Moderator
Boris E. Malyugin, MD, PhD
Panelists
Marcony R. Santhiago, MD, PhD
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
George O. Waring IV, MD, FACS
Purpose
To evaluate initial clinical outcomes of laser-assisted in-situ keratomileusis (LASIK) performed with the latest excimer laser (Technolas Teneo 317, Model 2) using an aspheric ablation profile for correcting myopia and myopic astigmatism.
Methods
This retrospective study included patients who underwent LASIK performed using the new Technolas Teneo 317 Model 2 excimer laser (version 1.28 US SW) by Bausch and Lomb, using the latest aspheric ablation profile. No nomogram adjustments were made, and the patient�s manifest refraction was used for the laser treatment. Study parameters included uncorrected and corrected distance visual acuity (UDVA and CDVA), manifest refraction spherical equivalent (MRSE), and astigmatism.
Results
Data from 47 eyes were analyzed. The mean age of 25 patients was 33.4�7.9 years. There were 44% males and 56% females. The mean preoperative CDVA was -0.05�0.09 logMAR and all (100%) eyes had CDVA of 20/30 or better preoperatively. At postoperative 1 month, the uncorrected visual acuity was -0.07�0.07 logMAR, with 100% of eyes achieving UDVA of 20/25 or better. The mean postoperative MRSE was -0.16�0.37 D, with 89.4% and 97.9% of eyes achieving postoperative MRSE within 0.50 D and 1.00 D, respectively. The mean postoperative cylinder was 0.18�0.23 D and 93.6% of eyes showed refractive astigmatism within 0.50 D.
Conclusion
LASIK performed with the Teneo 317 Model 2 excimer laser using an aspheric ablation profile for correcting myopia and myopic astigmatism yielded excellent visual and refractive outcomes. These outcomes were achieved using the patient�s manifest refraction with no nomogram adjustments.
Presenting Author
Shivani P. Pattnaik, MS
Co-Authors
Kumar Doctor MD
Purpose
To evaluate corneal structural changes and visual outcomes after the TREK procedure in keratoconus patients, assessing long-term efficacy and stability.
Methods
This prospective study involved keratoconus patients who underwent the TREK procedure. Pre- and post-operative corneal assessments included topography and epithelial mapping. Patients were followed for 9 months to track changes in corneal thickness, curvature, and visual acuity. Statistical analyses evaluated significant differences.
Results
The study observed significant improvements in corneal curvature and visual acuity post-TREK. Epithelial mapping revealed remodeling patterns consistent with reduced keratoconus progression.
Conclusion
The TREK procedure effectively stabilizes corneal structure in keratoconus, with notable improvements in visual outcomes and epithelial remodeling. These findings support its role in managing progressive keratoconus.
Presenting Author
O?uzhan Karabulut, MD
Co-Authors
Sibel Ahmet FEBO, FRCSEd, MD, Alper Agca MD, Dilek Yasa MD, Yusuf Yildirim MD, Burcin Kepez Yildiz MD, Nilay kandemir Besek MD, Ahmet Kirgiz FEBO, ahmet Alperen Koc MD, Mesut To?a� MD
Purpose
To evaluate the long-term visual, refractive, topographic, and high-order aberometric results of simultaneous topography-guided photorefractive keratectomy (T-PRK) and accelerated corneal collagen cross-linking therapy (ACCL) in keratoconus patients.
Methods
Uncorrected and best-corrected visual acuities (UCVA, BCVA), manifest refractions, corneal topography values (K1, K2, Kapex, MPP, KVB), high-order aberrations and thinnest corneal thicknesses obtained by Sirius�? (Costruzioni Strumenti Oftalmici, Italy) of keratoconus patients who underwent simultaneous T-PRK and ACCL between June 2015 and November 2016 were retrospectively evaluated.
Results
The mean follow-up time was 104.91 � 4.55 (93-110) months and the mean age was 26.42 � 5.86 (16-39) years. There was no significant change in UCVA (p:0.106), while BCVA increased significantly (p:0.006). Spherical value and spherical equivalent decreased significantly compared to preoperative period (p:0.008, p:0.012). There was no significant change in cylindrical values (p:0.936). K1, K2, Kapex, MPP, and TCT decreased significantly (each p<0.001). at="" 4="" mm="" pupil="" diameter="" (pd),="" hoa-rms,="" coma-rms,="" sa-rms="" decreased="" significantly="" (each=""><0.05). at="" 6="" mm-pd,="" hoa-rms,="" coma-rms,="" sa-lsa="" values="" decreased="" significantly="" (each=""><0.05). safety="" index="" was="" 1.64�0.81="" and="" efficacy="" index="" was="">
Conclusion
The simultaneous T-PRK and ACCL have been demonstrated to enhance functional vision by reducing high-order aberrations, in addition to halting the progression of keratoconus. The procedure has been shown to be both effective and safe in long-term follow-up.
