Moderator
Neda Nikpoor, MD, ABO
Panelists
Cristos Ifantides, MD, MBA, ABO
John F. Doane, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Eliya Levinger, MD
Co-Authors
Nadav Shemesh MD, Asaf Achiron MD, Adi Abulafia PhD, MD, Nir Sorkin MD
Purpose
The objective of this study was to evaluate adverse events following photorefractive keratectomy in patients who received 2 days preoperatively and 3 days postoperatively Nepafenac treatment, including pain, stinging, tearing, light sensitivity, and stress levels.
Methods
The study included a retrospective analysis of 66 patients grouped into two groups: underwent bilateral alcohol assisted photorefractive keratectomy (PRK) and transepithelial photorefractive keratectomy (transepithelial-PRK). Nepafenac was administered for pain control, with patients receiving three to five drops for two days before the surgery and three days postoperatively in accordance with clinical instructions. Patients completed questionnaires on the day of the surgery and for the first five days postoperatively.
Results
The study examined 66 patients (49% female) with a mean age of 25.11±6.81 years. The mean baseline SE was -3.16±2.20 D. Among these patients, 33 patients underwent PRK and 33 patients underwent transepithelial-PRK. The study found that the PRK group experienced significantly higher levels of pain than the transepithelial-PRK group (p=0.003). However, there was no significant difference between the groups in the average levels of stinging, tearing, or light sensation. Additionally, stress levels decreased over time in both groups, with levels becoming almost equal after five days, and there was no significant difference in the average stress levels between the two groups.
Conclusion
The study found that patients who underwent PRK procedure had significantly higher pain levels compared to those who underwent transepithelial-PRK, after being treated with Nepafenac for three days. However, there was no significant difference between the two groups in terms of stinging, tearing, light sensation, and stress levels.
Presenting Author
Daniel Terveen, MD
Co-Authors
Elise Meide MS, Tanner Ferguson MD, John Berdahl MD, Vance Thompson MD
Purpose
To compare post-operative visual and patient-reported outcomes of topography-guided (TG) with novel GIS-software versus wavefront-optimized (WFO) LASIK.
Methods
Prospective, bilateral, randomized, study at four sites with six surgeons and 120 patients. Eligible patients included those over 18 years of age with myopia of <8.00D, cylinder <3.00D, MRSE <9.00D and pachymetry of 490 um or greater with residual greater than 270um. Refractive error stability had to show <0.50D change in last year. Patients were randomized 1:1 to TG or WFO using the Wavelight EX500 excimer laser. The PROWL visual questionnaire was given pre-operatively and at 3 months. At 3 months post-operatively, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity (CS) and manifest refraction were measured.
Results
For UDVA, at 3-months post-op, 95%, 67%, 18%, and 3% of eyes had 20/20, 20/16, 20/12.5 and 20/10 in TG. For WFO, 92%, 75%, 29% and 2% had 20/20, 20/16, 20/12.5 and 20/10. Subjects achieving 20/12.5 was significantly higher in WFO (p=0.05). Mean MRSE was -0.12 in both TG and WFO (p=0.98). TG had 91% of patients within 0.50D of spherical equivalent refractive accuracy and WFO had 97% within 0.50D. Mean UDVA, CDVA, and CS were not significantly different. TG significantly improved starbursts versus WFO (p=0.03). All other visual symptoms were significantly similar.
Conclusion
Both TG and WFO achieved similar, excellent visual acuity outcomes. Contrast sensitivity and overall patient satisfaction were similar, with patient satisfaction trending higher in TG. TG using novel GIS-software showed fewer incidences of starbursts.
Presenting Author
Anas abu Said, MS
Co-Authors
Shihao Chen MD, OD, MSc
Purpose
Centration is crucial in refractive surgery for optimal visual outcomes. Chord mu indicates pupil center displacement from the corneal reflex. This study compares high-order aberrations post LASIK and SMILE, considering varied chord mu values to guide future procedure customization.
Methods
Study Design: This retrospective cohort study involved 417 patients (417 eyes) who underwent LASIK or SMILE refractive surgery, using Pentacam data. Inclusion Criteria: Eyes with refractive errors < 6 diopters and no other ocular abnormalities were included. Outcomes: Primary measures included Cornea HOA RMS, vertical coma (Zernike Z(3,1)), and spherical aberration (Zernike Z(4,0)). Chord Mu Stratification: Data was categorized into three groups: Group 1 (< 0.12), Group 2 (0.12 to < 0.2), and Group 3 (≥ 0.2). Comparative Analysis: LASIK and SMILE outcomes were compared pre- and postoperatively (one-month) within each chord mu group using independent t-tests in SPSS.
