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Intraoperative Aberrometry Mark Packer, MD, FACS Clinical Associate Professor Oregon Health & Sciences University.

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Presentation on theme: "Intraoperative Aberrometry Mark Packer, MD, FACS Clinical Associate Professor Oregon Health & Sciences University."— Presentation transcript:

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2 Intraoperative Aberrometry Mark Packer, MD, FACS Clinical Associate Professor Oregon Health & Sciences University

3 Mark Packer, MD Financial Disclosure (*stock options) Abbott Medical Optics, Inc. Advanced Vision Science, Inc. Bausch & Lomb Surgical, Inc. Carl Zeiss Surgical, Inc. Celgene, Inc. GE Healthcare Haag-Streit USA Ista Pharmaceuticals LensAR, Inc.* Rayner Intraocular Lenses, Ltd. Surgiview LLC* Transcend Medical, Inc.* TrueVision Systems, Inc.* WaveTec Vision Systems* April 1, 2010

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5 Purpose To determine the effect of intraoperative wavefront- guided enhancement of limbal relaxing incisions on the rate of postoperative excimer laser enhancement

6 ORange Aberrometer Talbot moire interferometry Fourier transform Calculation of spectacle correction

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9 Methods Retrospective chart review Patients having limbal relaxing incisions (LRIs) at the time of cataract or RLE surgery May 2007 to June 2009 August 2008  ORange – WaveTec, Inc., Aliso Viejo, CA

10 Methods Standardized LRI technique –Sim Ks (EyeSys, Tracey, Inc) –Nichamin nomogram –After IOL insertion (IOP ≥ 25 mm Hg) –10 mm OZ –Ruminson Astigmatic Gauge and Marker (Rhein Medical, Tampa, FL) –90% depth Cornea Gage Plus (Sonogage, Cleveland, OH) Stealth Triamond (Mastel Precision, Rapid City, SD)

11 Methods Enhancement by extending arcs –measured axis ± 15º of expected (SIA + 0.5 D @ 90º) –residual cylinder ≥ 1.0 D.

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15 Results - Total 67 eyes of 48 patients –62.6 ± 9.0 years –Mean pre op ∆K = 1.4 –Mean steep axis = 85º –Mean 10 mm pachy = 674 µ Post op MR Cyl at 29 days (n = 66) = 0.42 D Post op MR Cyl at 7 months (n = 34) = 0.59 D

16 Results – Group 1 37 eyes of 27 patients Not measured with intraoperative aberrometry –63.5 ± 9.0 years –Mean pre op ∆K = 1.5 D (0.51 – 2.64) –Mean steep axis = 83º –Mean pre op 10 mm pachy = 679 µ Post op MR Cyl at 33 days (n =36 ) = 0.48 D Post op MR Cyl at 9 months (n = 20) = 0.53 D

17 Results – Group 2 Total 30 eyes of 21 patients Measured with intraoperative aberrometry –61.5 ± 9.1 years –Mean pre op ∆K = 1.28 D (0.52 – 3.25) –Mean steep axis = 87º –Mean pre op 10 mm pachy = 668 µ Post op MR Cyl at 24 days (n = 28) = 0.37 D Post op MR Cyl at 5 months (n = 14) = 0.41 D

18 Mean Preoperative Characteristics Group 1Group 2p-value Age, years63.561.50.34 ∆K, D1.51.280.40 Axis, º 83870.21 Pachy, µ 6796680.42

19 Postoperative Characteristics Group 1Group 2 Mean Sphere-0.27 -0.33 Mean MRSE +0.0-0.15 Median UCVA20/2520/25 MR Cyl0.480.37 ≥ 0.75 D10 (27%)7 (23%) ≥ 1.00 D 9 (24%)2 (6.6%) ≥ 1.25 D 4 (11%)1 (3.3%)

20 Group 1: ∆K v MR Cyl

21 Group 2: ∆K v MR Cyl

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24 Results – Group 2 Enhanced 8 eyes of 6 patients Enhanced with extended LRIs –62.2 ± 12.5 years –Mean pre op ∆K = 1.75 D (0.87 – 3.25) –Mean steep axis = 82º –Mean pre op 10 mm pachy at steep axis = 655 µ Post op MR Cyl at 29 days (n = 8) = 0.31 D Post op MR Cyl at 6 months (n = 3) = 0.42 D

25 Group 2 (LRI enhanced): ∆K v MR Cyl

26 Results – Laser Enhanced 7 eyes of 5 patients (7/67 = 10.5%)

27 Results – Laser Enhanced Without aberrometry (Group 1)  6/37 = 16.2% 59.8 ± 3.7 years Mean pre op ∆K = 1.70 D (0.76 – 2.32) Mean steep axis = 95º Mean 10 mm pachy at steep axis = 664 µ Before excimer at 2 - 11 months MRSE = -0.39 D (-1.1 – 0.38) MR Cyl = 1.45 D (1.0 – 2.5)

28 Results – Laser Enhanced With aberrometry (Group 2)  1/30 = 3.3% –58 years –Pre op ∆K = 2.61 D –Steep axis = 78º –Pre op 10 mm pachy at steep axis = 658 µ Before excimer (1 month) MRSE = -0.50 D MR Cyl = 1.00 D

29 Laser enhanced: ∆K v MR Cyl

30 Comparison of Enhanced Eyes Non-ORange w/LASIK enh n = 6/37 (16.2%) ORange w/LASIK enh n = 1/30 (3.3%) ORange w/LRI enh n = 8/30 (26.7%) Age: Mean, SD59.8 + 3.75862.2 + 12.5 Pre-Op Delta K 1.70 D (0.76 - 2.32) 2.61 D1.75 D (0.87 - 3.25) Steep Axis95º78º82º Pre-op 10mm Pachymetry 664 microns658 microns655 microns Post LRI 1.45 D (1.0 - 2.5) 1 month (n = 6) 1.00 D 1 month (n = 1) 0.31 D (0.00 – 1.00) 1 month (n = 8) Post LASIK 0.95 + 0.29D 7-16 months (n = 6) 0.42D 6 months (n = 3)

31 Conclusion Intraoperative wavefront guided enhancement of LRIs reduced the rate of postoperative excimer laser enhancement from 16.2% to 3.3%, an odds ratio of 5.71 (p=0.12).

32 Conclusion Small case-control study indicates a trend Further research (prospective, randomized) indicated to validate effect

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