Presenting Author
Gizem Yayla Akincilar, MD
Co-Authors
Sibel Ahmet FEBO, FRCSEd, MD, Nilay kandemir Besek MD, Ahmet Kirgiz FEBO
Purpose
To evaluate the effect of axial length on the visual, topographic, and aberrometric outcomes of small incision lenticule extraction (SMILE) surgery in patients with high myopia.
Methods
In this retrospective, comparative, clinical interventional study, uncorrected and corrected distance visual acuities (UDVA, CDVA), significant refractions, corneal topography parameters (K1, K2, thinnest corneal thickness (TCT)), and high-grade aberrations obtained by Sirius�? (Costruzioni Strumenti Ophthalmici, Italy) were evaluated in patients undergoing small incision lenticule extraction for high myopic correction (SMILE) between November 2019 and December 2021. Patients with myopia exceeding -6 D were divided into two groups based on their axial length (AL < 26 mm: Group 1, 27 eyes; AL > 26 mm: Group 2, 28 eyes).
Results
No statistically significant difference was observed between the groups in terms of age, follow-up time, WTW, UDVA, CDVA, sphere, cylinder, and spherical equivalent (each p > 0.05). No significant differences were observed between the groups in postoperative UDVA, CDVA, safety and efficacy index, Kmax, TCT, Q value, trefoil and SA-RMS values (each p> 0.05). A statistically significant increase was observed in HOA, coma and SA values in both groups compared with the preoperative values (each p< 0.05). Postoperative HOA and coma values were significantly higher in the Group 2 (p: 0.002, p:0.010, respectively).
Conclusion
High myopic patients with an axial length exceeding 26 mm may experience a slight decrease in the quality of vision, without affecting visual acuity, due to the higher HOA and coma aberrations after SMILE surgery compared to eyes shorter than 26 mm.
Presenting Author
Kurt Hanebrink, MD
Co-Authors
Ankur Parikh MD, Brigid Devine BA, Amar Shah MBA, MD
Purpose
Epithelial basement membrane dystrophy (EBMD) and Salzmann nodular degeneration (SND) are common indications for phototherapeutic keratectomy (PTK) before cataract surgery. This study evaluates how cryopreserved amniotic membrane graft (AMG) following PTK for EBMD/SND affects IOL selection, visual and refractive outcomes after cataract surgery.
Methods
A retrospective chart review of patients undergoing PTK for EBMD or SND prior to cataract surgery by a single surgeon at a single center in Cincinnati, Ohio between 2021-2024. Patients were separated into PTK with AMG and PTK without AMG prior to cataract surgery. Best-corrected visual acuity (BCVA) and tomographic data were collected for each eye prior to PTK between PTK and cataract surgery. and Tomographic metrics included K1, K2, steep axis, magnitude of cylinder, and higher order aberrations (HOA). Post-cataract surgery IOL, final BCVA, and refractive outcomes were analyzed.
Results
Sixty-three eyes of 38 patients underwent PTK for SND/EBMD without AMG placement (non-AMG group), and six eyes of 5 patients underwent PTK with AMG placement (AMG group). Mean higher-order aberrations (HOA) in the non-AMG group was 0.325 pre-PTK and 0.372 post-PTK; mean HOA in the AMG group was 0.423 pre-PTK and 0.694 post-PTK. In the non-AMG group, the mean post-phaco month 1 (POM1) BCVA was 0.070logMAR. The mean refractive error (RE) of -0.39+0.63 at 81 degrees with average spherical equivalent (SE) was -0.081 (predicted SE of -0.056). The POM1 post-phaco BCVA for AMG patients was 0.067logMAR. Mean RE was -0.95 +0.33 at 97 degrees with mean SE -0.79 compared with -0.92 predicted SE.
Conclusion
While AMG theoretically may improve epithelial healing, it did not clearly improve refractive outcomes or HOA in this limited study of patients who underwent PTK for EBMD/SND. Thirteen more eyes of 7 patients post-AMG for PTK are awaiting phaco and/or the postoperative period. Thus, a more robust conclusion may be obtained with more future data.