Results
Out of 417 cases, 271 underwent LASIK, and 146 had SMILE. They were sorted by chord mu values: low (41 LASIK, 84 SMILE), moderate (54 LASIK, 96 SMILE), high (51 LASIK, 91 SMILE). Preoperatively, outcomes were similar for both procedures (p > 0.05). In the low chord mu group postoperatively, LASIK showed notable distinctions in Cornea HOA RMS and Z(4,0) values (p = 0.027, 0.001). LASIK: RMS HOA 0.53, Z(4,0) 0.3; SMILE: 0.45, 0.2. However, in the moderate and high chord mu groups, no significant postoperative differences were noted. These findings underscore substantial outcome variation between surgical techniques, particularly in cases with low chord mu values.
Conclusion
After one month postoperatively, SMILE surgery displayed better high-order aberration outcomes than LASIK in both low chord mu groups. Similar outcomes were observed in moderate and high chord mu groups, indicating a potential preference for SMILE, particularly in eyes with lower chord mu values.
Presenting Author
Majid Moshirfar, FACS, MD
Co-Authors
Purpose
To evaluate visual and clinical outcomes in patients undergoing myopic or myopic astigmatic laser vision correction with Wavelight CONTOURA™ Vision Topography Guided LASIK versus Visumax Small Incision Lenticule Extraction (SMILE)
Methods
This is a prospective, randomized, simultaneous, contralateral eye study recruiting 42 patients undergoing refractive correction. Myopic patients with low-moderate astigmatism were randomized and treated with SMILE in one eye and CONTOURA™ Vision LASIK in the contralateral eye. Outcomes were measured at 1, 3, and 12 months and include percentage of eyes with post-op uncorrected distance visual acuity of 20/15 or better and 20/20 or better, % of eyes ≤0.50 D SE of intended target, contrast sensitivity, higher-order aberrations, corneal hysteresis, dryness, and patient subjective visual and dry eye symptoms as reported using a patient questionnaire. Interim 1 and 3-months data to be reported.
Results
Three-month results of 33 patients were analyzed. Both groups showed 97% of eyes achieving acuity of 20/20 or better. LASIK achieved 90.9% UDVA of 20/16 or better, while the SMILE group was 78.8%. LASIK also achieved 54.55% UDVA of 20/12.5 or better, while the SMILE group was 39.4%. PRO for eye preference showed 65% with no preference, 26% preferred the LASIK eye, and 9% preferred the SMILE eye. The increase from preop to postop in Trefoil, Koma and Spherical Aberration between groups was not significant. However, the preop to postop change in the total higher order aberration (HOA) increased by 0.115±1.21 in LASIK and 0.188±0.164 in SMILE which was significant between the groups (p<0.011).
Conclusion
There was no difference in several aberration metrics and UDVA of 20/20 or better between the two groups. However, CONTOURA LASIK was superior to SMILE in a few visual performance metrics including HOAs, achieving levels of UDVA of 20/16 and 20/12.5, and patient reported outcome measures at the 3-month postoperative visit.
Presenting Author
Suphi Taneri, FEBO, MD
Co-Authors
Deniz Kilic MD, MRCSEd, Anika Foerster MSc, H. Burkhard Dick MD, PhD
Purpose
To compare clinical outcomes and rotational stability of toric implantable collamer lens (TICL) and toric implantable phakic contact lens (TIPCL).
Methods
Chart-review of all TICLs and TIPCLs implanted by a single surgeon (S.T.). Implant sizing according to manufacturer’s recommendation, however, latest 15 TIPCLs were 0.25mm larger than recommended to increase vaulting.
Results
Eighty-four TICLs and 98 TIPCLs were included. They had excellent refractive and visual results with no case of acute glaucoma or cataract induction. In total, 15 (8.2%) rotated lenses were recorded; 2 (2.4%) TICLs and 13 (13.3%) TIPCLs (p=0.013). Average TICL size was larger than TIPCL size (p<0.001). Rotation was positively correlated with Cyl and negatively with ACD but not with vaulting (p=0.001, r=0.253; p=0.011, r=-0.193; p=0.488, r=-0.057; respectively). In eyes with a rotated TIPCL, preoperative Cyl was higher and ACD was shallower than in eyes with a stable TIPCL (p=0.001 and 0.007, respectively). Increasing the implant size had no significant effect on rotation rate (p=0.685).
