PresbyMax Outcomes in Myopia, Hyperopia, Emmetropia and Patients post Lasik SCHWIND eye-tech-solutions Lunch Symposium Prof. Jorge L. Alió MD, PhD. UNIVERSIDAD MIGUEL HERNÁNDEZ VISSUM INSTITUTO OFTALMOLÓGICO DE ALICANTE SPAIN PresbyMax Methods The ablation pattern was performed using the SCHWIND excimer laser platforms (Schwind, Frankfurt, Germany),centered in corneal vertex and biaspherical profile. The main outcome measures were refraction, uncorrected and best corrected visual acuities for near and distance and corneal aberrations (spherical and coma). Visual Outcomes: Optec 6500 (Vision Sciences Research Corporation, CA, US) 1
PresbyMax Outcomes analysis by Ray Tracing Algorithm Our algorithm is customized, that is, to the topography map of the cornea. So, it is 100% personalized. The first step is to model the cornea with a Zernike polynomials. Then, 200 parallel rays make an impact toward the cornea and they are refracted. The number of rays 200 has been optimized. Results: HYPEROPS Visual acuities PREOP 3 Month DUCVA 0.3 ± 0.2 0.6 ± 0.3 Refraction PREOP 3 Month DUCVA AO 0.6 ± 0.2 0.8 ± 0.2 Sphere 2.8 ± 0.8-0.5 ± 0.3 DBCVA 0.9 ± 0.2 0.8 ± 0.2 Cylinder -0.8 ± 0.7-0.9 ± 1.0 DBCVA AO NDCVA NDCVA AO NUCVA NUCVA AO NBCVA 1.0 ± 0.03 0.4 ± 0.1 0.6 ± 0.2 0.3 ± 0.1 0.3 ± 0.2 0.9 ± 0.2 0.9 ± 0.1 0.6 ± 0.3 0.8 ± 0.3 0.8 ± 0.3 1.0 ± 0.2 0.9 ± 0.3 Sph. Equivalent Addition Corneal aberrations RMS spherical RMS coma 1.8 ± 1.6 1.8 ± 0.7 0.3 ± 0.1 0.5 ± 0.2-1.0 ± 0.4 0.9 ± 0.4-0.5 ± 0.1 0.6 ± 0.1 NBCVA AO 1.0 ± 0.1 1.0 ± 0.04 2
PresbyMax Outcome PREOP HPM POSTOP HPM Hyperopic cases Ablatión at 6mm diámeter.. Ablatión at 3mm diámeter. 3
PresbyMax Conclusions in Hyperopia The biaspherical profile of PresbyMAX in hyperops provides an effective presbyopia correction up to +2 D. The monocular results are consistent with J3 spectacle free reading and 0.7-0.8 average far distance vision. Binocular results increase the far and near vision performance. No photic phenomena, high patient s satisfaction. MYOPIC PATIENTS Prospective, non comparative pilot study 32 myopic eyes (16 patients) with age between 40 and 55 years Inclusion criteria: myopia - 4 (D), astigmatism 2 (D), corneal curvature between 40 and 48 D, pachymetry > 500, and near vision of J3 with addition of +1.50 D. 4
PresbyMax Outcome PREOP MYOPIC POSTOP MYOPIC Results: DISTANCE Visual Acuity (Uncorrected) DUCVA 1.0 0.8 0.6 0.4 Monocular 70 % 80 % 96.6 % Binocular 5
Results: NEAR Vision (Uncorrected) NUCVA J1 J2 J3 J4 Monocular 16 % 32 % 60 % 76 % Binocular 40.7 % 55.5 % 85.2 % 96.3 % Results: Corneal aberrations.5.6.4.5 RMS SPHERICAL ABERRATION.3.2 RMS COMA ABERRATION.4.3 N = 26 30 28 N = 26 30 28 PREOP 1 MONTH 3 MONTHS PREOP 1 MONTH 3 MONTHS At 3 months, no statistically significant changes in corneal spherical and coma aberrations (Bonferroni, p = 0.121 for spherical and p = 0.108 for coma) 6
Case 1#: Corneal topography PREOP 3 MONTHS Case 1#: Corneal aberrometry PREOP. RE RMS sph: 0.16 RMS coma:0.16 PREOP. LE RMS sph: 0.15 RMS coma:0.19 3 MONTHS. RE RMS sph: 0.27 RMS coma:0.20 3 MONTHS. LE RMS sph: 0.18 RMS coma:0.19 7
Myopic cases analysis Ablatión at 6mm diámeter. Ablatión at 3mm diámeter. PresbyMax Conclusions in Myopia PresbyMAX improves functional near vision in patients with presbyopia associated to low to moderate myopia (0 to 4 D) and near vision add up to+2d. No photic phenomena, very high patient s satisfaction. 8
PresbyMax Emmetropic patients PREOP EMMETROPIC POSTOP EMMETROPIC Emmetropic cases Ablatión at 6mm diámeter.. Ablatión at 3mm diámeter. 9
Emmetropic cases Summary of the depth of focus and estimated visual outcome at 3 y 6 mm Ojo 1 DOF 6mm 1.80D DOF 3mm 0.76D AV 6mm 1.27 Av 3mm 0.58 2 1.95D 1.66D 1.19 0.91 3 0.81D 0.98D 0.79 0.66 4 0.97D 1.04D 0.89 0.72 5 1.48D 2.01 1.13 1.28 Mean 1.40D 1.29D 1.05 0.83. CORNEAL TOPOGRAPHY PREOP. 6 MONTHS 10
PresbyMax in Post Lasik Patients A prospective, non comparative pilot study. Included: a total of 10 eyes with previous lasik. -Inclusion criteria: -Age between 55 and 60 years -Residual error following lasik -Corneal curvature between 40-48D -Pachymetry >450 microns -Near vision of J3 with addition of+2 Visual acuity results Distance: BCVA: 0.99 ± 0.02 (20/20); UCVA 0.85 ± 0.16 (20/23) Near: BCVA 1.00 ± 0.00 (J1+) UCVA 0.52 ± 0.14 (J3) Intermediate: NDCVA 0.38 ± 0.07. (J5) % of eyes 60 50 40 30 20 10 Gain/Lost of VA DUCVA NUCVA No eye lost any line of best corrected visual acuity. 0 lost 1 line no change gain 1 line gain 2 lines gain > 2 lines 11
Postoperative visual acuity results DUCVA 1.0 0.8 Monocular 40 % 90 % Binocular NUCVA J1 J2 J3 J4 Monocular 10 % 40 % 60 % Binocular 80 % 80 % PREDICTIVE FACTORS Good and significant correlation between the postoperative DCNVA and the pupil size in mesopic low conditions (r=-0.63, p=0.01) Good and significant correlation between the postoperative near addition required and the preoperative primary spherical aberration (r=-0.73, p<0.01) 12
Post Lasik cases Conclusions PresbyMax Central Biaspheric PresbyLasik, very useful to improve near vision in patients who develop presbyopia following the correction of a previous refractive defect with LASIK surgery High patient s satisfaction. 6 months after surgery, patients are spectacle independent for distance and near. This is the FIRST WORLDWIDE REPORT on Presbylasik (PresbyMax) on eyes with previous Lasik SCHWIND eye-tech-solutions Lunch Symposium 13