Presenting Author
Aneesha Ahluwalia, MD
Co-Authors
Edward Manche MD
Purpose
To examine patient-reported outcomes following wavefront-guided LASIK and topography-guided LASIK in a randomized contralateral fellow eye study of participants with myopia with or without astigmatism.
Methods
This was a prospective randomized contralateral fellow eye study of 100 eyes from 50 participants who received wavefront-guided LASIK in one eye and topography-guided LASIK in the other eye. All participants were age 22-59 years, had between -1.00 and -9.00 diopters of myopia, and less than 3.00 diopters of astigmatism. Patients with other corneal disorders were excluded. All procedures were performed using the Intralase iFS femtosecond laser, Johnson and Johnson Visx CustomVue excimer laser, and the Alcon Allegretto excimer laser. The primary outcomes of this study were scaled scores from the Patient-Reported Outcomes with LASIK (PROWL) survey administered 3, 6 and 12 months after LASIK.
Results
Self-reported worry related to vision and ability to perform daily activities significantly improved 3, 6 and 12 months after LASIK compared to pre-operatively (p<0.001). the="" prevalence="" of="" double="" images,="" glare,="" halos,="" or="" starbursts="" decreased="" from="" 70%="" preoperatively="" to="" 48%,="" and="" no="" participants="" reported="" �very�="" or="" "extremely"="" bothersome="" visual="" symptoms="" after="" 12="" months.="" vision-related="" impact="" work="" productivity="" and="" dry="" eye="" symptoms="" decreased="" significantly="" at="" all="" time="" points="" after="" surgery.="" overall,="" 56%="" of="" participants="" preferred="" wavefront-="" compared="" to="" topography-guided="" lasik.="" there="" was="" a="" 100%="" satisfaction="" rate="" with="" visual="" outcomes="" and="" time="" to="" improvement="" in="" vision="" following="">
Conclusion
There were significant improvements in the presence of double images, glare, halos, and starbursts and in vision-related quality-of-life metrics after LASIK compared to pre-operative levels. Satisfaction rates with post-procedural vision and time to recovery were high. More patients preferred wavefront- compared to topography-guided LASIK.
Presenting Author
Andrew J Abramson, None
Co-Authors
Camila Albo MD, Matthew Hirabayashi MD, Lauren Libfraind MD, Taj Nasser MD, Brett Mueller DO, PhD, Gregory Parkhurst MD
Purpose
To report the clinical outcomes of EVO/EVO+ Implantable Collamer Lenses (ICLs) in patients with low to moderate myopia, defined as a preoperative spherical equivalent of less than �6.00 D, in the United States (US).
Methods
This single center retrospective study evaluated one-month, single center postoperative data from 943 consecutive EVO/EVO+ cases from 4/6/2022 to 7/15/2024 at Parkhurst NuVision. Of the 943 patients, 261 eyes met the inclusion criteria of ICL implantation in the context of preoperative spherical equivalent refractive error of less than �6.00 D. Baseline characteristics, outcome visual acuity, IOP, ICL vault, rate of laser vision correction (LVC) enhancement, and rate of ICL rotation/exchange are reported.
Results
Of the 261 eyes with preoperative spherical equivalent refractive error of less than �6.00 D, average logMar visual acuity at 1 month was -0.03 � 0.10 (on average, slightly better than 20/20), with an average vault of 518.27 � 177.70 microns and an IOP of 14.57 � 3.91 mmHg. The average preoperative spherical equivalent was -4.66 � 0.95. Only 1.53% (4/261) required LVC enhancements and 2.30 % (6/261) required exchange or rotation. Most patients were female (55.17%) and Caucasian (44.06%), followed by Hispanic (33.33%). Patient age ranged from 19 to 58 years, with a mean age of 34 years. The most common ICL size was 12.6mm (54.02%), followed by 13.2 (34.87%), 12.1 (10.73%), and 13.7 (0.38%).
Conclusion
EVO/EVO+ ICLs demonstrate excellent safety and efficacy in low to moderate myopia, with most patients achieving 20/20 vision or better with few complications. These findings suggest ICL viability for a broader range of myopic patients, expanding their refractive surgery application. Future research should assess long-term stability and outcomes.
Presenting Author
Nishika Jain, MBBS, MS
Co-Authors
Sri Ganesh DNB, MS, FRCS
Purpose
Purpose: To validate the accuracy of the centaLign software which is the centration guide that allows the surgeon to centre the treatment on the visual axis in myopic eyes treated with small incision lenticule extraction (SMILE) using Visumax 800 (Carl Zeiss Meditec AG).