Conclusion
While both implants were safe and effective in highly myopic eyes, TICL rotated less frequently than TIPCL requiring fewer secondary interventions. No threshold for vaulting was found.
Presenting Author
Karen Saldana, MD
Co-Authors
Arturo Chayet MD, Erik Navas Villar MD, Maximiliano Barrera-Sanchez MD, Nora Robledo OD, Ivonne Curiel Arce MD
Purpose
To determine the preoperative predicted percentage of tissue altered accuracy with optical low-coherence reflectometry (Ex500) by comparing the predicted vs obtain PTA, RSB, AD and flap thickness using ultrasound and anterior segment OCT pachymetry
Methods
Prospective Cohort study of 50 eyes that underwent Femto-Lasik Surgery for correction of moderate to high myopia at CODET Vision Institute from October 2023 - January 2024. The femtosecond laser was programmed to cut LASIK flaps at a depth of 90um. Optical low-coherence reflectometry(EX500) was used to measure central corneal thickness prior to lifting the flap and the residual stromal bed immediately after excimer ablation. We compare same measurement with ultrasound pachymetry, and postoperative Anterior Segment Optical Coherence Tomography(Optoview). The PTA value was calculated based on the planned flap thickness and ablation depth and compared with the actual achieved postoperative PTA
Results
Mean CCT before surgery had no difference between Pentacam and EX500 (p=0.072). Predicted ablation depth with munnerlyn formula had a mean of 55.85 (+/-19.65) and with EX500 65 (+/-17.83) (p=0.02). The ablation depth measured by EX500 77.55 (+/-22.22) was statistically significant compared with the predicted ablation by EX500 and Munnerlyn formula (p=<0.001). The mean difference between the predicted ablation measured by EX500 and archived ablation was -12.55 (+/-7.4). The predicted PTA (Ex500) was 26.96% (+/-3.78) and the achieved PTA was 30.07% (+/-4.5) (p=001) with a mean difference of 3.11% (+/-2.04) underestimated by the predicted formulas.
Conclusion
There was a difference between the preoperative predicted PTA (EX500) and the actual achieved PTA value. The mean difference was 3%, clinically it could affect patients with borderline PTA as in high myopes. Preoperative refractive surgery planning should consider lowering preoperative PTA limits in this case.
Presenting Author
Edward Manche, MD
Co-Authors
Louisa Lu MD
Purpose
To prospectively compare refractive outcomes between wavefront-guided and topography-guided laser in situ keratomileusis (LASIK) surgery in the treatment of myopia with and without astigmatism.
Methods
This prospective, randomized, fellow eye-controlled clinical trial involved 100 eyes of 50 patients with myopia or compound myopic astigmatism who underwent wavefront-guided (WFG) LASIK in 1 eye and topography-guided (TG) LASIK in the fellow eye. Eyes were randomized according to ocular dominance. Each eye was evaluated for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and pre- and post-operative spherical equivalent refraction.
Results
Mean pre-op spherical equivalent was -4.76 +/- 2.09 D in the WFG group and -4.65 +/- 2.15 D in the TG group (p = 0.80). At month 6, 100% and 89% of eyes had an UDVA of 20/20 or better in the WFG and TG groups, respectively. 93% and 67% of eyes had an UDVA of 20/16 or better in the WFG and TG groups, respectively. 48% and 24% of eyes had an UDVA of 20/12.5 or better in the WFG and TG groups, respectively. Among 92 eyes of 46 patients with post-operative month 6 refractive outcomes, there was a statistically significant difference in the percentage of eyes that gained one or more lines of best corrected distance visual acuity in the WFG (43%) and TG (24%) groups, respectively (p = 0.05).
Conclusion
Wavefront-guided LASIK and topography-guided LASIK achieve similar refractive results with excellent clinical outcomes in both groups, though wavefront-guided LASIK achieved a statistically significant finding of having a higher percentage of eyes that gained one or more lines of CDVA compared to topography-guided LASIK at 6 months post-operation
Presenting Author
Pooja Khamar, MD, PhD
Co-Authors
Anisha Ramesh, MBBS, MS;
Rohit Shetty, FRCS;
Rahul P. Patil;
Abhijit S ROY, PhD
Purpose
To examine variances in gross collagen fibril structure at the ablation interface post refractive surgery using a custom-built ultrahigh-resolution Polarization Sensitive- Optical Coherence Tomography (PS-OCT).
