Moderator
John F. Doane, MD, ABO
Panelists
Arun C. Gulani, MD, ABO
Jonathan M. Davidorf, 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
Mauro Fioretto, MD, PhD
Co-Authors
Andrea Colonna MD, Rosa Maria D'Urso MD, Ruggero Tartaro MD, Daniele Rolle MD, Ilaria Scatassi MD
Purpose
To compare customers's subjective refractive outcomes after bilateral cataract with two extended depth of focus (edoff) intraocular lenses (IOL) versus a combination of one edoff IOL and one trifocal IOL. The focus was on evaluating visual acuity, far and near vision quality, vision during digital device use, and vision in dark driving conditions.
Methods
A first group of fifteen patients (age range 56-76 years old) with cataracts and BCVA between 3/10 and 7/10 underwent phacoemulsification with bilateral edoff IOL implantation. The second group of fifteen patients (age range 59-78 years old) with same clinical conditions underwent cataract surgery with implantation of one edoff IOL in the dominant eye and a trifocal IOL in the other ("mixed IOLs technique"). Target refraction goals were set for each group. Patients with ocular pathologies beyond cataracts and ametropia between -3 D and +3 D were included. One month after surgery, participants filled in a satisfaction's questionnaire (scores for each question ranging from 1 to 10).
Results
Here are reported the questionnaire's scores of both groups related to patients's satisfaction in terms of refractive outcome perception in different conditions: 1. General Visual Acuity Satisfaction: - Both edoff IOLs: mean 7.8 +/- 1.7 - Mixed IOLs: mean 8.7 +/- 0.8 2. Far Vision Quality: - Both edoff IOLs: mean 9.1 +/- 0.5 - Mixed IOLs: mean 8.9 +/- 0.6 3. Near Vision Quality: - Both edoff IOLs: mean 3.5 +/- 2.1 - Mixed IOLs: mean 6.9 +/- 2.4 4. Vision Quality During Device Use: - Both edoff IOLs: mean 9.2 +/- 0.4 - Mixed IOLs: mean 8.8 +/- 0.8 5. Vision Quality While Driving in the Dark: - Both edoff IOLs: mean 7.6 +/- 1.3 - Mixed IOLs: mean 7.1 +/- 1.2
Conclusion
The superior results observed with the second group (mixed IOLs) are mainly related to the better near vision quality, facilitated by the trifocal IOL in the non-dominant eye, but free from the subjective presence of halos and glare, which may be masked by the edoff IOL in the dominant eye.
Presenting Author
Tsung-Hsien Tsai, MD, MPH
Co-Authors
Chi-Chin Sun MD, PhD
Purpose
To analyze the correlation between the induction (?) of higher order aberrations (HOAs) and the effective optical zone (EOZ) in small incision lenticule extraction (SMILE) and wavefront-guided laser in situ keratomileusis (WG-LASIK), and to examine the effect of EOZ size on these correlations.
Methods
This retrospective observational study included patients treated with SMILE and WG-LASIK for myopia and myopic astigmatism between November 2018 and November 2022. HOAs and EOZ parameters were analyzed using Scheimpflug imaging and compared between the two procedures one month after surgery. Correlation analysis and multiple regressions between EOZ and ?HOAs were performed.
Results
A total of 271 eyes were included, with 141 underwent SMILE and 130 underwent WG-LASIK. In eyes with smaller EOZ areas, EOZ decentration in SMILE showed significant positive correlations with ?coma and ?vertical coma (p<0.001). eoz="" decentration="" along="" the="" y-axis="" in="" smile="" also="" correlated="" positively="" with="" ertical="" coma=""><0.001). in="" wg-lasik,="" eoz="" decentration="" along="" the="" x-axis="" correlated="" with="" oma=""><0.001) under="" similarly="" small="" eoz="" areas.="" eoz="" area="" significantly="" contributed="" to="" inductions="" of="" spherical="" aberration="" in="" both="" procedures=""><0.001) when="" the="" eoz="" area="" was="" below="" 24.9="" mm�.="" conversely,="" these="" correlations="" were="" either="" not="" observed="" or="" significantly="" smaller="" in="" eyes="" with="" larger="" eoz="">
Conclusion
Maintaining a sufficiently large EOZ post-SMILE or WG-LASIK is crucial. Moreover, precise surgical centration is vital for patients with smaller EOZ sizes, to reduce the induction of HOAs.
