"TransPRK outcomes in virgin eyes treated with the Aberration-Free profile and AMARIS 500Hz laser technology"

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1 "TransPRK outcomes in virgin eyes treated with the Aberration-Free profile and AMARIS 500Hz laser technology" Ants Haavel MD KSA Eye Center Tallinn, Estonia

2 TransPRK -message to patients New Generation Laser Procedure No Touch No Cut First choice laser treatment for young myopes Precise Excellent vision quality Safe Convenient Real 100% laser treatment

3 Pre operative exam Refraction: objective, subjective, cycloplegic Scheimpflug, topography, pachymetry Pupillometry: scotopic, mesoptic and photopic IOP Biomicroscopy Funduscopy Health and lifestyle questionnaire Patient education, expectations and post op time line of visual recovery

4 Decision for TransPRK vs. LASIK TransPRK myope under 38 y.o active lifestyle interested more in long than short term benefits healthy LASIK myope over 38 y.o interested in rapid recovery healthy

5 Medication protocol Pre op: starting 2 days before C vitamin 400 mg 2xd and Levofloxacin 0,5 % eye drops 4xd Intra op: Alcaine 0,5 %, Chilled PVC sponge ( 20 sec. post ablation ), Mitomycin 0,02% ( 90 sec. post ablation ), Acular 0,5%, Levofloxacin 0,5%, Dexamethasone 0,5 %, Oasys Hydraclear CL Post op up to 5 days Chloramphenicol-Dexamethasone 0,5 % 3xd, Acular 3xd, non preservative artificial tears every 30 minutes during wake up hours. Remove contact lenses 5-7 days post op not earlier. Post op up to 2 months Dexamethasone 0,5% next 2 months post op. 1 week 4xd; 2-3 week 3xd, 4-8 week 2xd. C vitamin 400 mg b.i.d. 2 weeks post op. Artificial tears if requested.

6 Op video 05/12/11

7 Optional follow-up schedule 5-7 days post op remove contact lenses 1 M objective refraction, visual acuity 3 M objective & subjective refraction 6 M objective & subjective refraction 12 M months objective & subjective refraction 1 year in next years

8 Average values and ranges pre operative in 49 patients (98 eyes) Age Optical Zone SEq [D] Ast [D] UCVA [logmar] UCVA [20/n] BCVA [logmar] BCVA [20/n] Mean ± StDev 28,08 ± 5,74 6,85 ± 0,32-3,41 ± 1,48-0,58 ± 0,63 0,95 ± 0,39 20/ ,00 ± 0,04 20/20 Range 19 to 40 6,30 to 7,50-6,75 to -0,50-2,90 to 0,00 0,10 to 1,60 20/25 to 20/800-0,20 to 0,10 20/10 to 20/25

9 Safety: PreOp BCVA vs. PostOp BCVA 62% 60% 40% 24% 20% 4% 6% 4% 0% loss 2 loss 1 unchanged gain 1 gain 2 monocular 3M (98 eyes)

10 CumulativePreOpBCVA vs. PostOpUCVA 100% 96% 92% 100% 98% 100% 100% 80% 60% 40% 26% 20% 2% 3% 4% 0% 20/12,5 or better 20/16 or better 20/20 or better 20/25 or better 20/32 or better preop BCVA postop UCVA 3M

11 Scattergram: Defocus Achieved [D] overcorrected y = 1,05x + 0,12 R 2 = 0,93 undercorrected Attempted SEQ [D]

12 Scattergram: Astigmatism 4 Achieved [D] 3 overcorrected 2 y = 0,92x + 0,06 R 2 = 0,86 1 undercorrected 0 Attempted Cyl [D]

13 Accuracy: Defocus 100% 94% 100% 80% 73% 83% 60% 52% 60% 40% 20% 0% ±0.13 D ±0.25 D ±0.50 D ±0.75 D ±1.00 D Accuracy in Defocus 3M (98 eyes) ±1.25 D

14 Accuracy: Astigmatism 100% 96% 100% 82% 80% 71% 60% 40% 20% 0% ±0.13 D ±0.25 D ±0.50 D Accuracy in Cylinder 3M (98 eyes) ±0.75 D

15 Refractive Summary 3-month post operative in 49 patients Seq [D] Ast [D] UCVA [logmar] UCVA [20/n] BCVA [logmar] BCVA [20/n] Mean±StDev 0,31 ± 0,42-0,13 ± 0,22-0,02 ± 0,07 20/20+ -0,02 ± 0,07 20/20+ Range -0,38 to 1,25-0,75 to 0,00-0,20 to 0,20 20/10 to 20/32-0,20 to 0,20 20/10 to 20/32

16 Adjustment of clinical protocol TransPRK gives cornea more energy load than conventional surface ablations. Extend your conventional surface ablation MMC, NSAID and dexamethasone treatment times. Educate patients to relax and look into laser during extended ablation times.

17 Marketing of Trans PRK You can change name of TransPRK for more customer friendly and attractive trade name which is suitable for your market and practice. New generation non touch laser procedure for new generation people. Premium product positioned and priced higher as Femto LASIK. Position it as treatment for intelligent, educated and open minded people. Young active people really prefer gradual visual recovery to avoid having life time cut in the cornea. Due plasticity of young tissues and accommodation abilities patients have high satisfaction rate, relatively quick visual recovery and real life is usually better than numbers in Datagraph.

18 Conclusion Highly patient driven No Touch No Cut laser procedure for treating myopia which rises practice s revenue and profitability. Lower overhead gives practice more resources for investments and marketing budget. Surface ablations need more time for educating patients and pro active communication from laser center personnel. TransPRK success = patient education, exact pre-op refraction and exams, precise laser technology, pro active communication, customized nomogram and adjusted clinical-medication protocol.

19 Welcome to TransPRK World!