REFRACTIVE OUTCOME IN PRESBYOPIC PATIENTS TREATED WITH SHWIND AMARIS PRESBYMAX LASER TREATMENT

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4 COMBINED SELECTIVE CORNEAL WAVEFRONT-GUIDED PHOTOREFRACTIVE KERATECTOMY AND CORNEAL CROSS-LINKING IN EYES WITH PROGRESSIVE MILD TO MODERATE KERATOCONUS Session Title: CRS/RLE Session Date/Time: Saturday 17/09/ :30-18:00 Paper Time: 16:42 Venue: Hall A3 First Author: S.Awwad LEBANON Co Author(s): V. Massoud D. Fahd N. Jabbur To evaluate the efficacy and safety of combined selective corneal wavefront-guided photorefractive keratectomy (CWG-PRK) and corneal cross-linking (CXL) in progressive mild to moderate keratoconus. American University of Beirut Medical Center, Beirut, Lebanon. A retrospective interventional case series of 6 eyes of six patients with mild to moderate keratoconus with a documented history of disease progression. Selective CWG-PRK was achieved using the Schwind Amaris excimer laser with static and dynamic cyclotorsion control and wavefront registration by treating selected out-of-range corneal higher order aberrations (HOAs) to minimize tissue ablation, all while treating a defined amount of sphere and cylinder so that the total peak ablation depth is kept under 50 microns and the residual corneal thickness is kept above 400 microns. CXL was performed at the same setting with application of 0.02% mitomycin C. Mean follow-up time was 9.2 months. Preoperative and postoperative UCVA and BSCVA mean logmar improved from 0.48 to 0.3 and 0.16 to 0.06 respectively. All patients reported noticeable improvement in their visual symptoms. There was a consistent decrease in total corneal HOAs and coma aberrations. Corneal topography showed an improvement in anterior surface irregularity indices (IS ratio decreased from 6.0 to 4.7, SAI from 2.8 to 2.5, and SRI form 1.3 to 1.2), while Scheimpflug imaging showed stable anterior and posterior floats over the course of the follow-ups, which ranged from 6 to 15 months. Combined selective CWG-PRK and CXL in progressive mild to moderate keratoconus is safe and effective. Compared to topography-guided ablation, CWG laser ablation permits selective treatment of corneal higher order aberrations, thus improving visual quality while sparing stromal tissue

5 REFRACTIVE OUTCOME IN PRESBYOPIC PATIENTS TREATED WITH SHWIND AMARIS PRESBYMAX LASER TREATMENT Session Title: Presbyopia Session Date/Time: Sunday 18/09/ :00-09:30 Paper Time: 08:24 Venue: Hall A1 First Author: H.Mahmood BAHRAIN Co Author(s) Study the effect of near and distance vision outcome by SHWIND AMARIS Presbymax approach Dr haifa Eye Specialist Center All patients were corrected with PresbyMax approach. Only laser PRK were included.the optical zone was set between 6.5mm and 7.5 mm. Treatement performed on the basis of both both eyes with same addition, same optical zone ans same surgical day. the preoperative manifest refraction of defocus: D to D, astigmatism : up to D, addition up to D. All data from from 40 patients (including 2 patients post RK surgery and 1 patient pseudophakic post phaco-emulsification both eyes) anylyzes for a post operative period of 6-18 months. 95% of patients have no significant changes in defocus, cylinder or addition, 100 % of patients with myopia and myopic astigmatism patients had arrange of 0.25 D defocus,and 95% of 0.5 D in hyperopic patients. Regression happen in 2 patients( one patient with hyperopia and one emmetropic patient). SHWIND AMARIS PresbyMax treatment is safe and effective for the treatment of prebypia