Presenting Author
Masayuki Ouchi, MD, PhD
Purpose
To compare postoperative vault differences and discrepancies between preoperative predictions and actual outcomes for vertical versus horizontal implantable collamer lens (ICL) fixation.
Methods
This study involved 126 patients (252 eyes) undergoing ICL insertion for myopia. The control group, consisting of 63 patients, received horizontal implantation in both eyes. The remaining 63 cases were in the experimental group; one eye was randomly assigned to horizontal fixation and the other to vertical fixation. Vault and anterior chamber depth (ACD) were measured preoperatively and at 2 hours, 1 day, 1 week, and 1 months, postoperatively. Differences between the predicted and actual postoperative vaults were also evaluated.
Results
ACD was consistent with preoperative measurements at all time points in both groups (P>0.05) and did not differ significantly between groups (P>0.05). However, vault values were consistently lower in the vertical group than horizontal group at all time points (P<0.001) and="" the="" difference="" at="" the="" final="" observation="" was="" 150.5="" (124.5)="" .="" the="" mean="" vault="" difference="" between="" right="" and="" left="" eyes="" at="" the="" final="" observation="" was="" significantly="" larger="" in="" the="" experimental="" group="" compared="" to="" the="" control="" group=""><0.001). furthermore,="" the="" discrepancy="" between="" preoperative="" vault="" predictions="" and="" actual="" postoperative="" measurements="" was="" significantly="" greater="" in="" the="" vertical="" group="" than="" horizontal="" group="">< />
Conclusion
Vertical ICL fixation results in approximately 150 ?m lower vault compared to horizontal fixation, diverging from preoperative predictions. This variance should be taken into account when selecting ICL size.
Presenting Author
Anas abu Said, MD, PhD
Co-Authors
Shihao Chen MD, OD, MSc
Purpose
In patients with high myopia, high order aberrations such as spherical aberrations and coma can significantly affect visual quality following refractive surgery. This study examines the relationship between changes in epithelial thickness and high order aberrations in highly myopic eyes undergoing SMILE, FS-LASIK, and SMART procedures.
Methods
This retrospective study analyzed preoperative and postoperative data from 87 highly myopic eyes that underwent SMILE, FS-LASIK, or SMART procedures. Epithelial thickness parameters and high order aberrations, including RMS, spherical aberration (Z_4_0), and vertical coma (Z_3_-1), were measured over a follow-up period of more than one year. Changes in these parameters were calculated, and regression analysis was performed to determine the impact of epithelial thickness changes on high order aberrations for each procedure.
Results
Regression analysis revealed that changes in the 5mm central epithelial thickness and SN zone were significant predictors of high order aberrations in highly myopic eyes across all procedures. SMILE showed less increase in RMS and spherical aberration (Z_4_0), likely due to its minimal disruption of the central cornea, while SMART was associated with a smaller increase in vertical coma (Z_3_-1), reflecting its precision in correcting vertical asymmetry.
Conclusion
In highly myopic eyes, epithelial thickness changes significantly influence postoperative high order aberrations. SMILE and SMART, which cause less disruption in key corneal zones, are linked to smaller increases in RMS and Z_4_0. This study clarifies how different procedures impact HOA outcomes, emphasizing role of epithelial thickness changes.
Presenting Author
Kayla Swiatek, MD
Co-Authors
Walter Steigleman MD, Yujia Zhou MD
Purpose
To compare the safety and efficacy of a low-tetrahydrocannabidiol-containing oral cannabidiol (CBD) chemovar with oral codeine-acetaminophen (T3) for controlling post-operative PRK pain.
