LADARVision4000%20%20%20%20%20Vs%20%20VISX%20CustomVue

1

• LADARVision4000 Vs VISX CustomVue
• CustomCornea
• 
  
• A Comparison of Wavefront Guided
• Refractive Surgery outcomes of LASIK

STAR S4 IR Excimer Laser System
Capt J. Richard Townley, MD Lt Col Charles D
Reilly, MD
Disclaimer
-This presentation does not reflect the official
views of the US Army, Air Force, or
government -There are no financial ties to VISX
or Alcon
2
Differences between the two laser platforms
LADARVision CustomCornea System
VISX CustomVue STAR S4 IR Excimer Laser System

• Among smallest-spot beam in industry
• Small-Spot (lt1mm) Scanning
• Minimized acoustic shock
• Depends on dilated pupil and preoperative
  peri-limbal demarcation to account for
  intraoperative cyclotorsion

• Combines advantages of larger and smaller
  diameter beams
• Minimize volume of tissue removed
• Smooth ablation
• Relies on iris registration to account for proper
  orientation of the preoperative wavescan for the
  intended treatment

3
Study Design
Objectives To analyze the US Air Force
Warfighter Refractory Surgery program to
determine whether there was a difference in
treatment outcomes between wavefront-guided LASIK
performed with LADARVision4000 CustomCornea vs.
VISX CustomVue.
Methods This study analyzed over 8,000 eyes
that had undergone refractive surgery by the USAF
over the past 8 yrs. Out of those 8000 eyes 936
had received custom Lasik treatments on either
the VISX or LADAR4000 platforms. Since the vast
majority of those eyes were treated with VISX,
the 22 eyes that had been treated on LADAR were
closely matched for age, gender, and pre-op
refractive errors with those treated with VISX.
All patients included in the study were operated
on by the same surgeon and used the same
keratome. Each of the eyes that were treated
were followed up at 1, 3, and 6 months after
surgery and the outcomes that were compared
between the two laser platforms based on their
uncorrected visual acuity (UCVa), best corrected
visual acuity (BCVa), manifested refractions
(MRx), and any documented complications.
4
Preoperative Patient Characteristics
Characteristics LADARVision CustomCornea VISX Custumvue P Value
No. Eyes 22 60
Mean Age 32.2 (22-43) 34.11 (22-48)
Males 68 66
Females 31 33
Mean Sphere -4.875 (-8.00 to -2.75) -4.34 (-8.00 to -2.75) 0.2173
Mean Cyl 0.93 (0.0 to 3.50) 0.69 (0.0 to 2.50) 0.3137
Mean SE -4.41 (-7.60 to -2.40) -4.00 (-7.50 to -2.38) 0.3610
5
1 Month Results
Characteristics LADARVision CustomCornea VISX Customvue P Value
Eyes at F/U 22 47
Mean Sphere 0.166 /- 0.33 -0.074 /- 0.39 0.0172
Mean Cyl 0.222 /- 0.33 0.212 /- 0.25 0.9137
Mean SE 0.11 /- 0.19 0.034 /- 0.35 0.2307
6
3 Months Results
Characteristics LADARVision CustomCornea VISX Customvue P Value
Eyes at F/U 15 36
Mean Sphere 0.1875 /- 0.73 -0.215 /- 0.43 0.1701
Mean Cyl 0.0625 /- 0.48 0.215 /- 0.24 0.4045
Mean SE 0.047 /- 0.13 -0.083 /- 0.33 0.6169
7
6 Months
Characteristics LADARVision CustomCornea VISX Customvue P Value
Eyes at F/U 10 36
Mean Sphere 0.031 /- 0.28 -0.076 /- 0.37 0.7074
Mean Cyl 0.25 /- 0.30 0.181 /- 0.22 0.5504
Mean SE 0.156 /- 0.27 -0.013 /- 0.37 0.2369
8
Which Laser Platform Achieved the Attempted
Treatment?
9
Conclusions

• One patient treated with LADAR was noted to have
  a small amount of micro striae post-op month
  three that spontaneously resolved by post-op
  month six. No other complications were observed
  in either group
• This study illustrated that although the
  LADAR6000 was pulled from the market due to
  residual central islands, wavefront-guided LASIK
  using the Visx CustomVue system or
  LADARVision4000 were effective, predictable, and
  safe for correction of moderate to high myopic
  refractive errors.
• One of the only notable difference was that most
  LADAR treatments resulted in plano to slightly
  hyperopic postoperative spherical equivalents
  while the VISX platform post-op SE had greater
  variation between slightly myopic and hyperopic
  outcomes. However these differences could be
  accounted for due to differences in the sample
  sizes between the two groups.

10
Future Studies

• Increased Sample Size
• Prospective Randomized Control Analysis
• Studies of Vision Quality
• Subjective Analysis with personal surveys
• Contrast Sensitivity Comparison
• Pre and Post Higher Order Aberration Comparison

11
References

• Awwad ST et al. Wavefront-guided laser in situ
  keratomileusis with Alcon CustomCornea and VISX
  CustomVue three-month results. J Refract Surg.
  2004 20 606-613
• Michael D. et.al. A Prospective Randomized
  Clinical Trial of Laser In Situ Keratomileusis
  With Two Different Lasers Am. J. Ophthalmol
  -01-AUG-2005 140(2) 173.1-11
• Michael S. et al. Comparison of LADARVision and
  Visx Star S3 laser in situ keratomileuisis
  outcomes in myopia and hyperopia. J Cataract
  Refract Surg 01-DEC 2003 29 2351-6
• Raymond P. G. et.al. Comparison of LASIK outcomes
  with Alcon LADARVision4000 and the VISX STAR S2
  Excimer Laser Using Optimized Nomograms. J
  Refract Surg. NOV 2005 21 683-690
• Sale et. al. Contralateral comparison of Alcon
  CustomCornea and VISX CustomVue wavefront-guided
  laser in situ keratomileusis one-month results.
  J Refract Surg. 2004 20 601-605
• Shady T. et. al. Wavefront-Guided LASIK for
  Myopia Using the LADAR CustomCornea and the VISX
  CustomVue. J Refract Surg JAN 2007 23 26-38
• Seiler T et al. Myopic photorefractive
  keratectomy with the excimer laser. One-year
  follow-up. Ophthalmology, 1991 981156-1163
• Seward MS et. al. Comparison of LADARVision and
  VISX Star S3 laser in situ keratomileusis
  outcomes in myopia and hyperopia. J Cataract
  Refract Surg. 2003 292351-2357
• Tobaigy FM. A control-matched comparison of laser
  epithelial keratomileusis and laser in situ
  keratomileusis for low to moderate myopia.  Am J
  Ophthalmol - 01-DEC-2006 142(6) 901-8