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

2.  Collectively we have performed >30 000 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

3. In myopia < -8.00 LASIK and ASA (Advanced Surface Ablation) provide very similar outcomes In myopia > -8.00 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

6. LASIK 12 Months LASEK 12 Months

9. 3 Months Follow-upFlap Thickness Hansatome8361136.88 ± 23.14 Hansatome XP2092141.16 ± 22.23 Rondo712115.96 ± 24.7 FS200476120.4 ± 7.6

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

15. CYLINDERSD HANSATOME0.360.34 XP0.310.30 RONDO0.280.26 FS 2000.260.20

17. Safety>-2-20+1+2>+2 LASIK 200 0.31.310.165.817.84.40.3 400 0.41.28.670.815.52.80.7 500 014652451 LASEK / ASA 200 008.652.7299.70 400 0.2210.365.617.83.40.8 500 005603582 ENHANCEMENTS 200 0.41.715.157.622.32.50.4 400 0.82.216.361.315.92.80.8 500 0013.360206.70

18. PARA- METER LASER6/46/56/66/7.56/12 UCVA2001.34363.577.587.5 4003.349.268.278.887.9 500650728893 BCVA2002.27089.697.199.5 4003.875.19197.199.3 5001587929497 UCVA, BCVA, PREDICTABILITY PREDICTABILITY 200 Hz400 Hz500 Hz ± 0.5085%83%88%

19. 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

20. 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

21. 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

22. 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

23.  85% receive WFO treatments  15% receive customized treatments  How do they compare?

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

25. WFO WFG Topography-Guided Custom-Q

26.  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 > -4.00 myopia or > 2.00 DC

27. WFO WFG T-CAT RT WFOWFG Topography-Guided RT

28.  75% receive WFO treatments  25% receive customized treatments  How do they compare?  RT not used in this cohort in this study

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

30.  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”