Moderator
Helen K. Wu, MD, ABO
Panelists
Mitchell P. Weikert, MD, MS, ABO
KAMRAN M. RIAZ, 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
Jiwon Jeong, MD
Purpose
Extensive research has shown that KLEX surgery is safe and effective. In addition, many authors have suggested that KLEX may have less impact on corneal biomechanics than other surgical techniques because no flap is created. In this study we noninvasively investigate biomechanics before and after KLEX.
Methods
Retrospective review of visually normal patients who underwent refractive surgery at Fatima Eye Clinic. Exclusion criteria included known eye diseases and prior ocular surgery. Pre-operative data comprised visual acuity, spherical equivalence, corneal thickness, intraocular pressure and scanning with a 10-point pattern on the Intelon Brillouin Scanning System (BOSSTM) device. The postoperative visits (1 week, 1 month and 3 months) varied across patients. Patients were assigned to Visumax 500 (Vis500) or Visumax 800 (Vis800) based on their request. Clinical data were compared to the Central, Mean, Min and Max Brillouin moduli (BMs, i.e., �stiffnesses�) using non-parametric statistics.
Results
The groups (172 Vis500 and 154 Vis800 patients (650 eyes)) differed in pre-op lenticle thickness and Central and Min BM (all P?0.03, Vis800>Vis500) but not age, sex, CT, IOP, SE or Mean or Max BM (P?0.06). No BM correlated with age, IOP, SE or CT (P?0.35) except Vis500�s MIN BM with IOP (P=0.006) and Central BM with SE (P=0.03). With Vis500, BMs trended lower at 1 week post-op and were significantly reduced at 1 month (P?0.03) for Mean, Min and Max BM; BMs rebounded from 1 to 3 months (P?0.03) to be ? baseline at 3 months. With Vis800, there were no significant differences between pre-op and any post-op time for Central, Mean and Max BMs (P?0.07); 3-month Min BM > pre-op (P=0.02).
Conclusion
IOPs decreased (P<0.001) after KLEX. Small (<10%) but significant decreases in stiffness occurred, chiefly at 1 month, in the Vis500 group; their BM values returned to ? baseline by 3 mon. The Vis800 group showed non-significantly higher BM post-op values. Thus, the biomechanical changes differed by type of surgery and follow-up time.
Presenting Author
Hallie Hahn, MD, BSc
Co-Authors
Lance Kugler MD
Purpose
To report the incidence of retinal tear and rhegmatogenous retinal detachment(RRD) after refractive lens exchange (RLE) and the risk factors associated with development of a retinal tear or RRD in this population.
Methods
Retrospective multi-center study of eyes that underwent RLE from January 2019 to August 2023 at participating sites. Patients from seven surgeons at four sites were included. All patients undergoing RLE that were 18+ years old at surgery with 1+ year of follow up data available were included. Exclusion criteria: preoperative retinal detachment or tear, diabetic retinopathy, prior pars plana vitrectomy, ocular trauma, or congenital ocular disorder. Primary outcomes: incidence of retinal tear and RRD. Patient data collected: age, sex, race, axial length, preoperative refraction, preoperative PVD, preoperative lattice degeneration, surgical complications, and performance of a YAG capsulotomy.
Results
Of the 272 eyes of 149 patients included, 1 eye (0.37%) developed RRD and 3 (1.47%) eyes developed RT, 2 without RRD and 1 with RRD within the follow up period. 129 patients (86.6%) were reached via a follow up text message or phone call, 28 patients did not respond. The mean follow up duration was 578 days (SD ? 101). The mean age was 55 (SD ? 6.59). The mean axial length (AL) and pre-operative spherical equivalent (SEQ) was 23.9 mm (SD ? 1.49) and +0.069 (SD ? 3.39), respectively. The AL and pre-operative SEQ of the eye with a RRD was 23.4 mm and +2.0 D, respectively. The RRD occurred 133 days post-operatively and did not undergo a YAG capsulotomy prior to development of the RRD.