Methods
In this crossover, randomized, paired-eye controlled trial, 35 patients were randomized to receive either a CBD chemovar or T3 to manage post-operative PRK pain for their first eye and the other treatment for their second eye two weeks later. Adult myopic patients meeting criteria for PRK without surgical or medical contraindications were included. Primary outcome measures were self-reported pain and side effects after PRK. Secondary measures were final refractive error and responses to surveys examining quality of life and visual and ocular surface symptoms pre- and post-operatively at various time points. Non-parametric U-test was used to determine differences in survey responses.
Results
Among the 35 recruited participants, 26 completed surveys 1 week after both treatments. T3 was given first to 12 participants and a CBD chemovar was given first to 14 participants. There were no significant differences between any survey responses at post-operative week 1 after both surgeries (? = 0.05), but both treatments were associated with increased light sensitivity, gritty sensation, pain, and blurry vision in the week after each surgery (p < 0.001). Both treatments had significantly increased vision satisfaction after surgery compared to before surgery (p < 0.001).
Conclusion
Preliminary post-operative week 1 data from this crossover, randomized, paired-eye controlled trial suggests that there is no significant difference between the efficacy of T3 and a CBD chemovar for the control of post-PRK pain at post-operative week 1. Future primary outcome and survey results are pending completion of the study.
Presenting Author
Edward E. Manche, MD, ABO
Co-Authors
Brian Soetikno MD
Purpose
To compare measurements of epithelial thickness after topography-guided and wavefront-guided LASIK.
Methods
This prospective, randomized observational study included 100 eyes of 50 patients who underwent either topography-guided or wavefront-guided femtosecond LASIK to correct myopia at the Byers Eye Institute, Stanford University. Patients were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively. Corneal epithelial thickness was measured with anterior segment optical coherence tomography. The mean central corneal epithelium thickness along with the concentric zones was analyzed.
Results
For topography-guided LASIK, the mean central epithelial thickness was 48.3, 50.2, 38.5, 39.3, and 47.7 microns at pre-operative, 1, 3, 6, and 12 months. Similarly, for wavefront-guided LASIK, the thickness was 49.1, 44.6, 40.7, 37.9, and 51.2 microns at the respective time points. Measurements were not statistically different (p>0.05) between the procedures at each of the timepoints.
Conclusion
Epithelial remodeling in the central zone followed similar trends in topography-guided and wavefront-guided LASIK.
Presenting Author
Nicholas E Dudenhoefer, MD
Co-Authors
Samantha Rodgers MD, Charisma Evangelista MD, Gary Legault MD, Jose Capo-Aponte OD, PhD, Quan Bui MS
Purpose
This study aims to compare visual outcomes, refractive outcomes, and patient-reported symptoms in patients undergoing laser-assisted in situ keratomileusis (LASIK) surgery using either the topographic-guided (Contoura� with Phorcides�) or wavefront-optimized (iDesign�) ablation profiles.
Methods
This prospective, randomized, contralateral study included 66 subjects aged 21 to 50 years. Each underwent LASIK surgery with topographic-guided (TG) ablation in one eye and wavefront-optimized (WO) in the other. Inclusion criteria included myopia between -2.00D and -8.00D and astigmatism ? 3.00D, with similar levels in both eyes. Subjects unsuitable for LASIK by standard measures were excluded. Post-operative month 3 (POM3) visual acuity (VA), low contrast visual acuity (LCVA), manifest refractive (MR), satisfaction with vision using the Patient-Reported Outcomes with LASIK (PROWL), and dry eye symptoms using the Standard Patient Evaluation of Eye Dryness (SPEED) are reported.
