1. Patient Outcomes with Advanced Femtosecond Technologies Mr. Sumith Perera FRCS Mr. Jay Dermott BSc. (Optm) ULTRALASE, United Kingdom The Authors have received travel grants from Bausch & Lomb UK

2. Rationale Behind The Study Since 2004, there have been a number of innovations in laser vision correction technology. The purpose of this study is to determine whether the path of these advances offers tangible clinical advantages in outcome quality and satisfaction to the patient as the end-user. The Bausch & Lomb Z 217 Laser platform was used for all treatments The study takes a snapshot of results at five different points, designed to be indicative of typical performance at each stage.

3. Methods This retrospective multi-surgeon, multi-centre study used a cohort of 14 555 eyes stratified into five separate prescription-matched samples of 2911 eyes each, using a Neyman allocation strategy to reflect homogeneity of preoperative prescription distribution of low, medium and high myopia, hyperopia and high cylinder.

4. Further Details Review was at 1 day, 1 week, 1 month and at discharge, normally at 6 months Data for each eye in the study is given for the latest available consultation All treatments were carried out by surgeons experienced with the technology at each stage, and with established nomograms. Monovision eyes, eyes not achieving 6/6 best corrected prior to treatment, or those not attending for followup at least 1 month post-op were excluded from the study.

5. Samples Sample 1: Standard (Planoscan) microkeratome treatment, n = 2911, ♂ 51.1% ♀ 48.9%, Mean age 44.4 ± 6.1 Sample 2: Wavefront treatment, microkeratome flap n = 2911, ♂ 52.3% ♀ 47.7%, Mean age 41.2 ± 7.8 Sample 3: Wavefront treatment, femtosecond flap, n= 2911, ♂ 41.2% ♀ 58.8%, Mean age 38.6 ± 6.6 Sample 4: Advanced Personalised, femtosecond flap n = 2911, ♂ 46.2% ♀ 53.7%, Mean age 36.9 ± 7.1 Sample 5: Rochester nomogram, Rotational eyetracking, femtosecond flap n = 2911, ♂ 42.6% ♀ 57.3%, Mean age 39.8 ± 6.9

6. Uncorrected Distance Visual Acuity UDVA (Mean,LogMAR) Difference between sample 1 and sample 5, p<0.01

7. Uncorrected Distance Visual Acuity Distribution (% Achieving 6/6) Difference between sample 1 and sample 5, p<0.01

8. Uncorrected Distance Visual Acuity Distribution (% Achieving 6/4) Difference between sample 1 and sample 5, p<0.01

9. Defocus Equivalent, Proportion 0.50 or less (%) Difference between sample 1 and sample 5, p<0.01

10. Subjective Patient Satisfaction (% declaring as either “delighted” or “pleased”) Difference between sample 1 and sample 5, p<0.01

11. Conclusions This large-scale study appears to show that the technological refinements since 2004 from standard Planoscan treatment to wavefront treatment, the move to femtosecond flap creation, advanced nomogram calculation, and Advanced Control Eyetracking on the Zyoptix ® platform have brought measurable and statistically significant improvements in patient outcomes and satisfaction.