Conclusion
Based on this data set, the rate of RRD is 1 in 272 refractive lens exchanges. A larger sample size is needed to identify risk factors for RRD and retinal tear following refractive lens exchange. This data may be useful during informed consent counseling for a refractive lens exchange.
Presenting Author
Mark C. Lobanoff, MD, ABO
Purpose
To assess patient subjective responses regarding satisfaction of vision, visual disturbances, and dry eye symptoms following WaveLight LASIK surgery for myopia or myopic astigmatism.
Methods
This was an ambispective, multi-site, single arm, observational study of patient reported satisfaction, visual disturbances, and dry eye symptoms. A total of 300 patients were targeted. Outcome measures included administration of the modified PROWL and OSDI questionnaires at least 12 months postoperatively.
Results
Results: To date, 275 subjects have completed the study. Postoperatively, 94% of patients reported being �Completely Satisfied� or �Very Satisfied� with their vision. In addition, 96%, 78%, 79%, and 71% of subjects reported �Never� or �Rarely� experiencing double images, glare, halos, and starbursts, respectively, while 0%, 2%, 1%, and 3% of subjects reported that these same visual disturbances were �Extremely� or �Very� bothersome, respectively. Furthermore, 99% of patients said they would choose to have the procedure again and 98% would recommend it. Mean score on the OSDI questionnaire was 8.73 � 8.33.
Conclusion
Interim results suggest a high percentage of post-WaveLight LASIK patients were satisfied with their vision. Few patients had significant visual disturbances at night. Most patients did not struggle with dry eye.
Presenting Author
Jiwon Jeong, MD
Purpose
Extensive research has shown that KLEX surgery is safe and effective. In addition, many authors have suggested that KLEX may have less impact on corneal biomechanics than other surgical techniques because no flap is created. In this study we noninvasively investigated biomechanics before and after KLEX.
Methods
Retrospective review of visually normal patients who underwent refractive surgery at Fatima Eye Clinic. Exclusion criteria included known eye disease and prior ocular surgery. Pre-operative data comprised visual acuity, spherical equivalence(SE), central corneal thickness(CT), intraocular pressure(IOP) and scanning with a 10 point corneal pattern on the Intelon Brillouin Scanning System(BOSS)device. the postoperative visits ( 1week, 1month, 3months) varied across patients. Patients were assigned to Visumax 500("Vis500") or Visumax800 ("Vis800) based on their request. Clinical data were compared to the Central, Mean, Min and Max Brillouin modulii(BMs) using non-parametric statistics.
Results
The groups(172 Vis500 and 154 Vis800 patients (650eyes)) differed in pre-op lenticule thickness and Central and Min BM (all p<0.03 Vis800>Vis500) but not age, sex, CT, IOP, SE or Mean or Max BM (p>0.06). No BM correlated with age, IOP, SE or CT(p>0.35) except Vis500's Min BM with IOP(p=0.006) and Central BM with SE (p=0.03). With Vis500, BMs trended lower at 1 week post-op and were significantly reduced at 1month (p<0.03) for Mean, Min, and Max BM; BMs rebounded from 1 to 3 months ( p<0.03) to be > baseline at 3 months. With Vis800, there were no significant differences between pre-op and any post-op time for Central, Mean and Max BMs(p>0.07); 3month Min BM > pre-op ( p=0.02 ).
Conclusion
IOPs decreased (p<0.001) after KLEX. Small (<10%) but significant decreases in stiffness occured, chiefly at 1month, in the Vis500 group; their BM values returned to > baseline by 3 mon. The Vis800 group showed non-significantly higher BM post-op values. Thus, the biomechanical changes differed by type of surgery and follow-up times.
Presenting Author
James B Randleman, MD
Purpose
To evaluate the ability of motion-tracking Brillouin (MTB) microscopy to differentiate subclinical keratoconus form normal controls as compared to multimodal corneal imaging.