Results
For the 22 subjects that have completed POM3 there were statistical differences in MR sphere (TG=-0.09�0.33D, WO=0.14�0.25D; p=0.015) and MR spherical equivalent (MRSE) (TG=0.04�0.27D, WO=0.24�0.24D; p=0.017). There were no statistical differences in uncorrected distance VA (TG=20/17.25�3.22, WO=20/16.30�2.39; p=0.250), corrected distance VA (TG=20/15.18�2.21, WO=20/14.72�2.09; p=0.349), MR cylinder (TG=0.27�0.32D, WO=0.19�0.20D; p=0.318), uncorrected LCVA (TG=20/36.18�10.66, WO=20/31.87�6.34; p=0.083), corrected LCVA (TG=20/30.89�5.78, WO=20/29.23�5.89; p=0.149), SPEED score (TG=2.73�4.97, WO=2.68�4.96; p=0.329) and satisfaction with vision (TG=1.41�0.80, WO=1.32�0.48; p=0.427).
Conclusion
POM3 results suggest that TG LASIK may provide superior outcomes in MR sphere and MRSE compared to WO LASIK. Despite these differences, patient-reported outcomes, including dry eye symptoms and overall satisfaction with vision, were similar. Further analysis will continue to the six-month mark to confirm these findings.
Presenting Author
Buki Kim, MD
Purpose
To investigate the frequency of side effects that remained 1 year after keratorefractive lenticule extraction (KLEX) and Implantable Collamer Lens (ICL; STAAR Surgical) implantation, and to identify associated factors.
Methods
A total of 324 eyes from 324 myopic patients who underwent refractive surgeries including KLEX (227 patients) and ICL implantation (97 patients) were analyzed. One year after surgery, a questionnaire about postoperative side effects was completed. The rates of residual side effects were compared between the two surgeries, and logistic regression analysis was used to identify factors associated with each residual side effect.
Results
In the KLEX group, 18.1% of patients reported blurry vision, 15.4% focusing difficulties, 48.9% glare/halos (G/H), and 29.5% dryness. In the ICL group, 18.6% reported blurry vision, 17.5% focusing difficulties, 63.9% G/H, 35.8% dryness. Residual G/H was significantly lower in the KLEX group compared to the ICL group (p = 0.034), with no significant differences observed in the other side effects. Logistic regression analysis showed that older age, female, high preoperative myopia, and large pupil were risk factors for residual side effects in the KLEX group, whereas large pupil, high residual myopia/ astigmatism, female, and high preoperative astigmatism were risk factors in the ICL group.
Conclusion
One year after surgery, G/H was the most common residual side effect in both the KLEX and ICL groups, with a significantly lower rate in the KLEX group. Factors such as older age, high pre- and post-surgery refractive errors, large pupil size, and female sex were associated with a higher risk of residual side effects.
Presenting Author
Abigail E Harrover, MD
Co-Authors
Allison Chen MD, MPH, Mitchell Weikert MD, MS, Douglas Koch MD, Li Wang PhD, MD
Purpose
To evaluate and compare the induced corneal stromal bed roughness (CSR) measured with atomic force microscopy (AFM) after LASIK flap creation with five modern femtosecond lasers: Zeiss Visumax 500, J&J iFS, Alcon Wavelight FS200, Ziemer LDV V8 NEO, Zeiss Visumax 800.
Methods
High-quality full-thickness human corneal donor tissues were mounted on an anterior chamber maintainer. LASIK flaps were made in three corneas with each femtosecond laser. Each cornea was trephined using a 9.0 mm vacuum donor punch, and the flap was carefully lifted using corneal forceps without touching the underlying stroma. The corneal button was glued with cyanoacrylate to a microscope slide and covered with 2.5% glutaraldehyde solution. AFM surface stromal roughness measurements were made in the central cornea of each sample. CSR was measured using the root-mean-squared value within the given regions. The mean CSR values were calculated for each laser and then compared among lasers.
