Diapositiva 1

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Corneal Wavefront vs. Ocular Wavefront Wavefront
Customised Ablation Strategies with ORK-CAM
Treatments Clinical Results
Six months experience in state-of-the-art LASIK
treatments
Maria C. Arbelaez, MD Samuel Arba Mosquera,
MS Camila Vidal, OD
The authors Arbelaez and Vidal have no
proprietary interest in the materials presented
herein
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Corneal vs. Ocular Wavefront Customised Ablation
Strategies with ORK-CAM Clinical Results
Purpose To compare the clinical outcomes of
Aspheric Corneal Wavefront ablation profiles vs.
Aspheric Ocular Wavefront ablation profiles
related to LASIK treatments on aberrated corneas.
Wavefront Customised ORK-CAM Aspheric treatments
have been performed in all cases.

• Materials
• SCHWIND ESIRIS Excimer Laser System CAM
  Software Platform ( not FDA approved)
• Ocular Wavefront Analyzer
• Corneal Wavefront Analyzer OPTIKON Keratron
  Scout
• Contrast Sensitivity Tester
• Vision Sciences Research Corporation CST 1800 D

• 2 myopic astigmatism groups, each with 50 eyes,
  were treated
• Corneal Wavefront Considering an eye-model the
  departure of the measured corneal topography to
  the theoretically optimal corneal surface is
  calculated. Optical errors centred on the
  line-of-sight are described by Zernike
  coefficients
• Ocular Wavefront High resolution Hartmann-Shack
  measurement (gt800 points for 7.0 mm pupil)
  referred to the entire eye. Optical errors
  centred on the line-of-sight are described by
  Zernike coefficients
• Treatment Selection Criteria
• All of them Wavefront Customised Aspherical
  Treatments
• Symptomatic aberrations (more than 0.25 µm RMS HO
  measured by the ORK-Wavefront Analyzer and the
  OPTIKON Keratron Scout)
• BSCVA 20/20
• Corneal / Ocular treatment randomly assigned

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SCHWIND CAM
Corneal Wavefront (Ray-Tracing) Customised
Ablation Corneal Aberrometry wavefront error
referred to the cornea. Wavefront errors up to
the 7th Zernike order Considers Optical errors
Different from Wavefront Optimised, Q-Factor, or
Topography-guided Does not depend on pupil size,
or accomodation
Ocular Wavefront (Hartmann-Shack) Customised
Ablation Ocular Aberrometry wavefront error
referred to the entire eye. Wavefront errors up
to the 10th Zernike order Aspherical customised
Different from Wavefront Optimised or Q-Val
treatments Considers Objective Ocular
refraction Different from Topography-guided
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Corneal vs. Ocular wavefront Profiles Clinical
Results
Corneal Wavefront treatments 6-month
Refractive Outcome plot shows a high level of
accuracy 65 eyes in 0.25 D, 85 eyes in 0.50 D
Ocular Wavefront treatments 6-month
Refractive Outcome plot shows a high level of
accuracy 63 eyes in 0.25 D, 86 eyes in 0.50 D
Aspherical treatments 54 eyes in 0.25 D, 83
eyes in 0.50 D
Comparison No significant difference
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Corneal vs. Ocular wavefront Profiles Clinical
Results
Corneal Wavefront treatments 6-month Safety
plot reflects accurate results 35 eyes improved
their VA, due to aberration balance in CAM
profiles.

• Ocular Wavefront treatments
• 6-month Safety plot reflects accurate results
  33 eyes improved their VA, due to aberration
  balance in CAM profiles.