Methods
In this longitudinal study, 55 eyes that underwent refractive surgery across various platforms were imaged pre- and post-operatively at 6 months using PS-OCT. The cohort consisted of 10 eyes each from PRK, LASIK, Zeiss SMILE, J and J SILK and Schwind Smart sight platforms. Utilizing PS-OCT, a scan field with a 10 mm diameter was achieved and the conical can setup ensured uniform signal strength throughout cornea. Study aims to assess residual stromal depth differences, phase retardation (PR) en-face maps at custom depths (considering percent tissue ablation and attempted spherical equivalent correction) were generated and post-operative difference was analyzed for all eyes.
Results
Post-operative difference in intra-stromal PR response from PRK eyes displayed the most favorable outcome, exhibiting minimal difference. Similarly, J and J SILK demonstrated a nearly zero change in PR response. In contrast, Zeiss SMILE exhibited a higher peak, slightly skewed towards the right. The Schwind Smart sight platform also displayed a distinctive peak response. Meanwhile, LASIK response peaked at zero phase retardation difference, with a slightly broader distribution compared to PRK and other SMILE platforms.
Conclusion
PS-OCT showed distinct changes in peak PR differences across various refractive surgery platforms. These observations can help artificial intelligence (AI) based platforms to better predict favorable refractive procedure and associated wound healing response for a given candidate, before the surgery is even performed
Presenting Author
Raghav Malik, MD
Co-Authors
Mahipal Sachdev MD, Pooja Khamar PhD, MD, Rohit Shetty FRCS, Brian Schwam MD, Ritika Sachdev MD, Andrew Voorhees PhD, Hong Fu PhD, Ying Wang MSc, D. Priya Janakiraman OD
Purpose
ELITA system utilizes ultralow energy per laser pulse and tight spot spacing, creating precise corneal incisions with minimum tissue-bridges and a smooth stromal bed for an easy flap lift. This study compares flap quality and visual outcomes after laser-in situ keratomileusis (LASIK) performed with ELITA vs iFS for compound myopic astigmatism.
Methods
In this multicenter, prospective, randomized clinical trial which was conducted at three sites, 83 consecutive subjects received LASIK surgery using the ELITA laser in 1 eye and iFS in the fellow eye for flap creation. Ease of flap lift for each subject was evaluated by the surgeons using the following grading scale: 1 = iFS is much better than ELITA, 2 = iFS is superior to ELITA, 3 = iFS is similar to ELITA, 4 = nFS is superior to ELITA, 5 = nFS is much better than ELITA. Uncorrected visual acuity (UCVA), manifest refractive spherical equivalent (MRSE), and best spectacle-corrected visual acuity (BSCVA) were obtained at 3 month postoperatively.
Results
The ease of flap lift was graded 3 or higher in 98% of the cases, with 71% of them graded as 4 or 5 during the procedure (n=83). At 3-month (n=20), 100% of ELITA eyes and 95% of iFS eyes were within +/- 0.50D of target refraction. UCVA was 20/20 or better in 94% of ELITA eyes and 88% of iFS eyes at 1 day (n=83), and in 95% of both ELITA and iFS eyes at 3-month (n=20). BSCVA was 20/20 or better in 100% of both ELITA and iFS eyes at 1-month post op and on.
Conclusion
The ELITA laser demonstrates equivalent or easier flap lifting compared to iFS when creating flaps as well as excellent visual outcomes for LASIK
Presenting Author
Patricia Fortin, MD
Co-Authors
Luke Rebenitsch MD, Ashley Fondren MBA
Purpose
To determine if there is increased patient satisfaction throughout the early healing process with SMILE versus LASIK, we will compare STODS and visual outcomes. Decreased nerve disruption has been reported with SMILE when compared to LASIK. In this study, we will assess if this translates into improved comfort and visual outcomes.
Methods
This is a single site, prospective study comparing two groups: 50 patients receiving LASIK and 50 patients receiving SMILE. Outcomes will be assessed at 1 day and 1 month, including UDVA 20/20 or better, SE within ± 0.50D and cylinder within ± 0.50D of target, and change in corneal HOAs (overall, spherical aberration, and coma). STODS will be evaluated by giving the SPEED questionnaire on postoperative day 1, week 1, and month 1. Inclusion criteria include receiving LVC OU, myopia –1.00D to –8.00D and/or cylinder up to –2.00D, preoperative CDVA of 20/20 or better, and postoperative exam at day 1 and month 1. Treatments will be planned by using third party nomogram software.