Methods
Ongoing prospective study of patients determined to have subclinical keratoconus or normal corneas based on routine clinical imaging. All patients will have MTB, Scheimpflug imaging (Pentacam HR), OCT imaging including epithelial maps, and corneal hysteresis determined via the CorvisST. Receiver operating characteristic (ROC) curves were generated for all imaging metrics evaluated to determine the area under the curve (AUC), sensitivity, and specificity for all variables.
Results
There were 60 eyes from 60 patients evaluated, including 30 Control eyes from 30 patients and 30 Subclinical keratoconus eyes from 30 patients. There were no significant differences between groups for age, sex, or K Mean. There were significant differences between control, SKC, and KC groups for MT Brillouin minimum shift metrics. MT Brillouin metrics outperformed CorvisST imaging in identifying SKC eyes and in discrimination between normal controls and SKC eyes.
Conclusion
MT Brillouin microscopy identified mechanical differences between controls eyes and those with subclinical keratoconus and outperformed Scheimpflug CorvisST imaging in discriminating subclinical keratoconus from normal corneas.
Presenting Author
Yuexi Y. Chen, PhD
Co-Authors
Zheng Wang PhD, Jiansu Chen PhD
Purpose
To develop an effective approach for the reprogramming of human corneal stromal cells (hCSCs, also called keratocytes) derived from SMILE lenticules into stem-like cells without using transcription factors. Then, further, prove that these cells can be good seed cells for tissue engineering corneal construction and cell therapy.
Methods
Primary hCSCs were isolated from SMILE-derived lenticules and cultured in a low-serum RIFA medium with soluble human corneal stromal extract (hCSE). A novel platform with 62 V-bottom micro-cavities and essential 8 (E8) medium was used to generate adherent 3D keratocyte spheroids in the polydimethylsiloxane (PDMS) microwell. Besides, we used induced pluripotent stem (iPS) supernatant as the conditioned medium (iPS-CM) to culture the 3D keratocyte spheroid. The reprogramming results were compared between 3D spheroids with 2D cultures via qPCR and Immunofluorescence (IF) staining.
Results
The hCSCs were successfully isolated from SMILE-derived lenticules, exhibiting dendritic or stellate shapes and strongly expressing keratocyte markers. We successfully generated efficient and homogeneous 3D spheroids in the PDMS microwell and cultured these cells in iPS-CM. The average diameter of 3D spheroids is 433.40 � 68.66 �m. qPCR analysis showed that the expression of stem cell marker genes (SOX2, PAX6, OCT4, NANOG, NGFR, and NESTIN) was significantly greater in 3D spheroids than those in 2D cells. Furthermore, IF staining revealed that KLF4, NANOG, SOX2, and PAX6 were positively expressed in adherent 3D spheroids but negatively in 2D cells.
Conclusion
Our results indicated that the physiological cells and culture conditions enhance the reprogramming of keratocytes derived from SMILE lenticules into stem-like cells, suggesting its potential application for developing implants in tissue engineering and regenerative medicine.
Presenting Author
Michael X. Lin, BA
Co-Authors
Gavin Li BSc, Esen Akpek MD, Jason Jo BA
Purpose
This study investigates demographic and hospital differences between corneal scar and keratoconus (KCN) patients who receive penetrating keratoplasty (PK) vs deep anterior lamellar keratoplasty (DALK).
Methods
This retrospective study analyzed all patients in the 2019 Nationwide Ambulatory Surgery Sample with a diagnosis of KCN or corneal scar and no history of corneal transplantation who received PK (n = 1855) or DALK (n = 214). Within KCN and corneal scar groups, significant differences between PK and DALK recipients were analyzed with a standard two-tailed t-test and chi-squared analysis. Multivariable logistic regression was further used to analyze demographic factors and hospital center characteristics to identify features associated with receiving DALK over PK.
