1. Sze H. Wong Emil W. Chynn, MD, MBA Maximiliano Plana, MD Emily Ceisler, MD ASCRS, May 2013 San Francisco, CA LASEK /Epi-LASIK to treat amblyopes is not FDA-approved.

2. Can adult strabismic and/or refractive amblyopes be safely and effectively treated with Advanced Surface Ablation (ASA)? Can UCVA, BCVA, functional vision be improved? Can strabismus be decreased?

3. Retrospective review of adult amblyopes who underwent LASEK or Epi-LASEK with a VISX S4 IR excimer laser between 2006-2013 Adjunctive treatment to prevent scarring: Mitomycin C (MMC) 0.01% intraoperatively Oral + Topical steroids: 1-6 mo postop Vitamin C + UV protection: 6-12 mo postop

4. n = 24 eyes Female54 % Male46 % Age (mean ± SD; range)31 ± 9; 22 - 52 Strabismic4 % Anisometropic Refractive29 % Isometropic Refractive67 % LASEK79 % Epi-LASEK21 % WaveFront42 % Rx Range (SE)-14 to +7.50 Preop BCVA logMAR0.27 ± 0.23 Preop Corneal Thickness588 ± 41 µm Ablation Depth99 ± 41 µm Postop Corneal Thickness489 ± 69 µm

5. 20/200 Postop UCVA vs Preop UCVA: 100% had improvement in UCVA Corneal haze: trace 29%, 1+ 4%, 2+ 4% There was no loss of UCVA (haze = clin. insig.) UCVA Log MAR error bar = sd 20/20 PreOpPostOp (months) 20/2000

6. Postop vs Preop BCVA: Mean gain of BCVA of 1.43 lines (± 1.11) 87.5% had improved BCVA

7. Correlation coefficient = 0.62 Postop BCVA Minus Preop BCVA (logMAR) Spherical Equivalent Hyperopic amblyopes with lower Rx have more BCVA improvement

8. Unilateral (anisometropic) amblyopes had a greater improvement in BCVA (2.5 lines) than Bilateral (isometropic) amblyopes (1.0 line) (1-tailed p value 0.04)

9. FUNCTIONAL VISION better peripheral vision: 63% improved driving: 58% increased sports ability: 29% STRABISMUS ETpreop: 20Δ postop: 8Δ UCVA preop: 20/200postop: 20/30 BCVA preop: 20/30-1 postop: 20/25 Would do it again?YES! PATIENT SATISFACTION 76% would undergo the operation again if given the choice

10. Adult strabismic/refractive amblyopes may be safely & effectively treated with ASA No loss of UCVA (all scarring was clinically insignificant due to adjunctive measures) Significant gains in BCVA & functional visual improvement, with excellent patient satisfaction Better results for unilateral refractive amblyopes and low hyperopes Further investigation is necessary, especially in strabismic amblyopes (low n)

11. Tychsen L. Refractive surgery for children: excimer laser, phakic intraocular lens, and clear lens extraction. Curr Opin Ophthalmol. 2008 Jul;19(4):342-8.