6 3 MONTH EXPERIENCE WITH PRIMARY CORNEAL WAVEFRONT GUIDED TREATMENTS USING THE SCHWIND AMARIS 750S LASER: CLINICAL OUTCOMES Session Title: Laser Refractive Surgery Session Date/Time: Monday 19/09/ :30-17:00 Paper Time: 15:12 Venue: Hall A3 First Author: J.Tan SINGAPORE Co Author(s): Y. Por To evaluate post-operative outcomes on refraction, corneal higher order aberrations and contrast sensitivity among previously unoperated eyes that underwent LASIK treatments with the Schwind Amaris 750S. All cases were treated prospectively using corneal wavefront guided treatments. Jerry Tan Eye Surgery, Singapore One hundred eyes for corneal wavefront guided treatments were enrolled. Pre-and postoperative uncorrected and best corrected distance visual acuities, corneal and ocular wavefronts, and contrast sensitivities were performed. Corneal wavefronts were measured with the Scout and Sirius topographers, and ocular wavefronts with the IRX 3 (Schwind Eye-Tech-Solutions, Kleinostheim, Germany). Contrast sensitivity was performed with the Sine Wave Contrast Test (Stereo Optical Co, USA). Treatments were planned with the ORK-CAM software, and ablation performed with the Amaris 750S (Schwind Eye-Tech-Solutions, Kleinostheim, Germany). LASIK flaps were cut with the ifs Intralase laser (Abbott Medical Optics, USA). Clinical outcomes were evaluated in terms of predictability of refractive outcomes, safety, corneal wavefront changes and contrast sensitivity. At 3 months post-operatively, 100% of patients were within 1.00D of targeted refraction. No patient lost 2 or more lines of best corrected vision. Coma and spherical aberration were reduced in all cases with less than 6.00D of myopia pre-operatively. Contrast sensitivity was improved in the majority of cases. Corneal wavefront guided treatments with the 750Hz Schwind Amaris 750S laser are safe and predictable when used in previously untreated eyes. Refractive errors and higher order aberrations were reduced post-operatively in low and moderate myopes. No nomogram adjustments were necessary.... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented,...receives consulting fees, retainer, or contract payments from a competing company

7 CROSS-LINKING FOLLOWED BY CUSTOMIZED TRANS-PRK Session Title: Cross-Linking 2 Session Date/Time: Tuesday 20/09/ :00-16:00 Paper Time: 15:22 Venue: Strauss 2 First Author: M.Camellin ITALY Co Author(s): S. Mosquera To evaluate the use of a single-step optimized Corneal-Wavefront guided TransPRK to correct High Order aberrations (Coma) problems after Cross Linking following Keratoconus. Dr. Massimo Camellin, SEKAL Rovigo Microsurgery Centre, Rovigo, Italy. Retrospective, non-comparative, consecutive case series, 21 eyes underwent at first Cross linking and, after 4 months, Corneal-Wavefront guided TransPRK for correction of aberrations (Mainly coma) 4 months following cross linking. Keratron-Scout topography (Optikon 2000) and a flying-spot laser (AMARIS; SCHWIND eye-techsolutions) were used. As in keratoconus, the most frequent and negative aberration is coma, we decided to reduce only it so saving tissue. Preoperatively, eyes showed irregular astigmatism 3.7D (SD 1.4) and corneal wavefront coma (5mm) 1.7u (SD 1.1). BCVA pre was 4.9/10 (SD 2.2). UCVA pre was 1.1/10 (SD 1.1). Complete ophthalmic examinations were performed before and after surgery. The mean age of the patients was 32 (SD 10) years (range 16 to 62 years) at the time of the surgery. Mean follow-up was 8±7 months (2 to 31 months). Postoperatively, eyes showed astigmatism 2.4D (SD 1.9) and corneal wavefront coma (5mm) 0.8u (SD 0.5). BCVA post was 6.3/10 (SD 1.9). UCVA post was 3.3/10 (SD 3). No Snellen lines of BSCVA lost, and 13 eyes (65%) had an increase of more than 2 lines. Haze was 0 in all eyes. Apex pachimetry (thinnest point) passed from 455 to 410 so the real weakening of the cornea is negligible. Corneal-Wavefront guided TransPRK using AMARIS is a safe and effective suitable solution for reducing coma problems after Cross linking for keratoconus. This procedure has a fast recovery time and is good solution in eyes not candidate for transplant. These patients can use soft contact lenses or glasses to reduce their residual refractive error.