Results
TBD
Conclusion
TBD
Presenting Author
Sung Min Kim, MD
Purpose
To compare the 6-month clinical outcomes between small-incision lenticule extraction done by VisuMax 500 (SMILE) and VisuMax 800 (SMILE Pro) for patients with myopia and myopic astigmatism
Methods
Total of 98 patients who underwent SMILE with VisuMax� 500(94 eyes) and SMILE Pro with VisuMax� 800(100 eyes) were inculded. Central corneal thickness(CCT), manifest refraction(MR), higher order aberration(HoA), tear meniscus height(TMH), and non-invasive tear break-up time(NIBUT) were measured pre-op. The laser time for creating a lenticule was measured during the surgery. The uncorrected distance visual acuity(UDVA) and MR was measured at 1 day, 1 week, 1 month, and 6 month post-op. The UDVA, MR, HoA, TMH and NIBUT was recorded at 1 month and 3 month post-op. and chi-square test and independent samples t-test were used to compare the pre- and post-op results between the two groups.
Results
The mean lenticule creation time(sec) was 22.85�1.29 for the SMILE group and 10.1�1.01 for the SMILE Pro group, significantly shorter in the SMILE Pro group(p=0.000). On post-op day 1, month 1, and month 6, the UDVA was significantly better in the SMILE Pro group (p=0.030, p=0.002, p=0.003, respectively), while the spherical equivalent refractions did not show a significant difference between the two groups. At 1 month and 3 month post-op. v-coma was significantly lower in the SMILE Pro group compared to the SMILE group(p=0.008, p=0.047, respectively). However, no significant differences were observed between the two groups in terms of change in the total HoAs, NIBUT, TMH.
Conclusion
Compared to SMILE done by VisuMax 500, SMILE Pro by VisuMax 800 showed faster and more effective vision correction with better long-term post-operative visual outcomes.
Presenting Author
Anas-Alexis Benyoussef, MD, MSc
Co-Authors
Beatrice Cochener MD, PhD, Corentin Barbo MD
Purpose
To evaluate and compare the performance of two innovative platforms for lenticular surgery: Zeiss VISUMAX 800 (SMILE�) versus Johnson and Johnson ELITA (SILK�).
Methods
In this prospective, comparative, non-randomised, single-centre study, the first 78 patients received laser treatment with the VISUMAX 800� platform and the next 55 patients received laser treatment with the ELITA� platform. The primary outcome was uncorrected monocular visual acuity and refraction at 3 months. Secondary outcomes were quality of vision, optical aberrations and ocular surface analysis.
Results
There was no statistically significant difference between the 2 groups for monocular (p=0.093) and binocular (p=0.13) UDVA. On the other hand, there was a significant difference for monocular (p = 0.0136) and binocular (p= 0.024) CDVA in favour of the SILK � operated group. The mean spherical equivalent for the SMILE� group was 0.155 and 0.022 for the SILK� group, with a significant difference between the 2 groups (p= 0.0067). The questionnaire (QOV 10) only found a significant difference in favor of the SILK group for symptoms of glare and blurred vision. Satisfaction analysis was comparable between the 2 groups.
Conclusion
These two innovative platforms, each with their own specific features, show good refractive predictability, efficacy and safety in the indications they are used for. The refractive results are similar between the two platforms, with promising cylindrical correction via cyclotorsion compensation.
Presenting Author
Ramy A Elbassiouny, PhD, MRCSEd
Co-Authors
Ahmed El-Massry PhD
Purpose
the aim of this study was to evaluate epithelial mapping changes after photorefractive keratectomy (PRK) and to compare them with changes after Femtosecond Small Incision Lenticule Extraction (Femto-SMILE)
Methods
The study was a prospective comparative interventional study that included forty-eight eyes. The study was approved by the ethical review committee (No. 0107025/2022). Half of the eyes were treated by photorefractive keratectomy (Group A), while the other half were treated by Femto-SMILE (Group B). Before surgery, all patients were subjected to full ophthalmologic examination, corneal topography, and epithelial mapping. All patients were examined at one week, one month, three months, and six months postoperatively. The epithelial mapping data were evaluated and compared.
