Laser Vision Correction for Myopia, Myopic Astigmatism, Hyperopia and Hyperopic Astigmatism with CustomVis Solid State Laser (213nm) THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF OPHTHALMOLOGISTS 24 – 28 NOVEMBER, 2007 Dr. Ian Anderson Dr. Paul van Saarloos Dr. Gabriel Marin Dr. Tarak Pujara

Purpose To evaluate the clinical efficiency, predictability and safety of a new high speed, 0.6 mm Gaussian shaped flying spot, 213nm solid state laser for the correction of myopia, myopic astigmatism, hyperopia, hyperopic astigmatism in laser in situ keratomileusis (LASIK). To evaluate the clinical efficiency, predictability and safety of a new high speed, 0.6 mm Gaussian shaped flying spot, 213nm solid state laser for the correction of myopia, myopic astigmatism, hyperopia, hyperopic astigmatism in laser in situ keratomileusis (LASIK). All Lasiks performed at eight international sites. All Lasiks performed at eight international sites. Compare these results to personal results using Advanced Surface Ablation ( PRK, Lasek & eppi- lasek) Compare these results to personal results using Advanced Surface Ablation ( PRK, Lasek & eppi- lasek) Data collection done by ophthalmic assistant. Data collection done by ophthalmic assistant.

CustomVis™ Pulzar™ Z1

Solid State Laser Source Diode-pumped Nd:YAG laser Three non-linear crystals generate the 213nm wavelength Eliminates need for toxic gases and storage Energy efficient; no high voltage requirements Low maintenance

UV Spectrum BSS Transmission (%) Depth (µm) (Dair et al., 2001) 213nm has a significantly higher transmission through 0.9% NaCl and BSS than 193nm (Jain et al., 2004; unpublished data) UV Wavelengths (220nm – 190nm) 0.9% NaCl Transmission 213nm 193nm 213nm transmits 1620 times more than 193nm in 0.9%NaCL

ZCAD Treatment Planning Choices Choices  Optical Zone/ Treatment zone  Blend type :- tissue saving, refractive, linear  Treatment :- Standard, Topography, Wavefront Review Review  Post operative topography  Post op Residual thickness map

LASIK Patients 436 eyes with myopia up to D and astigmatism up to -5.5 D. 436 eyes with myopia up to D and astigmatism up to -5.5 D. 195 eyes with hyperopia up to +6 D and mixed astigmatism up to -6.5 D. 195 eyes with hyperopia up to +6 D and mixed astigmatism up to -6.5 D. All Underwent Laser Vision Correction at eight different sites. All Underwent Laser Vision Correction at eight different sites. All cases were followed for minimum 3 months. All cases were followed for minimum 3 months. All data were collected by Ophthalmic Assistants and were evaluated by all surgeons. All data were collected by Ophthalmic Assistants and were evaluated by all surgeons.

Surface Ablation Patients 62 Eyes with myopia up to -6D and astigmatism up to -4D 62 Eyes with myopia up to -6D and astigmatism up to -4D Majority with abnormal corneas Majority with abnormal corneas  Less than 500microns  Irregular astigmatism  Scarring, RK, PK  Recurrent Erosions  Very Large pupils

Lasik Myopia and Myopic Astigmatism (SE ≥ -15D) With minimum 3 months follow-up (n=436) Note: The graph has some overlapping points

LASIK Visual Results

Myopia and Myopic Astigmatism Attempted vs Achieved Correction UCVA

Lasik Hyperopia and Mixed Astigmatism Post-Op UCVA At latest follow-up of 3 months (n=195) UCVA Attempted Vs Achieved

Summary Myopia/ Astigmatism Lasik Surface Myopia/ Astigmatism Lasik Surface  LASIK 84% (95%)were ± 0.5 D and 98% (100%) were ± 1 D of intended correction  Uncorrected Visual Acuity 6/6 in 74% (75%) and 6/12 was achieved in 88% (98) of eyes.  BSCVA was improved by 1 line in 22 eyes and no eye lost over 1 line of BSCVA. Hyperopia/ Astigmatism Hyperopia/ Astigmatism  68% were ± 0.5D and 88% were ± 1D of intended correction  86% of 195 Hyperopic cases had 6/6 UCVA post operatively.

Conclusions The Clinical Data supports the safety, predictability and effectiveness of the PULZAR Z1 Solid State Refractive Laser (213nm) for the correction of a whole range of refractive treatments including high myopia, hyperopia and mixed astigmatism using both Lasik and Surface Ablation. The Clinical Data supports the safety, predictability and effectiveness of the PULZAR Z1 Solid State Refractive Laser (213nm) for the correction of a whole range of refractive treatments including high myopia, hyperopia and mixed astigmatism using both Lasik and Surface Ablation. CustomVis™ Pulzar Z1 laser system is a good alternative to conventional Excimer systems. CustomVis™ Pulzar Z1 laser system is a good alternative to conventional Excimer systems.

Thank You Ride for Youth

My Personal Results with PULZAR Z1