8 ABLATION VOLUME AND POSTOPERATIVE REFRACTION IN EXCIMER LASER MYOPIC CORRECTION MEASURED WITH SCHEIMPFLUG IMAGING Session Title: Outcome Myopia Session Date/Time: Tuesday 20/09/ :00-16:00 Paper Time: 15:24 Venue: Hall A2 First Author: M.Arbelaez OMAN Co Author(s): S. Arba Mosquera To analyse measurements of a Scheimpflug imaging technique to describe the ablated volume after myopic astigmatic corneal laser refractive surgery and achieved refractive correction. Maria Clara Arbelaez, MD, Muscat Eye Laser Center, PO Box 938, PC 117, Muscat, Oman. Tel: ; Fax: ; drmaria@omantel.net.om Three-hundred myopic astigmatism treatments using LASIK or LASEK in 150 patients with 3-month followup were retrospectively analyzed. In all cases, standard examinations, pre-/postoperative corneal topography, aberrometry, and Scheimpflug were performed. SCHWIND Custom Ablation Manager (CAM) software and the AMARIS 750S laser were used for planning treatments and performing ablations. Outcomes were evaluated in terms of predictability, safety, and wavefront aberration. Pachymetry maps was taken before treatment (Scheimpflug [CSO SIRIUS]) and at 3- month follow-up (Scheimpflug [CSO SIRIUS]). The changes in corneal volume were compared to the theoretical ablation volume provided by the AMARIS readout. The statistical significance of the differences were evaluated with paired Student T-test, correlations between parameters were evaluated with the coefficient of determination. At 3 months, 93% of eyes achieved 20/20 UCVA, and 92% of eyes were within 0.50 diopters (D). Postoperative mean spherical equivalent refraction was -0.16±0.32 D. Best spectacle-corrected visual acuity improved in 31% of eyes. Differential corneal volume correlated to intended ablation volume r2=0.90, P<.0001, slope Relative differential volume correlated only marginally to achieved refractive correction. Differential corneal volume is a metric useful for describing intended ablation volume but not for achieved refractive correction. The rotating Scheimpflug technique offers good estimation (slope close to 1) and fair correlation (r2 close to 1) for describing ablation volume. Only borderline correlations were obtained for achieved refractive correction.... is employed by a forprofit company with an interest in the subject of the presentation,... travel has been funded, fully or partially, by a competing company

9 TRANSEPITHELIAL PHOTOTHERAPEUTIC KERATECTOMY MODE USING THE SCHWIND AMARIS EXCIMER LASER Session Title: Outcome Myopia Session Date/Time: Tuesday 20/09/ :00-16:00 Paper Time: 15:36 Venue: Hall A2 First Author: S.Adib-Moghadam IRAN, ISLAMIC REPUBLIC OF Co Author(s) To evaluate epithelial healing and refractive outcomes after transepithelial photorefractive keratectomy (tprk) mode using the Schwind Amaris 500 excimer laser. Bina Eye Hospital, Tehran, Iran. Twenty-seven eyes from 18 patients with myopia underwent tprk using a multistage program to perform PTK followed by PRK. All ablations were performed with an Amaris 500 excimer laser platform (Schwind Eye-Tech-Solutions GmbH & Co. KG.). Epithelial healing was evaluated by taking slit-lamp photographs every 24 hours until complete reepithelialization. All outcomes are reported for 3 months postoperatively. Haze was graded by two ophthalmologists, each masked to the other s result. Mean reepithelialization took 2.20±0.60 days. The postoperative 3-month remaining mean spherical equivalents were ± 1.01 diopters. At the last follow-up, the uncorrected distance visual acuity was better than 20/25 in 28 eyes (100%) and better than 20/20 in 22 eyes (82%); 26 eyes (92%) were within ±0.50 D of the attempted spherical equivalent. Best spectacle-corrected visual acuity was 20/20 or better in 26 eyes. No eye lost Snellen lines of corrected distance visual acuity. Haze developed in 1 eye. This study shows tprk mode using Schwind Amaris is a safe and effective procedure with rapid epithelial healing. Additional studies are needed to determine long-term outcomes.

