Arthur Cummings, Richard Corkin Wellington Eye Clinic UPMC Beacon Hospital, Dublin ICO Cavan, 12 th May 2011

 Collectively we have performed > LASIK, LASEK and PRK procedures  All surgery performed by AC or RC  WaveLight Allegretto 200, 400 & 500 Hz lasers  Hansatome, XP, Rondo, WaveLight FS200  This paper is made up of a collection of papers that have been presented over the past few years

In myopia < LASIK and ASA (Advanced Surface Ablation) provide very similar outcomes In myopia > LASIK provides better and more stable outcomes A great percentage of eyes gain lines of BCVA in the higher myopia group LASIK outperforms ASA for hyperopia

LASIK 12 Months LASEK 12 Months

3 Months Follow-upFlap Thickness Hansatome ± Hansatome XP ± Rondo ± 24.7 FS ± 7.6

Epithelial ErosionsButton Hole / Free Cap Hansatome3.2%0 Hansatome XP1.1%0 Rondo0.1%0 FS20000

CYLINDERSD HANSATOME XP RONDO FS

Safety> >+2 LASIK LASEK / ASA ENHANCEMENTS

PARA- METER LASER6/46/56/66/7.56/12 UCVA BCVA UCVA, BCVA, PREDICTABILITY PREDICTABILITY 200 Hz400 Hz500 Hz ± %83%88%

Primary treatments have better safety profiles than secondary treatments Enhancement surgery has a very high success rate in terms of improving UCVA It does however lead to more loss of lines of BCVA than the primary procedure This is true for myopia & hyperopia as well as LASIK and ASA “Get it right the 1 st time” has merit

LASIK 6 Months 7.2% of Myopic LASIK eyes lose 1 or more lines of BCVA while 15.7% of LASIK Enhancement eyes lose 1 or more lines of BCVA. 1.1% of enhancement eyes lose >2 lines of BCVA which very comfortably meets the FDA requirements of a safe procedure (less than 5% should lose >2 lines) Enhancements 6 Months

6.9% of Myopic LASEK eyes lose 1 or more lines of BCVA while 9.8% of LASEK Enhancement eyes lose 1 or more lines of BCVA. 0.3% of LASEK eyes lose >2 lines of BCVA which very comfortably meets the FDA requirements of a safe procedure (less than 5% should lose >2 lines) LASEK 6 MonthsEnhancements 6 Months

The WaveLight Allegretto offers the widest range of refractive tools in the form of: WaveFront Optimised treatments WaveFront-Guided treatments Topography-Guided profiles (2 modes) Asphericity-Guided profiles Ray-Tracing profiles

 85% receive WFO treatments  15% receive customized treatments  How do they compare?

 Compare 4 profiles across all refractive errors  WFO  WFG  T-CAT  Custom-Q

WFO WFG Topography-Guided Custom-Q

 European Multicentre Trial completed  3 Centres (Zurich, Cologne, Dublin)  132 Eyes treated, 111 with full follow-up  Ray Tracing was only done on Primary treatments in this clinic trial  All eyes > myopia or > 2.00 DC

WFO WFG T-CAT RT WFOWFG Topography-Guided RT

 75% receive WFO treatments  25% receive customized treatments  How do they compare?  RT not used in this cohort in this study

WFO enhancementWFG enhancement Custom Q enhancementT-CAT enhancement WFO enhancementWFG enhancement Custom Q enhancement T-CAT enhancement SAFETY

 LASIK and ASA have proven to be very effective and safe  LASIK better than ASA in high myopia / hyperopia  Primary treatments safer than Secondary treatments  Different profiles have different applications  Ray Tracing promises to get closer to the “holy grail”