposed for keratoconus. It is the only treatment that treats not only the refractive effects of the condition but the underlying pathophysiology. In this prospective, nonrandomized clinical study, 20 eyes of 19 patients with keratoconus were treated by combined riboflavin UV-A collagen cross linking. The eyes were saturated with riboflavin solution and were subjected for 30 min under UV-A light with a dose parameter of 3 mW/cm(2). Safety and effectiveness of the treatment was assessed by measuring the uncorrected visual acuity, best corrected visual acuity, manifest cylinder/sphere, keratometry, pachymetry, posterior and anterior elevations from Pentacam and corneal aberrations at 6 months and 1 year post-treatment. Comparative analysis of the pre-operative and 1 year post-operative evaluation showed a mean gain of 4.15 lines of UCVA (P= 0.001) and 1.65 lines of BCVA (P= 0.002). The reduction in the average keratometry reading was 1.36 D (P= 0.0004) and 1.4 D (P= 0.001) at the apex. Manifest refraction sphere showed a mean reduction of 1.26 D (P= 0.033) and 1.25 D (0.0003) for manifest cylinder. Topo-aberrometric analysis showed improvement in corneal symmetry. Cross-linking was safe and an effective therapeutical option for progressive keratoconus.
To compare measurements of ultrasound, Scheimpflug, and optical coherence pachymetric techniques ... more To compare measurements of ultrasound, Scheimpflug, and optical coherence pachymetric techniques to describe ablated depth after myopic astigmatic corneal laser refractive surgery and achieved refractive correction. Ninety-six myopic astigmatism treatments using LASIK or LASEK in 58 patients with 3-month followup were retrospectively analyzed. In all cases, standard examinations, pre-/postoperative corneal topography, ocular aberrometry, and pachymetry were performed. SCHWIND Custom Ablation Manager (CAM) software and the ESIRIS laser were used for planning treatments and performing ablations. Outcomes were evaluated in terms of predictability, safety, and wavefront aberration. Pachymetry was taken before treatment (ultrasound [DGH Pachette 2], Scheimpflug [Oculus Pentacam HR], and optical coherence pachymetry [OCP] [Heidelberg-Engineering OCP]), after lifting the flap (Pachette 2, OCP), immediately after finishing ablation (Pachette 2, OCP), and at 3-month follow-up (Pachette 2, Pentacam HR). At 3 months, 87 (91%) of eyes achieved 20/20 UCVA, and 89 (93%) of eyes were within +/-0.50 diopters (D). Postoperative mean spherical equivalent refraction was -0.15 +/- 0.30 D. Best spectacle-corrected visual acuity improved in 30 (31%) of eyes. Differential pachymetry correlated to intended central ablation depth for all techniques: r2 = 0.60, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001, slope 0.81 for ultrasound; r2 = 0.75, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001, slope 0.97 for Scheimpflug; and r2 = 0.76, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001, slope 1.03 for OCR Relative differential pachymetry correlated only marginally to achieved refractive correction for ultrasound and OCP. Differential pachymetry is a metric useful for describing intended central ablation depth but not for achieved refractive correction. The rotating Scheimpflug technique offers the best estimation (closest slope to 1) and OCP offers the best correlation (closest r2 to 1) for describing intended central ablation depth achieved. The three techniques give different measurements for ablation depth, with OCP being substantially different from ultrasound and Scheimpflug. Only borderline correlations were obtained for achieved refractive correction with ultrasound and OCP.
Purpose: To evaluate postoperative clinical outcomes, and corneal High Order Aberrations, among e... more Purpose: To evaluate postoperative clinical outcomes, and corneal High Order Aberrations, among eyes with hyperopia up to +5 D of spherical equivalent, that have undergone LASIK treatments using the SCHWIND AMARIS laser system. Methods: At six-month follow-up, 100 eyes with preoperative hyperopia or hyperopic astigmatism up to +5 D of spherical equivalent were retrospectively analysed. Standard examinations, pre-and postoperative wavefront analysis with a corneal-wavefront-analyzer (OPTIKON Scout) were performed. Aberration-Free aspheric treatments were planned with Custom Ablation Manager software and ablations performed using the SCHWIND AMARIS fl ying-spot excimer laser system (both SCHWIND eye-tech-solutions). LASIK flaps were created using a LDV femtosecond laser (Ziemer Group) in all cases. Clinical outcomes were evaluated in terms of predictability, refractive outcome, safety, and wavefront aberration. Results: At six month, 90 % of eyes achieved ≥ 20/25 UCVA and 44 % achieved ≥ 20/16 UCVA. Seventy-four percent of eyes were within ± 0.25D of spherical equivalent and 89 % within ± 0.50D, with 94 % within 0.50D of astigmatism. Mean spherical equivalent was -0.12 ± 0.51D and 0.50 ± 0.51D for the astigmatism. Fifty-two percent of eyes improved BSCVA vs. only 19 % losing lines of BSCVA. Predictability slope for refraction was 1.03 and intercept +0.01 D. On average, negative corneal spherical aberrations were signifi cantly increased by the treatments, no other aberration terms changed from pre-to postoperative values. Conclusions: LASIK for hyperopia and hyperopic astigmatism with SCHWIND AMARIS yields very satisfactory visual outcomes. Preoperative refractions were postoperatively reduced to subclinical values with no clinically relevant induction of corneal HOA.