Results
In our study, the mean preoperative minimum epithelial thickness in group A was 42.33 �m and that in Group B was 44.25 �m. The mean preoperative maximum epithelial thickness in Group A was 54.46 �m and that in Group B was 54.25 �m. After six months of surgery, we noticed an increase in the thinnest epithelial point in all patients. There were no statistically significant changes in epithelial thickness in the four paracentral quadrants between the groups after 3 months of follow-up. The central 3 mm of the corneal epithelium was significantly thicker after PRK at the first postoperative visit.
Conclusion
Epithelial healing after PRK is associated with early epithelial thickening followed by epithelial remodeling to become thinner and more regular. There was no significant difference in epithelial thickness after PRK and Femto-SMILE.
Presenting Author
Sung Min Kim, MD
Purpose
To compare 1 month clinical outcomes of lenticule extractions done by SMILE(VisuMax 500, Zeiss), SMILE pro(VisuMax 800, Zeiss), SILK(ELITA, Johnson & Johnson), CLEAR(Z8, Zeimer) and SmartSight(ATOS, Schwind).
Methods
This study retrospectively analyzed 366 eyes of 185 patients who underwent lenticule extraction surgery with VisuMax 500(Zeiss, 104 eyes), VisuMax 800(Zeiss, 108 eyes), ELITA(Johnson & Johnson, 52 eyes), Z8(Ziemer, 56 eyes) and ATOS(Schwind, 46 eyes). Hyperopia or mixed astigmatism, extreme high myopia > -9.0D, high astigmatism > -2.5D and pre-operative best corrected vision < 20/20 were excluded. Central corneal thickness (CCT), manifest refraction (MR), higher order aberration (HoA) were measured pre-operatively. The uncorrected distance visual acuity (UDVA) and MR was measured at 1 day and 1 week after the surgery. The UDVA, MR, HoA was recorded at 1 month after the surgery and compared.
Results
At 1day post-op, UDVA for VisuMax 500 (SMILE: 1.04�0.19), VisuMax 800 (SMILE pro: 1.14�0.19), Z8 (CLEAR: 0.90�0.16), ATOS (SMART: 0.95�0.08) and ELITA (SILK:1.08�0.12) showed significant differences. However, SEQ at 1day showed no differences(SMILE: -0.11�0.30, SMILE pro: -0.09�0.33, CLEAR: -0.13�0.42, SMART: -0.18�0.27, SILK: -0.13�0.27). At 1month, UDVA for all groups increased but there showed no significant differences(SMILE: 1.26�0.20, SMILE pro: 1.36�0.18, CLEAR: 1.29�0.19, SMART: 1.38�0.21, SILK: 1.38�0.18). Vertical coma was less induced in SMILE pro, SMART and SILK group at 1month(p=0.000).
Conclusion
All femto-machines showed comparable and superb visual outcomes. There showed slight difference in early post-op visual outcomes depending on suction type, however, at 1month there showed no differences in uncorrected vision.
Presenting Author
Viana Wirtz, MD
Co-Authors
Jascha Wendelstein MD
Purpose
This study aims to compare the accuracy and clinical outcomes of wavefront-guided versus wavefront-optimized excimer laser ablation for refractive correction. The objective is to determine which technique offers superior efficacy and safety for patients undergoing laser vision correction.
Methods
A prospective observational study was conducted with patients requiring refractive correction. Participants underwent wavefront-guided and wavefront-optimized excimer laser ablation. Preoperative and postoperative assessments included uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), higher-order aberrations (HOAs), and patient satisfaction. Statistical analyses compared the outcomes between the two groups to evaluate differences in visual acuity, accuracy, refractive stability, and incidence of HOAs. Follow-up assessments were conducted at 1 month, and 3 months postoperatively.
Results
TBD
Conclusion
TBD
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