Results
Groups had similar demographics (p-value >0.05). Average preoperative spherical equivalent was -3.53 in SMILE, -3.20 in LASIK (p-value 0.032). Average preoperative UCDVA (logMAR) was 1.13 in SMILE, 0.97 in LASIK (p-value 0.019). All eyes were best corrected to 20/20. 40 LASIK eyes and 20 SMILE eyes had postoperative month 1 exams. Postoperative spherical equivalent was 0.01 in SMILE, 0.04 in LASIK (p-value 0.92). Postoperative UCDVA (logMAR) was -0.04 in SMILE, -0.04 in LASIK (p-value 0.98). The change in corneal HOAs was 0.13 in SMILE, 0.10 in LASIK (p-value 0.22). A significant difference in the STODS questionnaire score was seen at postoperative day 1 (p-value 0.024).
Conclusion
This study proves that nomogram-based SMILE gives equivalent visual outcomes when compared with LASIK. Both procedures lead to great vision and happy patients. In the very early healing period, SMILE patients had fewer STODS symptoms than LASIK patients.
Presenting Author
Sung Min Kim, MD
Co-Authors
Purpose
To report first clinical outcomes of SMILE operation using VisuMax® 800 in Korean patients, by comparing with SMILE using VisuMax® 500
Methods
A retrospective analysis of 199 eyes from 47 patients who underwent SMILE with VisuMax® 800 and 53 patients with VisuMax® 500 were done. Inclusion criteria consisted of a pre-op. best-corrected visual acuity of 1.0 or better, age between 19 and 40 years, stable refraction for at least 1-year before surgery, and completion of post-op. follow-up and examinations. Pre-op. CCT, refractive errors, IOP, HoA, and dry eye-related measurements were taken before surgery. Lenticule creation time was recorded during surgery. UDVA, and MR were done on 1 day, 1 week, and 1 month post-op. NIBUT, TMH, and HoA were assessed at 1 month. Laser energy and nomograms were standardized between the two groups.
Results
The mean laser procedure time was significantly shorter in the VisuMax® 800 group (10.30±1.04 seconds) than in the VisuMax® 500 group (22.52±1.33 seconds) (p=0.000). On post-op. day 1 and 1 week, the VisuMax® 800 group showed significantly better uncorrected distance visual acuity compared to the VisuMax® 500 group (p=0.000 for both time points), but there was no significant difference in spherical equivalent between the two groups at 1 day and 1 week post-op. Uncorrected distance visual acuity, spherical equivalent, and tear-related measurements at 1 month post-op. did not show significant differences between the two groups.
Conclusion
Compared to SMILE with VisuMax® 500, VisuMax® 800 reduces lenticule creation time, allowing for faster and effective visual correction. It also yields better initial visual outcomes and nomograms from the existing VisuMax® 500 could be safely used for VisuMax® 800. However, furthur study is required to confirm long-term clinical outcomes.
Presenting Author
Sheetal Brar, MS
Co-Authors
Sri Ganesh MS, FRCS, DNB
Purpose
To compare the visual and refractive results, induced aberrations and objective scatter index in normal versus large angle kappa following Smile performed with VisuMax 800
Methods
The new VisuMax 800 is equipped with a centration aid(CentrAlign) based on the pre-operative x and y coordinates of the pupil, which may be helpful in eyes with large angle kappa. A total of 50 eyes from 50 patients undergoing SMILE procedure with VisuMax 800 for correction of myopia and myopic astigmatism were included. All eyes were divided into 2 groups- Group 1 : normal angle kappa (<0.5 mm) , n=25 eyes and group 2: eyes with large angle kappa (>0.5 mm), n=25 eyes.Docking and centration of the treatment was done using the centration aid. Post-operative follow-ups were conducted on day 1, 1 week and 3 months for UDVA, manifest refraction, Objective scatter Index (OSI) and MTF cut off.
Results
The mean pre-op angle kappa value in the normal group was 0.07± 0.03 mm versus 0.52±0.08 mm in the large angle kappa group, p<0.001. At 3 months,% eyes seeing 20/20 or better was 92% (n=23) and 88% (n=22) in the normal and large angle kappa group respectively.No eye in either group lost 2 lines or more in CDVA.Intra-operative treatment decentration was 0.18±0.07 mm in the large angle kappa group versus the normal angle kappa group (0.11±0.08 mm),p=0.01. The mean values of OSI at day 1, 1 week and 3 months post-op was higher in the large angle kappa group,without any statistically significant differences.Post-op abberations and patient satisfaction scores were comparable between the groups.
Conclusion
CentraLign assisted centration resulted in favourable results in eyes with normal as well as large angle kappa. Despite a statistically significant intra-op decentration in the large angle kappa group, mean decentration in both groups was within 0.2 mm, without any differences for clinical results and patient satisfaction.
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