Results
In comparison to PKs, DALKs were performed in younger patients with corneal scarring (51.5 v. 57.7; p=0.009). In comparison to rural hospitals, urban hospitals were more likely to perform DALKs in KCN patients (Odds Ratio [OR]=2.52, 95% Confidence Interval [1.25 � 5.44]), but not for corneal scar patients. In comparison to the Northeast, hospitals in the West were less likely to perform DALKs for KCN patients (OR=0.33, [0.16 - 0.68]). No racial differences were noted in the administration of PK or DALK in patients with KCN or corneal scars.
Conclusion
KCN patients at urban hospital centers and younger corneal scar patients were more likely to receive deep anterior lamellar keratoplasties (DALKs) than penetrating keratoplasties (PKs). No differences were observed based on race, insurance type, or region.
Presenting Author
Lional Raj Daniel Raj Ponniah, MD, PhD
Purpose
To evaluate computer-based perceptual visual therapy (PL) regime using Gabor patches for improving best-corrected vision(BCVA) & contrast sensitivity function(CSF) in crosslinked stable keratoconus(KC)
Methods
A Prospective, controlled randomized, open-label study. Subjects aged 18-35 with stable KC clinically and by serial topographic assessments. KC stable over 1 yr with BCVA worse than 20/40 were randomized in 2:1 into treatment (G1), control (G2) arms. The study consisted of 2 phases (screening + therapy periods). Post 20 and 40 training sessions were evaluated for improvements in BCVA distance & near (ETDRS) & CSF at spatial freq. of 3, 6,12,18 CPD
Results
30 cases randomised in 2:1. Baseline BCVA was 68.20+/-8.11 & 67.40+/-7.09 in G1,G2 (p=0.793). BCVA of PL(G1) improved to 73.30+/-7.47 & 79.10+/-8.46 post 20 & 40 sessions(over 2.5 LogMAR lines,p<0.0001) &="" not="" in="" controls(g2).="" csf="" at="" 3,6,12,18="" cpd="" (friedman="" repeated="" measure="" tests)="" showed="" significant="" improvements="" in="" pl=""><0.0001), &="" not="" in="">
Conclusion
Vision is limited by image capturing and image processing, While all modalities only treat refraction (capturing), Visual Perceptual Therapy trains the brain to see better (image processing) without additional surgery, enhancements, drugs, or side effects in cases with Stable Keratoconus & is a good post-operative therapeutic adjuvant.
Presenting Author
Divya Trivedi, MBBS, MS
Co-Authors
Deepti Mujumdar MS, Harpal Singh MS
Purpose
To assess under-graduate medical students� understanding of refractive surgery.
Methods
A questionnaire-based survey was conducted among a cross-section of undergraduate medical students, over a period of one month. Students aged ?18 years were included, and those who were unwilling to participate, were excluded. The questionnaire was addressed to identify awareness about refractive errors that can be surgically corrected, reasons for reluctance to undergo refractive surgery and their sources of information. Close-ended questions with single-choice, multiple choices and contingency questions were included, and the participants were asked to choose the most suitable response from among the options.
Results
Of the 643 students, 596 (92.62%) were aware of existence of surgical procedures for correction of refractive errors. 324 (54.36%) of them felt vision could become poor again after refractive surgery, 383 (64.26%) said that refractive surgery is a painless procedure, 281 (47.14%) stated that refractive surgery does not leave a permanent scar on eye. 192 (32.21%) knew that refractive surgeries can correct all three refractive errors, and 137 (40.29%) were willing to undergo the procedure themselves. Among those reluctant to undergo surgical correction (59.70%), the reasons were inadequate information (32.01%), high cost of the procedure (24.13%) and fear of further loss of vision (20.19%).
Conclusion
In spite of good awareness about refractive surgery among undergraduate medical students, they remain hesitant to undergo the procedure themselves. Doctors and social media platforms form the most common sources of information about these procedures.