10 CLINICAL RESULTS OF LASIK USING SCHWIND AMARIS 750S AND FEMTO LDV CRYSTAL LINE IN 1,112 MYOPIC EYES Session Title: RSNT/Presbyopia Session Date/Time: Wednesday 21/09/ :00-10:00 Paper Time: 08:36 Venue: Hall A2 First Author: : M.Tomita JAPAN Co Author(s): : S. Yukawa N. Nakamura T. Nakamura T. Tsuru To evaluate the visual outcomes, safety, stability, efficacy, and predictability of LASIK for myopia using SCHWIND AMARIS 750S (SCHWIND Eye-Tech-Solutions GmbH, (Kleinostheim, Germany) and Femto LDV Crystal Line (Ziemer Group AG, Port, Switzerland) for corneal flap creation. Shinagawa LASIK Center, Tokyo, Japan In this retrospective and non-comparative study, 1,112 eyes of 595 patients underwent LASIK with SCHWIND AMARIS 750S for myopic correction and Femto LDV Crystal Line for flap creation. The patients mean age was 34.2 ± 7.81 years (range, 17 ~ 65 years) and the mean preoperative manifest refraction spherical equivalent (MRSE) was ± 2.13 D (range, ~ D), respectively. At 3 months after LASIK, 80% of the eyes achieved 20/16 or better vision and 97% of the eyes 20/20 or better. The MRSE was within +/-0.50 D for 94% and within +/-1.00 D for 99% of the patients. There were no significant post-operative complications. Our study demonstrated that LASIK using SCHWIND AMARIS 750S and Femto LDV Crystal Line was highly safe, efficient and predictable for the correction of myopia of wide range.... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

11 CORNEAL HIGHER ORDER ABERRATIONS AND REFRACTIVE OUTCOMES IN LASIK FOR HIGH MYOPIA WITH A SIXTH GENERATION EXCIMER LASER PLATFORM Session Title: RSNT/Presbyopia Session Date/Time: Wednesday 21/09/ :00-10:00 Paper Time: 08:48 Venue: Hall A2 First Author: A.Vega-Estrada SPAIN Co Author(s): J. Alio, D. Pi, A. El Aswad To evaluate corneal higher order aberrations and refractive outcomes after LASIK for the treatment of high myopia using the Amaris excimer laser Vissum Corporation, Alicante, Spain 52 eyes of 32 patients (age range years) with high level of myopia or myopic astigmatism (Spherical equivalent? 7 D) were included. All cases underwent uneventful LASIK surgery using the Amaris excimer laser (Schwind) and optimized aspherical profiles. Mean preoperative spherical equivalent was (ranging from to D). The follow-up period was 6 months. Corneal higher order aberration and Strehl ratio (6-mm pupil) were recorded and analyzed. Changes in visual acuity and refraction were also assessed. Four eyes were excluded from the analysis because of LASIK enhancement for correcting the residual refractive error during the follow-up. In the remaining eyes (48), a statistically significant reduction of the spherical equivalent was observed ( p<0.01), distance corrected visual acuity remained the same or improved in 91.7% of eyes at 6 months after LASIK surgery. Corneal primary spherical aberration changed from a mean value of 0.21 preoperatively to a mean postoperative value of 0.52?m (p<0.01). Mean magnitude of primary coma also changed significantly from 0.21 to 0.54?m postoperatively (p<0.01) In relation with the spherical-like aberration, a statistically significant change was observed in the postoperative period (p<0.01). The same was seen with the coma-like aberration (p<0.01). Regarding corneal Strehl ratio, there was no statistically significant change between the preoperative and postoperative period (p=0.81). Correction of high levels of myopia with a sixth generation LASIK platform significantly improves refractive status of patients. Even when there is a statistically significant induction of corneal higher order aberrations, they may not be clinically relevant as they are found to be within 3 standard deviation of the levels considered as physiological for the normal population.

