1. 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

2. 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; 17:S596-S601.
Moreno-Barriuso E, et al. Invest Ophthalmic Vis Sci 2001; 42:
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; 17:
Tabernero J, et al. J Opt Soc Am A 2007; 24:
Artal P, et al. Opt Soc Am A 2002; 19:

3. 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:
Total Wavefront analysis with the Zywave® aberrometer (Bausch & Lomb)

4. Spherical equivalent (D)
METHODS:
40 MIOPIC EYES 2 groups:
<45 years
>45 years p
Male/Female
40% / 60%
57,9% / 42,1%
Age (years)
28,1±5,9 (22-43)
52,8±6,4 (46-64)
Spherical equivalent (D)
-4,7±1,3 [(-4,0)-(-7,5)]
-4,9±2,4 [(-3,0)-(-8,0)]
0.76
Keratometry (D)
43,5±1,7 (40,4-45,8)
44,3±1,4 (42,5-46,8)
0.13

5. METHODS: 40 MIOPIC EYES 2 groups: <45 years >45 years
Pachymetry (µm)
552±35 ( )
567±37 ( )
0.22
Ablation depth (µm)
89,42±25,4 (50-138)
88,7±28,9(40-134)
0.95
Optical Zone (mm) 6
Corneal Z mm (µm)
0.30±0.06 (0.13 – 0.39)
0.23±0.09 (0.10 – 0.37)
0.16

6. RESULTS: CORNEAL HOA (6 mm) (µm) < 45 years > 45 years p
RMS HOA
RMS 3rd
RMS 4th
CORNEAL HOA (6 mm) (µm)
< 45 years
> 45 years p
RMS HOA
0.74±0.15
0.77±0.19
0.31
RMS 3rd
0.38±0.14
0.44±0.14
0.17
RMS 4th
0.57±0.12
0.57±0.15
0.67
Z-33
-0.04±0.15
-0.09±0.11
0.61
Z-13
-0.02±0.25
-0.05±0.24
0.88
Z13
0.05±0.22
0.03±0.28
0.64
Z33
0.04±0.17
0.03±0.22
0.91
Z04
0.54±0.12
0.52±0.15
0.77
No difference between both groups

7. RESULTS: TOTAL HOA (6 mm) (µm) < 45 years > 45 years p 0.53±0.22
RMS HOA
RMS 3rd
RMS 4th
TOTAL HOA (6 mm) (µm)
< 45 years
> 45 years p
RMS HOA
0.53±0.22
0.91±0.21
0.0002
RMS 3er
0.36±0.21
0.55±0.21
0.0027
RMS 4º
0.35±0.16
0.55±0.14
Z-33
-0.07±0.14
-0.16±0.12
0.037
Z-13
-0.22±0.20
-0.32±0.25
0.058
Z13
0.05±0.19
0.23±0.24
0.0066
Z33
-0.01±0.13
-0.04±0.18
0.43
Z04
0.33±0.16
0.53±0.12
<0.0001

8. RESULTS: INTERNAL HOA (6 mm) (µm) < 45 years > 45 years p
RMS HOA
RMS 3rd
RMS 4th
INTERNAL HOA (6 mm) (µm)
< 45 years
> 45 years p
RMS HOA
0.52±0.18
0.60±0.21
0.13
RMS 3er
0.40±0.13
0.50±0.20
0.068
RMS 4º
0.30±0.13
0.25±0.13
0.63
Z-33
-0.03±0.09
-0.07±0.15
Z-13
-0.21±0.19
-0.26±0.22
0.17
Z13
0.03±0.19
0.22±0.35
Z33
-0.05±0.18
-0.10±0.19
0.44
Z04
-0.22±0.14
0.00±0.13
<0.0001

9. 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, (2002)]
Z μm
Z μm
Z μm
≥45 YEARS
Z μm
Z μm
Z μm
<45 YEARS
TOTAL
TOTAL
CORNEAL
CORNEAL
INTERNAL
INTERNAL

10. 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
<45 YEARS
0.75 D
0.35 D
0.20 D
0.09 D
-1.51 D
-0.73 D
Z μm
Z μm

11. 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.