Methods
Methods: This study included 114 consecutive eyes treated with SMILE with the CentraLign centration software in VisuMax 800 femtosecond laser. A difference map of the pre operative and 6th month post operative tangential curvature map was obtained using the ATLAS 500 (Carl Zeiss Meditec AG) to mark the area of lenticule extraction. A fixed grid was superimposed on the difference map to locate the centre of the lenticule. This was compared with the pre op visual axis and the offset from the centre of lenticule was measured.
Results
Results: The mean difference between the Visual Axis X Co-ordinate (VAXC) and the Centre of Lenticule X Co-ordinate (CLXC) is -0.05325. The t(113) = -1.881with p-value(two tailed) is 0.063 (>0.05), and this is evidence to prove that there was significant decentration of the lenticule along horizontal axis. The mean difference between the Visual Axis Y Co-ordinate (VAYC) and Centre of Lenticule Y Co-ordinate (CLYC) is 0.08623. The t(113) = 3.330 with p-value(two tailed) is 0.001 (< 0.05), hence there was no significant decentration of the lenticle along vertical axis.
Conclusion
Conclusion: The mean difference of the X and Y coordinates are within 100micros which validates the centration of the centraLign software. The significant decentration of the X coordinates can be attributed to the surgeons method of aligning the centre between the pupillary axis and the visual axis.
Presenting Author
Wonseok Choi, MD
Purpose
To evaluate corneal clarity and visual outcome after new femtosecond laser (SmartSight) lenticule extraction surgery
Methods
896 eyes of 451 patients were enrolled and divided into two groups, high energy dose (group 1) and low energy dose (group 2). The new femtosecond laser system (Atos) was used for lenticule extraction. Postoperative corneal opacity and visual outcome were evaluated at postop one week, one month, three months and one year. Corneal clarity was evluated by measuring densitometry value (CDV) with PentacamHR. We also saw if there was any correlation between corneal opacity and visual acuity after surgery.
Results
The CDVs were significantly elevated at 1 week and 1 month postoperatively. When comparing between groups, the And after three months, CDVs in group 2 was significantly lower than those in group 1 at 1 week and 1 month postoperatively. CDVs of both groups became similar to preoperative values after three months. There was no difference in visual acuity between two groups during the entire observation period.
Conclusion
There may be a decrease in corneal clarity in the early postoperative period, but it returned to normal after 3 months after SmartSight. Lower energy dose could improve corneal clarity in the early postoperative period.
Presenting Author
Jascha A. Wendelstein, MD
Co-Authors
Theo Seiler MD, Achim Langenbucher PhD, Kamran Riaz MD, Seth Pantanelli MS, MD
Purpose
This study aims to compare the accuracy and clinical outcomes of wavefront-guided (WFG) versus wavefront-optimized (WFO) 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
The study included 122 eyes (61 patients). Both groups achieved comparable postoperative SEQ and DEQ (0.08 D vs. 0.11 D and 0.09 D vs. 0.14 D). Refraction within �0.50 D was achieved in 100% (WFO) and 96.72% (WFG). Postoperative astigmatism ?0.50 D was 100% (WFO) and 98.36% (WFG). Mean UDVA was 1.48 (WFO) vs. 1.41 (WFG), and CDVA was 1.52 (WFO) vs. 1.47 (WFG). Efficacy Index: 1.06 (WFO) vs. 1.01 (WFG), Safety Index: 1.12 (WFO) vs. 1.09 (WFG), showing high precision and safety for both techniques.
Conclusion
Both wavefront-optimized (WFO) and wavefront-guided (WFG) excimer laser ablation provided excellent refractive accuracy, visual outcomes, and safety in patients undergoing laser vision correction. There is no recommendation to prefer WFG over WFO in standard patients.
Presenting Author
Amit Gupta, MS
Co-Authors
Byanjana Bashyal MD, Chintan Malhotra MS, Sraddha Limbu MS, Divya Reddy Challa MD
Purpose
To study the qualitative and quantitative visual parameters following myopic corrective surgery with SMILE using the Ray Tracing technology.
Methods
72 eyes (36 patients) underwent SMILE surgery for correction of myopia. The qualitative and quantitative visual parameters using iTrace, contrast sensitivity, Schirmer score and subjective questionnaire were compared at baseline versus 3 months postoperatively.