12 CUSTOMIZED TRANS-PRK TO FIX HAZE AND SCARS Session Title: Cornea Surgical Session Date/Time: Wednesday 21/09/ :00-10:30 Paper Time: 10:03 Venue: Strauss 2 First Author: M.Camellin ITALY Co Author(s): S. Mosquera To evaluate the use of a single-step optimized Corneal-Wavefront guided TransPRK to correct corneal opacities and surface irregularities following previous PRK and scars due to trauma or keratities. Dr. Massimo Camellin, SEKAL Rovigo Microsurgery Centre, Rovigo, Italy. Retrospective, non-comparative, consecutive case series, 43 eyes underwent Corneal- Wavefront guided TransPRK for correction of aberrations and refractive errors. All these cases in past would have had a PTK procedure to eliminate opacities and corneal irregularities. A single step laser procedure allows a reduction of opacities and surface irregularities avoiding unwanted sacrifices of tissue. Keratron-Scout topography (Optikon 2000) and a flying-spot laser (AMARIS; SCHWIND eye-tech-solutions) were used. Preoperatively, eyes showed opacities and irregular astigmatism 2.5D (SD 3.5) and corneal wavefront was RMS (5mm) 1.9u (SD 1.2). BCVA pre was 5.8/10 (SD 2.6). UCVA pre was 2/10 (SD 1.9). Complete ophthalmic examinations were performed before and after surgery. The mean age of the patients was 40 (SD 10) years (range 19 to 64 years) at the time of the surgery. Mean follow-up was 30±15 months (2 to 50 months). Postoperatively, eyes showed astigmatism 0.9D (SD 0.9) and corneal wavefront RMS (5mm) 1.1u (SD 0.6). BCVA post was 7.9/10 (SD 2). UCVA post was 5/10 (SD 3). No Snellen lines of BSCVA lost, and 30 eyes (70%) had an increase of more than 2 lines. Haze was 0 in almost all eyes, only one eye had a 2 degree haze. Corneal-Wavefront guided TransPRK using AMARIS is a safe and effective suitable solution for reducing opacities and high RMS aberrations following haze and scars. This procedure avoid the unpredictable results of a PTK and solves in a single step the problems, opacities plus refractive error.

13 ROLLING AND Z MOVEMENTS MEASURED WITH THE 6D EYE- TRACKER OF THE SCHWIND AMARIS TOTAL-TECH LASER Session Title: Laser Refractive Surgery. Session Date/Time: Wednesday 21/09/ :00-10:30 Paper Time: 08:18 Venue: Strauss 3 First Author: : M.Arbelaez OMAN Co Author(s): : S. Arba mosquera To evaluate intraoperative dynamic eye rolling and z movements among eyes that underwent LASIK treatments with 6D Eye-Tracking using SCHWIND AMARIS. Dr. M.C. Arbelaez, Muscat Eye Laser Center, Muscat, Sultanate of Oman. The first few scleral-tracker images obtained when starting the ablation were used as references (natural rolling and levelling) and compared to any further scleral-tracker image to determine eye rolling and the axial displacements. The rate of successful registration was calculated as the ratio between RegisteredEyes and TotalEyes. The difference between the maximum and minimum eye rolling and axial displacement values for each eye was taken as a metric of the movement range. Mean values, standard deviation, and minimum and maximum values were computed for eye rolling and axial displacement and expressed as percent of treatments, as well. The rate of successful registration was 90% (52/58 successful registrations). Mean rolling was 2±3 (-4 to +7 ) horizontally and -3±3 (-7 to +1 ) vertically. Seventyeight percent mean rolling measurements were within 5 horizontally and 70% vertically. Mean axial displacement was -295±455?m (-1129 to +404?m). Mean axial displacement values were >1 mm in 10% of measurements. Mean rolling range during treatment was 4±2 (1 to 9 ) horizontally and 5±2 (range: 1 to 8 ) vertically. Horizontally, 3% rolling ranges were >8. Mean axial displacement during treatment was 460±271?m (60 to 1188?m). Three percent axial displacement ranges were >1 mm. 6D eye-tracker is valuable because uncompensated rolling movements can induce decentrations (visually comatic aberrations), whereas uncompensated axial movements may induce undercorrections asymmetrically. We retrieved 5 for natural-rolling, and observed patients push their heads back at the beginning of the treatment and return to a more level position during treatment.... is employed by a forprofit company with an interest in the subject of the presentation,... travel has been funded, fully or partially, by a competing company