Presenting Author
David Smadja, MD
Co-Authors
Sara Sella MD, Itay Lavy MD, Marcony Santhiago MD, PhD, Glauco Reggiani Mello MD, Tomer Batash MD
Purpose
To investigate a new machine learning based algorithm in the detection of corneal at risk of ectasia before laser vision correction
Methods
A total of 372 eyes of 197 patients were enrolled: 177 normal eyes of 95 subjects, 47 eyes of 47 patients with forme fruste keratoconus and 148 eyes of 102 patients with keratoconus All eyes were imaged with a Dual Scheimpflug Analyzer System (Galilei G6). Fifty-five parameters derived from anterior and posterior corneal measurements were analyzed for each eye. A set of 3 synergistic decisions trees were built to improve the performance of detection of subclinical keratoconus.
Results
The discriminating rules generated with the automated decision tree classifier allowed to discriminate between normal and keratoconus with 100% sensitivity and 99.5% specificity and between normal and FFKC with 97.6% sensitivity and 99.2% specificity. The first 2 decisions tree are based on anterior asymmetry-based indices and enable 80% sensitivity and 91% specificity, whereas the additional third decision tree incorporates posterior and pachymetry based indices and enable the further improvement of the sensitivity (97.6) and specificity (99.2)
Conclusion
This new machine learning classifier synergistic method showed a very good performance for discriminating between normal corneas and subclinical keratoconus and provided a tool that is closer to an automated medical reasoning.
Presenting Author
Hannuy CHOI, MD, MS
Purpose
Surgical options for refractive surgery has gradually changed with the emergence of new machines, advancements in surgical techniques, and research on safety of surgery. We analyzed how the trend of refractive surgery changed from 2012 to 2023 and examined changes in surgical trends based on each dioptric category in high volume center in Korea
Methods
The Patients who had refractive surgery from 2012 to 2023 in our clinic were retrospectively reviewed. 161,468 Patients were included. We analyzed the trend change in surgical methods over the time and the trends based on patients' diopter values. Refractive surgeries are categorized into phakic intraocular lens implantation(pIOL), photorefractive keratectomy(PRK), laser-assisted in situ keratomileusis(LASIK), and refractive lenticule extraction(ReLEx). The patient's refractive error was converted to a spherical equivalent (SE) value, and we analyzed which type of refractive surgery was performed based on the diopter of refractive error and how the surgical methods have changed over time.
Results
When analyzing all patients, pIOL were 4%, 6.1%, 13% in 2012, 2017, and 2023. PRK showed 38.2%, 22.9%, and 15% in the same years. LASIK were 56.2%, 27.1%, 5.1% and ReLEx were 1.6%, 33%, 66.9% respectively. For patients with SE -6D, pIOL were 1%, 1.4%, 3.1%, 5.9% in 2012, 2016, 2020, 2023 and PRK were 40.7%, 31.8%, 20%, 8.6% respectively. LASIK were 56.5%, 42.7%, 15.5%, 3.8% and ReLEx were 1.8%, 24.1%, 61.3%, 71.7% respectively. For patients with SE -9D, pIOL were 23.7%, 26.1%, 47.1%, 76.2% in same year as above and PRK were 38.2%, 55%, 47.9%, 23.8% respectively. LASIK were 33.3%, 11.2%, 3.6%, 0% and ReLEx percentages were 4.7%, 7.7%, 1.4%, 0% respectively (p-value for trend < 0.001).
Conclusion
Over the past 12 years, it appears that LASIK surgeries have gradually transitioned to ReLEx each year. ReLEx showed rapid growth from 2014, surpassing 60% surgeries after 2021. PIOL have shown a gradual increase among all patients. Especially, the patients with high refractive error, pIOL appears to increase significantly.
Presenting Author
Hamidreza Hasani, MD, MSc, BA
Purpose
To assess the effects of Trans-Epithelial Photorefractive Keratectomy (Trans-PRK) on stereopsis and contrast sensitivity.
Methods
This quasi-experimental clinical trial involved all patients undergoing refractive surgery with Trans-PRK by a designated ophthalmologist. In addition to standard preoperative evaluations, contrast sensitivity was measured using the Pelli-Robson chart, and stereoacuity was assessed with the TNO Test, both before surgery and 12 months postoperatively. Data were analyzed using STATA software (Version 17) at intervals of 3, 6, and 12 months� post-surgery, with statistical significance set at a p-value ? 0.05.
