Diapositiva 1

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Age-related difference in Lasik Treatment
J. Orbegozo Gárate B. de Luis Eguileor V. Díaz
Lacalle
CENTRO OFTALMOLÓGICO INTEGRAL . BILBAO - SPAIN
ASCRS /ASOA Chicago 2008
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INTRODUCTION
In eyes after Lasik, the Higher Order Aberrations
change (spherical aberration increase). Most
changes to the total aberration pattern can be
attributed to change in the anterior corneal
aberrations. Marcos S. J Refract Surg 2001
17S596-S601. Moreno-Barriuso E, et al. Invest
Ophthalmic Vis Sci 2001 421396-1403.
The balance between the aberrations of the
corneal and the internal surfaces changes with
the age. As the lens grows, its dimensions,
surface curvatures, and refractive index change,
altering the lens aberrations. Guiaro A, et al. J
Opt Soc Am A 2000 171697-1702. Tabernero J, et
al. J Opt Soc Am A 2007 243274-3283. Artal P,
et al. Opt Soc Am A 2002 19137-143.
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PURPOSE
To evaluate the High Order Aberrations (HOA) in
eyes after Laser in situ keratomileusis (LASIK)
as a function of age.
METHODS

• Preoperative Evaluation for the study
• Corneal topography with Orbscan IIz (Bausch
  Lomb)
• Manifest and Cycloplegic refraction
• Analysis of HOA with CTView software
• LASIK performed with
• Technolas 217z system (Bausch Lomb)
• Postoperative evaluation for the study
• Corneal topography with Orbscan IIz (Bausch
  Lomb)
• Total Wavefront analysis with the Zywave
  aberrometer (Bausch Lomb)
• Analysis of HOA with CTView software

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METHODS
40 MIOPIC EYES 2 groups 40 MIOPIC EYES 2 groups 40 MIOPIC EYES 2 groups 40 MIOPIC EYES 2 groups 40 MIOPIC EYES 2 groups
lt45 years lt45 years gt45 years p
Male/Female 40 / 60 57,9 / 42,1 57,9 / 42,1
Age (years) 28,15,9 (22-43) 52,86,4 (46-64) 52,86,4 (46-64)
Spherical equivalent (D) -4,71,3 (-4,0)-(-7,5) -4,92,4 (-3,0)-(-8,0) -4,92,4 (-3,0)-(-8,0) 0.76
Keratometry (D) 43,51,7 (40,4-45,8) 44,31,4 (42,5-46,8) 44,31,4 (42,5-46,8) 0.13
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METHODS
40 MIOPIC EYES 2 groups 40 MIOPIC EYES 2 groups 40 MIOPIC EYES 2 groups 40 MIOPIC EYES 2 groups 40 MIOPIC EYES 2 groups
lt45 years lt45 years gt45 years p
Pachymetry (µm) 55235 (500-611) 56737 (500-630) 56737 (500-630) 0.22
Ablation depth (µm) 89,4225,4 (50-138) 88,728,9(40-134) 88,728,9(40-134) 0.95
Optical Zone (mm) 6 6 6
Corneal Z40 6 mm (µm) 0.300.06 (0.13 0.39) 0.230.09 (0.10 0.37) 0.230.09 (0.10 0.37) 0.16
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RESULTS
µm
RMS 4th
RMS 3rd
RMS HOA
CORNEAL HOA (6 mm) (µm) CORNEAL HOA (6 mm) (µm) CORNEAL HOA (6 mm) (µm) CORNEAL HOA (6 mm) (µm)
lt 45 years gt 45 years p
RMS HOA 0.740.15 0.770.19 0.31
RMS 3rd 0.380.14 0.440.14 0.17
RMS 4th 0.570.12 0.570.15 0.67
Z-33 -0.040.15 -0.090.11 0.61
Z-13 -0.020.25 -0.050.24 0.88
Z13 0.050.22 0.030.28 0.64
Z33 0.040.17 0.030.22 0.91
Z04 0.540.12 0.520.15 0.77


No difference between both groups
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RESULTS
µm
RMS 4th
RMS 3rd
RMS HOA
TOTAL HOA (6 mm) (µm) TOTAL HOA (6 mm) (µm) TOTAL HOA (6 mm) (µm) TOTAL HOA (6 mm) (µm)
lt 45 years gt 45 years p
RMS HOA 0.530.22 0.910.21 0.0002
RMS 3er 0.360.21 0.550.21 0.0027
RMS 4º 0.350.16 0.550.14 0.0002
Z-33 -0.070.14 -0.160.12 0.037
Z-13 -0.220.20 -0.320.25 0.058
Z13 0.050.19 0.230.24 0.0066
Z33 -0.010.13 -0.040.18 0.43
Z04 0.330.16 0.530.12 lt0.0001
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RESULTS
µm
RMS HOA
RMS 4th
RMS 3rd
INTERNAL HOA (6 mm) (µm) INTERNAL HOA (6 mm) (µm) INTERNAL HOA (6 mm) (µm) INTERNAL HOA (6 mm) (µm)
lt 45 years gt 45 years p
RMS HOA 0.520.18 0.600.21 0.13
RMS 3er 0.400.13 0.500.20 0.068
RMS 4º 0.300.13 0.250.13 0.63
Z-33 -0.030.09 -0.070.15 0.13
Z-13 -0.210.19 -0.260.22 0.17
Z13 0.030.19 0.220.35 0.13
Z33 -0.050.18 -0.100.19 0.44
Z04 -0.220.14 0.000.13 lt0.0001
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CONCLUSIONS
FOR THE SAME LASIK MYOPIC TREATMENT THE SPHERICAL
ABERRATION INCREASES WITH THE AGE. The
degradation of the ocular optics with age can be
explained largely by the loss of the balance
between the aberrations of the corneal and the
internal surfaces. Artal P, Berrio E, Guirao A.
Contribution of the cornea and internal surfaces
to the change of ocular aberratons with age. J.
Opt. Soc. Am. A 19, 137-143 (2002)
45 YEARS
lt45 YEARS
TOTAL
TOTAL
CORNEAL
CORNEAL
INTERNAL
INTERNAL
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CONCLUSIONS
OLDER SUBJECTS HAVE GREATER SPHERICAL ABERRATION
(POSITIVE) THAT SUGGEST A MINOR DEPTH OF FOCUS
AND WORSE NEAR VISION. In patients with no
accommodation, zero spherical aberration still
provides the best quality image. However, a small
amount of negative spherical aberration affords
an improvement in near vision. Cheryl
Guttmann. Researchers conclude zero spherical
aberration equates with optimal visual
performance. Eurotimes November 2007
45 YEARS
lt45 YEARS
0.35 D
0.75 D
0.09 D
0.20 D
-0.73 D
-1.51 D
Z04 0.24 µm
Z04 0.51 µm
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CONCLUSIONS
THE DEGRADATION OF THE OCULAR OPTICS THAT OCCURS
WITH AGE INCREASE WITH LASER IN SITU
KERATOMILEUSIS. THE RESULTS CAN BE WORSE FOR
OLDER PATIENTS.
CAN BE NECESSARY TO MEASURE THE TOTAL, INTERNAL
AND CORNEAL ABERRATIONS IN THE PREOPERATIVE
EVALUATION TO DETERMINE THE BEST TREATMENT IN A
MYOPIC PATIENT.