14 FIRST CLINICAL RESULTS OF TRANSEPITHELIAL PHOTOREFRACTIVE KERATECTOMY IN MYOPIA Session Title: Laser Refractive Surgery. Session Date/Time: Wednesday 21/09/ :00-10:30 Paper Time: 08:30 Venue: Strauss 3 First Author: M.Kynigopoulos SWITZERLAND Co Author(s): A. Wild M. B To evaluate the efficacy of transepithelial photorefractive keratectomy (transprk) using the Schwind Amaris excimer laser for the treatment of myopia. Vedis Augenlaserzentrum Zurich Prospective consecutive clinical study of 41 eyes (22 patients, mean age 32.5 ± 6.9 years) who were treated by transprk using the aberration free ablation protocol. The optical zone was 7 mm and standard epithelial thickness (centrally 55 µm and 65 µm in the periphery) was used. In 12 eyes Mitomycin C 0.02% for 30 seconds was applied. We report the 3 months results. Mean refractive spherical equivalent changed from ± 1.55 to ± 0.22 postoperatively. No patient lost best spectacle-corrected visual acuity. The uncorrected Snellen distance visual acuity (UDVA) changed from 0.15 ± 0.1 to 1.1 ± 0.13 (range ). 40 eyes (97.6%) achieved a UDVA? 0.8. All eyes had best spectacle-corrected visual acuity of 1.0 or better. Haze Grade 1 appeared in 4 eyes (reversible with topical steroid treatment). No patient required an enhancement. TransPRK appears to be an safe and effective therapeutic option for myopia.

15 A NEW METHOD OF CORNEA MODULATION WITH EXCIMER LASER FOR SIMULTANEOUS CORRECTION OF PRESBYOPIA AND AMMETROPIA: 12 MONTHS RESULTS Session Title: Laser Refractive Surgery. Session Date/Time: Wednesday 21/09/ :00-10:30 Paper Time: 09:24 Venue: Strauss 3 First Author: D.Holland GERMANY Co Author(s): M. P D. Hepper D. Uthoff To investigate the outcomes for simultaneous correction of presbyopia and ammetropia by biaspherical Presby-Lasik technique (PresbyMAX) based on the creation of a central area hyperpositive for near vision and leaving the midperipheral cornea for far vision in emmetropic, hyperopic and myopic presbyopic patients. 60 eyes of 30 patients were treated with the PresbyMAX technique by one surgeon (D.U.) at the Augenklinik Bellevue. 20 eyes with emmetropic presbyopia, 20 eyes with myopic presbyopia and 20 eyes with hyperopic presbyopia underwent FEMTO-LASIK and were assessed out to 12 months postoperatively. Mean patient age was 52 years (range: years) for the emmetropic presbyopic group, 54 years (range: years) for the hyperopic presbyopic group and 51 years (range: years) for the myopic presbyopic group. All eyes underwent cornea treatment using the PresbyMAX software delivering bi-aspherical multifocal ablation profiles developed by SCHWIND eye-tech-solutions (Kleinostheim, Germany). All Flaps were created by Ziemer LDV Femtolaser (Port, Switzerland). The mean binocular DUCVA improved in the hyperopic group from 0.28±0.29 logmar to -0.04±0.07 logmar, in the emmetropic group from -0.05±0.07 logmar to 0.02±0.11 logmar and in the myopic group from 0.78±0.27 logmar to 0.09±0.08 logmar. The mean binocular NUCVA increased in the hyperopic group from 0.86±0.62 lograd to 0.24±0.23 lograd and in the emmetropic group from 0.48±0.14 lograd to 0.18± 0.11 lograd. The myopic presbyopes showed a decrease of the mean binocular NUCVA from 0.04±0.19 lograd to 0.12±0.18 lograd. In presbyopic patients without symptomatic cataract, but refractive errors, PresbyMAX will decrease the presbyopic symptoms and correct far-distance refraction in the same treatment offering spectacle-free vision in daily life in most of the treated patients. Further investigation is necessary to evaluate the overall benefit of this procedure.