Results
The study included 62 patients, with 46.77% (29 patients) male and the remainder female. The average age was 29.51 � 0.67 years. Postoperative stereoacuity showed a significant gradual improvement (P = 0.001), while contrast sensitivity initially declined at 3 months, returned to near preoperative levels at 6 months, and significantly increased by 12 months compared to preoperative values (P < 0.001). Best Corrected Visual Acuity (BCVA) remained statistically unchanged post-surgery (P = 0.418).
Conclusion
Trans-epithelial Photorefractive Keratectomy leads to a significant improvement in postoperative stereoacuity and contrast sensitivity. The study also indicates no significant differences between myopic and hyperopic patients in these outcomes.
Presenting Author
Hamidreza Hasani, MD, MSc, BA
Purpose
This study aimed to assess the effects of oral ascorbate supplementation on corneal epithelial healing time and haze formation following Trans-Epithelial Photorefractive Keratectomy (TPRK).
Methods
In this randomized clinical trial, 172 patients undergoing TPRK for refractive error correction were enrolled. Participants were randomly divided into two groups: one receiving routine postoperative care and the other receiving routine care plus oral ascorbate supplementation (500 mg chewable tablets, four times daily for four days postoperatively). Follow-up evaluations were conducted to measure epithelial healing time, corneal haze, photophobia, and pain levels, with pain assessed using the McGill Pain Questionnaire.
Results
Oral ascorbate supplementation significantly accelerated corneal epithelial healing and reduced corneal haze compared to the control group (P<0.05). additionally,="" the="" incidence="" of="" photophobia="" was="" significantly="" lower="" in="" the="" ascorbate="" group=""><0.05). although="" pain="" levels="" were="" higher="" in="" the="" control="" group,="" this="" difference="" was="" not="" statistically="" significant="" (p="">
Conclusion
Ascorbate supplementation effectively reduces corneal epithelial healing time and decreases postoperative complications such as corneal haze, photophobia, and pain following TPRK.
Presenting Author
Alena Shen, BSc
Co-Authors
Rasika Sudharshan BA, Sandy Zhang-Nunes MD, Linda Wu BA
Purpose
This study aims to characterize viewer engagement and quality of TikTok videos on laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) and compare physician- vs. patient-produced content.
Methods
The first 50 relevant videos on TikTok under �LASIK� and �PRK� in October 2023 (n=100) were analyzed by four reviewers with various questionnaires: DISCERN for reliability and quality, PEMAT-A/V for understandability and actionability, Global Quality Score (GQS) for quality, and JAMA metrics for accuracy. Metrics on video reach (views, followers, likes, comments, and video length) were collected, and the videos were categorized by video source (physician, patient, or other) and classified into video purposes (education, lived experience, process, before/after). �SMILE surgery� and �ICL� were also searched, but they yielded less than 30 relevant results and were excluded from the study.
Results
Of all videos in the study, 33 videos were created by physicians, 63 by patients, and 4 by other sources. Physician-produced videos received 3.30 times as many views as patient-produced videos (1.3 million vs. 401,342). Physician-produced videos were, on average, significantly shorter than patient-produced videos (33.5 vs. 89.6 seconds). More educational videos were produced by physicians (36.4% vs. 3.2%), and the majority of patient-produced videos were lived experiences (71.4%). Quality of physician-produced videos was higher with GQS (3.43 vs. 2.79) but lower with DISCERN (0.36 vs. 0.41). JAMA accuracy of physician-produced videos was higher than patient-produced videos (0.32 vs. 0.27).
Conclusion
Physician-produced videos had higher engagement but are less prevalent than patient-produced videos. The insufficiency of physician-produced videos and low overall quality of patient-generated videos paired with TikTok�s extensive user reach highlights the need for more physician-produced content to enhance ophthalmology health literacy.
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