Aspherical treatments 31 eyes improved
their BCVA
Comparison Slightly better for Corneal Wavefront
treatments, no statistical significance can be
concluded.
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Corneal vs. Ocular wavefront Profiles Clinical
Results
Corneal Wavefront treatments 6-month Contrast
Sensitivity Mesopic plot reflects positive
results post-op CS is slightly better than
pre-op CS
Ocular Wavefront treatments 6-month Contrast
Sensitivity Mesopic plot reflects positive
results post-op CS is slightly better than
pre-op CS
Comparison Slightly better for Corneal Wavefront
treatments, no statistical significance can be
concluded.
Aspherical treatments
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Corneal vs. Ocular wavefront Profiles Clinical
Results
Corneal Wavefront treatments 6-month
Corrected Coma for 6 mm plot reflects that 84 of
the Coma was corrected.
Ocular Wavefront treatments 6-month
Corrected Coma for 6 mm plot reflects that 72 of
the Coma was corrected.
Comparison Slightly better for Corneal
Wavefront, probably helped because Ocular Coma is
a coupling of Corneal Coma and Internal Coma.
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Corneal vs. Ocular wavefront Profiles Clinical
Results
Corneal Wavefront treatments 6-month
Corrected Trefoil for 6 mm plot reflects that 91
of the Trefoil was corrected.
Ocular Wavefront treatments 6-month
Corrected Trefoil for 6 mm plot reflects that 84
of the Trefoil was corrected.
Comparison Slightly better for Corneal
Wavefront, probably helped because Ocular Trefoil
is a coupling of Corneal Trefoil and Internal
Trefoil.
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Corneal vs. Ocular wavefront Profiles Clinical
Results
Corneal Wavefront treatments 6-month
Corrected SphAb for 6 mm plot reflects that 72
of the SphAb was balanced, probably enhanced by
the cases with higher amount of SphAb.
Ocular Wavefront treatments 6-month
Corrected SphAb for 6 mm plot reflects that 77
of the SphAb was balanced, probably enhanced by
the cases with higher amount of SphAb.
Comparison Better for Ocular Wavefront
treatments.
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Corneal vs. Ocular wavefront Profiles Clinical
Results

• Conclusions
• 6 months post-op results prove the
  predictability, efficacy, safety and stability of
  the correction by both customisations
• With this analysis no significant differences
  have been found
• Despite of trends favour
• Corneal Wavefront treatments for Efficacy,
  Safety, Contrast Sensitivity
• Ocular Wavefront treatments for Predictability,
  Refractive Outcome
• The small amount of aberrations found in both
  groups similar to the repeatability / accuracy
  (0.2 µm), introduces some scatter
• 0.48µm RMSHO, 0.25µm Coma, 0.24µm Trefoil,
  0.32µm SphAb for Corneal Wavefront group
• 0.32µm RMSHO, 0.13µm Coma, 0.21µm Trefoil,
  0.07µm SphAb for Ocular Wavefront group
• According to this analysis, there are no
  significant differents favouring CW or OW for the
  general patients
• As part of the customisation process each single
  eyes must be comprehensively analysed in order to
  apply the optimum treatment approach for its
  needs
• Customisation
• Our definition of Customisation is conceptually
  different and can be stated as

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Corneal vs. Ocular wavefront Profiles Clinical
Results

• Summary of aberrations gt0.2 µm
• Corneal Wavefront Treatments Ocular Wavefront
  Treatments
• Pre Post Change Pre Post Change
• Coma 0.38 µm 0.31 µm -19 Coma 0.35 µm 0.17
  µm -51
• Trefoil 0.35 µm 0.12 µm -66 Trefoil 0.33
  µm 0.09 µm -73
• SphAb 0.37 µm 0.31 µm -17 SphAb 0.42
  µm 0.16 µm -62

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Corneal vs. Ocular wavefront Profiles Clinical
Results

• Discussion
• From the analysis presented here, can be
  concluded that the Wavefront-guided treatments
  are not always the Gold Standard
• Wavefront customised treatments (both Corneal or
  Ocular Wavefront) can only be reasonably
  successful when the pre-existing aberrations are
  huger than the repeatability, biological noise
  and accommodation effects
• Considerations as treatment duration or tissue
  removal make more difficult to establish a
  universal optimal profile
• Discussion II
• General optimum in non-wavefront-driven
  refractive surgery is to balance the effects on
  the Wavefront aberration, and, to provide normal
  eyes with the best quality of vision, without
  affecting their perception of the world
• Ocular Wavefront treatments have the advantage of
  being based on Objective Refraction of the
  complete human eye system
• Corneal Wavefront treatments have the advantage
  of being independent from accommodation effects
  or light/pupil conditions

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Thank you very much for your kind attention!