To compare the clinical outcomes of aberration-free ablation profiles based on the normal corneal... more To compare the clinical outcomes of aberration-free ablation profiles based on the normal corneal vertex (CV) and the pupil center (PC) in relation to laser in situ keratomileusis. Aberration-free aspheric ablation treatments were performed in all cases. METHODS. Two myopic astigmatism groups (CV centered using the offset between pupil center and normal corneal vertex and PC centered using the pupil center) comprising 24 and 29 eyes (16 and 19 patients), respectively, with a 6-month follow-up, were included. All enrolled eyes had Ͻ0.65 m RMS-higher order aberration (HOA) for 6.00 mm analysis diameter and pupillary offset Ͼ200 m. In all cases, standard examinations, and preoperative and postoperative wavefront analysis were performed. Custom ablation software was used to plan aberration-free aspheric treatments and a flying spot excimer laser system was used to perform ablations. The clinical outcomes were evaluated for predictability, refractive outcome, safety, ocular wavefront aberration, and asphericity. RESULTS. Of the CV eyes, 38% had improved best spectaclecorrected visual acuity (BSCVA) compared with 24% of the PC eyes (comparison CV/PC P ϭ 0.38). Induced ocular coma was on average 0.17 m in the CV group and 0.26 m in the PC group (comparison CV/PC P ϭ 0.01 favoring CV). Induced ocular spherical aberration was on average ϩ0.01 m in the CV group and ϩ0.07 m in the PC group (comparison CV/PC P ϭ 0.05 favoring CV). Change in asphericity was on average ϩ0.56 in the CV group and ϩ0.76 in the PC group (comparison CV/PC P ϭ 0.05 favoring CV). No significant shift was observed in the pupillary offset after treatments. CONCLUSIONS. In myopic eyes with moderate to large pupillary offset, CV-centered treatments performed better in terms of induced ocular aberrations and asphericity, but both centrations were identical in photopic visual acuity. (Invest Ophthalmol Vis Sci. 2008;49:5287-5294)
To evaluate the clinical outcomes of LASIK using optimized &amp;amp;amp;amp;amp;amp;amp;amp;a... more To evaluate the clinical outcomes of LASIK using optimized &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;aberration neutral&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; ablation profiles. Laser in situ keratomileusis was performed in 231 eyes (120 patients) with a mean spherical equivalent refraction of -4.12+/-2.26 diopters (D) (range: -0.37 to -9.50 D) using a SCHWIND Pendular microkeratome with a 130-microm cutting head and the SCHWIND ESIRIS excimer laser. In all cases, pre- and postoperative autorefractor measurements, manifest refraction, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), topography and corneal wavefront analysis, and ocular wavefront analysis as well as complications were analyzed. Ablations were calculated using the ORK-CAM software. Clinical outcomes were evaluated in terms of efficacy, predictability, stability, refractive outcome, safety, and wavefront aberrations. At 3 months, mean spherical equivalent refraction was -0.10+/-0.33 D (range: +0.86 to -1.18 D). Of 231 eyes, 201 (87%) were within +/-0.50 D of attempted correction. Uncorrected visual acuity was 20/16 or better in 71% (164 eyes), 20/20 or better in 92% (213 eyes), and 20/32 or better in 100%. Average root-mean-square higher order aberrations increased 0.05 microm after treatment, mean spherical aberration increased 0.08 microm after treatment, and mean coma increased 0.04 microm after treatment (all for 6.0-mm analysis diameter). Our results show that non-customized &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;aberration neutral&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; ablation profiles derived from wavefront analysis are able to minimize the amount of induced aberrations of both the cornea and the eye.
PURPOSE: To evaluate the postoperative clinical outcomes and higher-order aberrations (HOAs) in e... more PURPOSE: To evaluate the postoperative clinical outcomes and higher-order aberrations (HOAs) in eyes with astigmatism greater than 2.00 diopters (D) that had laser in situ keratomileusis (LASIK) using a non-wavefront-guided aberration-free ablation profile.
Purpose: To evaluate the clinical outcomes of aspheric corneal wavefront (CW) ablation profiles ... more Purpose: To evaluate the clinical outcomes of aspheric corneal wavefront (CW) ablation profiles in LASIK treatments.Methods: Thirty eyes treated with CW ablation profiles were included after a follow-up of 6 months. In all cases, standard examinations including preoperative and postoperative wavefront analysis with a CW topographer (Optikon Keratron Scout) were performed. Custom Ablation Manager (CAM) software was used to plan corneal wavefront customized aspheric treatments, and the ESIRIS flying spot excimer laser system was used to perform the ablations (both SCHWIND eye-tech-solutions, Kleinhostheim, Germany). Clinical outcomes were evaluated in terms of predictability, refractive outcome, safety, and wavefront aberration.Results: In general, the postoperative uncorrected visual acuity and the best corrected visual acuity improved (p < 0.001). In particular, the trefoil, coma, and spherical aberrations, as well as the total root-mean-square values of higher order aberrations, were significantly reduced (p < 0.05) when the pre-existing aberrations were greater than the repeatability and the biological noise.Conclusions: The study results indicate that the aspheric corneal wavefront customized CAM approach for planning ablation volumes yields visual, optical, and refractive results comparable to those of other wavefront-guided customized techniques for correction of myopia and myopic astigmatism. The CW customized approach shows its strength in cases where abnormal optical systems are expected. Apart from the risk of additional ablation of corneal tissue, systematic wavefront-customized corneal ablation can be considered as a safe and beneficial method.
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Papers by Camila Vidal