Results
Postoperative MRSE was -0.05 � 0.20, Corneal aberrations induced per diopter were 0.05�0.05, spherical aberration 0.003� 0.008, coma 0.02� 0.019, Strehl ratio -0.05� 0.072, modulation transfer function -0.02�0.059, Q value change: 0.16�0.073. Change in Schirmer�s score was 1.82 � 4.061.
Conclusion
SMILE surgery for myopic vision correction had a significantly satisfactory outcome using ray tracing aberometry. Advantages of ray tracing projected more realistic outcomes including respecting the pupillary centroid, uses a forward projection system with 256 individual points, more physiological results and higher visual function scores.
Presenting Author
Abha D Shah, MS
Co-Authors
Rohit Shetty FRCS, Pooja Khamar MD, PhD, Abhijit Roy PhD
Purpose
To assess visual outcomes after Small Incision Lenticule Extraction (SILK) by analyzing residual refractive error and ocular aberrations during accommodation, and to compare these findings with those in emmetropic (EM) eyes.
Methods
This study included 50 patients over the age of 37 who had undergone SILK and were evaluated three months postoperatively. Ocular aberrometry (Tracey Technologies, Houston, TX) was used to measure refractive errors and ocular aberrations at distance (6 m), intermediate (60 cm), and near (40 cm) targets. Additionally, a control group of 50 age-matched emmetropic eyes with 20/20 vision was assessed using identical measurement protocols. The Kruskal-Wallis test was employed to compare differences in refractive and aberrometric parameters between the SILK-treated and emmetropic groups across various accommodation levels.
Results
There were no significant differences in spherical aberration (SA) or defocus for near, intermediate and distant (p<0.001) targets="" between="" the="" two="" groups.="" furthermore,="" spherical="" equivalent="" (se)="" did="" not="" significantly="" differ="" between="" groups="" for="" near,="" intermediate,="" and="" distance="" targets="">< />
Conclusion
SILK-treated eyes demonstrated visual performance comparable to emmetropic eyes in terms of refractive and aberrometric status across different accommodation levels. The results suggest that SILK may offer a comparable depth of focus to emmetropic eyes, potentially enhancing patient satisfaction.
Presenting Author
Ivan Gabric, MD
Co-Authors
Victor Derhartunian MD
Purpose
Cases of slow recovery after KLEx surgery have been reported. There was a noticed difference in patients with "orange peel" pattern having a worse UCVA and contrast sensitivity in the early post operative period. We wanted to create an objective measurement system for this using an aberrometer. MASI is defined as Micro-Aberrations Scattering Index
Methods
We measured MASI before and after surgery on POD1, POW1, POM1 and POM3, we also did a validated Sine wave contrast sensitivity test using Qvision Visual CSF test at each visit. MASI was then compared for statistical significance against UCVA, CDVA and CS tests. We performed measurements on 200 eyes, 100 KLEx, 50 LASIK and 50 PRK patients
Results
Primary end point was validation of MASI against an existing clinically validated test, secondary end point was to understand the effects of different doses in KLEx on visual recovery. MASI showed great correlation with expected UCVA, CDVA and contrast sensitivity. It help to objectively gage quality of vision during a simple scan that takes less than 10 seconds per eye versus a 8-10 minute per eye sine wave contrast sensitivity test.
Conclusion
We believe Micro-Aberrations Scattering Index will become the standard for evaluating and simulating patient outcomes after keratorefractive procedures in high volume surgery centers where regular sine wave contrast sensitivity would be time consuming. This will allow us to create objective playing filed vs. pure reporting of UCVA and CDVA.
Presenting Author
Samuel Arba Mosquera, PhD
Co-Authors
Ivan Gabric MD
Purpose
To determine the size of the effective optical and treatment zones after lenticule extraction procedures.
Methods
A fully automated method to determine the boundaries of the optical and treatment zones of a lenticule of tissue extracted from a cornea has been developed, in which the boundaries of the corrected area are derived from differences between post and preoperative maps of several corneal metrics by determining the smallest cross-over point along each semi-meridian.
Results
The method has been applied to a pilot cohort of 84 eyes, clinical data showing average diameters of 6.56 � 0.46 mm [5.25 to 7.51] and 8.49 � 0.56 mm [6.58 to 9.52] for tangential anterior curvature and corneal thickness, respectively.
Conclusion
The method provides a reliable and objective way to determine the size of a lenticule of tissue extracted from a cornea and it can be applied to any topo- or tomographic derived metric. Translational Relevance: To determine the size of the effective optical and treatment zones after laser vision correction, a fully automated method was developed.
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