1. Importance of Oculign Eye Registration with the ZEISS MEL 80 LASER FRANK GOES MD GOES EYE CENTRE ANTWERP BELGIUM frank@goes.be

2. CRS-Master OcuLign Eye Registration Aim:  Exact positioning of customized treatment on the eye  Coincidence of diagnostic and treatment location Compensates for: Pupil centre shift between photopic and scotopic pupil size Pupil centre shift between photopic and scotopic pupil size Rotation of the eye between measurement and treatment Surgical image of MEL 80 eyetracker camera

3. OcuLign- WASCA Wavefront Acquisition WASCA Reference Image MEL 80 Surgical Image Two pictures are taken;one at the wavescan and one at the laser The software identifies Iris and Limbus details and matches the images Then the laser Rotates the axis of the treatment to compensate for the offset

4. IS THERE ANY TORSION? Knorz et al: Review of Ophthalmology; 2006 Torsion in 10% of eyes more than 7° Ciccio et al: Journal of Refractive Surgery; 2005 Majority of eyes had torsion Mean:4.05° More than 2°:in 68% eyes Kohnen et al: Cataract and Refractive Surgery today; 2006 Torsion:mean value 3.2° in 58% more than 2°

5. THE HIGHER THE ASTIGMATISM THE MORE EFFECT TORSION MISALIGNMENT WILL HAVE

6. DO TORSION AND PUPIL SHIFT CHANGE DURING TREATMENT? WE MEASURED 100 CONSECUTIVE EYES BEFORE THE MICROKERATOME CUTBEFORE THE MICROKERATOME CUT AFTER THE MICROKERATOME CUTAFTER THE MICROKERATOME CUT AT END OF THE LASER TREATMENTAT END OF THE LASER TREATMENT

7. 100 EYES RESULTS FOR TORSION before cut Mean 3.3° At least 10° in 7%At least 5° in 32% Before Microkeratome Cut

8. At least 0,25 mm in 30% Before Microkeratome Cut At least 0,25 mm in 10% 100 EYES RESULTS FOR OFFSET before cut

9. PUPIL OFFSET CHANGE DURING TREATMENT More than 0.2 mm in only 5 % More than 0.2 mm in only 2 %

10. TORSION CHANGE DURING TREATMENT Mean 1.3° More than 3° in only 5%

11. RESULTS TREATMENT ASTIGMATISM USING OCULIGN 28 EYES

12. OCULIGN CONCLUSION...PUPIL CENTROID SHIFT AND TORSION ARE ADDRESSED BY THE LIMBUS TRACKER. 30% OF EYES HAVE MORE THAN 5° STATIC TORSION AND MORE THAN 0.25 MM OFFSET BEFORE TREATMENT 30% OF EYES HAVE MORE THAN 5° STATIC TORSION AND MORE THAN 0.25 MM OFFSET BEFORE TREATMENT ONCE INSTALLED TORSION AND OFFSET DOES NOT CHANGE ANYMORE ASTIGMATISM TREATMENT USING OCULIGN IS HIGLY EFFICIENT  OCULIGN TM IS the right way to go