Moderator
Daniel H. Chang, MD, ABO
Panelists
Sara K Sella, MD
Lloyd B Williams, MD, PhD, MS
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
David Smadja, MD
Purpose
Comparing of visual refractive and HOA outcomes between using the PROSCAN platform of the Technolas Teneo 317 excimer laser and Alcon Wavelight laser suit
Methods
This retrospective, multicenter study involve 80 eyes from 80 patients, divided into two groups of 40 each. Group A underwent LASIK with PROSCAN platform of Teneo 317 (model 2) excimer laser by Bausch+Lomb, Inc, using aspheric ablation profile. Group B underwent using Alcon Wavelight. Visual, Refractive outcomes and Higher-order aberration (HOA) were evaluated at 1 week, 1 month and 3 months postoperativley. HOAs were measured with Pentacam aberration mapping and both visual acuity and refractive status were throughly assessed.
Results
A total of 80 eyes (40 per group) were analyzed. Preoperative measurements showed no significant differences (p > 0.5). At 6 months, 96.2% (Teneo) and 97.4% (Wavefront Optimized) achieved 20/25 or better UCVA. Safety and efficacy indices were similar (p > 0.5). Residual astigmatism was -0.19 � 0.27 D (Teneo) and -0.15 � 0.25 D (Wavefront Optimized) (p = 0.51). HOAs increased postoperatively but were comparable (p = 0.53).HOA of 0.37 � 0.12 �m in the Teneo group and 0.35 � 0.11 �m in the Wavefront Optimized group (p = 0.49)
Conclusion
Both Bausch + Lomb Teneo and Alcon Wavefront Optimized platforms induced similar levels of HOA changes, with no statistically significant difference in total RMS, coma, trefoil, or spherical aberration. The observed increases were within the expected range for myopic LASIK procedures, reinforcing the safety and predictability of both lasers
Presenting Author
Anuradha Kunapuli, MBBS, MS
Co-Authors
Pratik Gogri MBBS, MD
Purpose
Sterile infiltrates following laser refractive surgery is an uncommon complication. This study was undertaken to analyze the visual outcomes of sterile infiltrates following photorefractive keratectomy (PRK).
Methods
This retrospective study included 14 eyes that developed sterile infiltrates following PRK out of a total of 6280 eyes that underwent PRK between 2014 and 2017. Medical records of these patients, including patient demographics, characteristics of the infiltrate, presenting visual acuity, and treatment outcomes were recorded and analyzed.
Results
The incidence of sterile corneal infiltrates post-PRK in our study was 0.22% (14/6280). The mean age of the patients was 27.42 � 4.87 years. The uncorrected visual acuity (UCVA) at presentation was 0.49 � 0.13 log MAR units. The mean size of the infiltrate was 3.22 � 2.85 mm2. All cases were successfully managed medically with topical steroids. The mean UCVA and best-corrected visual acuity (BCVA) at the last follow-up visit were 0.08 � 0.08 and 0.05 � 0.07 log MAR units, respectively. The mean time taken for resolution of the infiltrate was 8.91 � 4.57 days.
Conclusion
Sterile infiltrates following PRK can be effectively treated with aggressive topical steroids. The outcome is generally favorable and does not require surgical intervention if treatment is instituted early.
Presenting Author
Leyla Mirzaee, DS
Co-Authors
Pedram Hamrah MD, Sandra Hunt BA, Akhil Mekka MD, Maria Lopez MD, Bet�l Bayraktutar MD, Neslihan Koseoglu MD, Stephanie Cox OD, Robert Kim BA
Purpose
To compare ocular pain perception and its impact on quality of life (QoL) dimensions in patients with refractive surgery (RS)-related (after Laser-assisted in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK]), and non-RS-related neuropathic corneal pain (NCP).
Methods
A cross-sectional retrospective study was performed, evaluating ocular pain perception and physical, emotional and social QoL dimensions in NCP patients with RS (LASIK or PRK), and non-RS using the Ocular Pain Assessment Survey (OPAS). Medical records of NCP patients, diagnosed based on clinical and in vivo confocal microscopic findings were evaluated. The demographic features, pain intensity, and QoL interference were analyzed, and comparisons between groups were conducted to determine statistical significance.
Results
The study included 67 with RS (52 post-LASIK, 17 post-PRK), and 164 without RS. Age and sex were comparable between groups (P>0.05). The RS group showed significant lower average pain intensity at 24h (p=0.048) and least eye pain intensity at 24h (p=0.01) and 2 weeks (p=0.004) as compared to the non-RS group. However, despite lower pain intensity, pain interfered significantly more with emotional (mood) (p<0.0001) and="" social="" (enjoying="" life/relations="" with="" other="" people)="" dimensions="" of="" qol="" (p="0.006)" in="" the="" rs="" group,="" while="" the="" physical="" qol="" dimension="" was="" comparable.="" no="" significant="" difference="" was="" observed="" in="" pain="" perception="" or="" qol="" dimensions="" between="" lasik="" and="" prk="">
Conclusion
Patients with refractive surgery-related NCP demonstrate significantly higher interference of their pain with both emotional (mood) and social (enjoying life/relations) dimensions of QoL, despite lower pain intensity levels, as compared to patients with non-refractive surgery-related NCP.
Presenting Author
Hannuy CHOI, MD, MS
Purpose
Achieving an optimal vault after posterior phakic intraocular lens (pIOL) implantation surgery is crucial. When the vault is either too high or too low, sometimes it is necessary to exchange the lens size to adjust vault. We aim to analyze how the vault changes when sizing of pIOL is exchanged.
Methods
Retrospective chart review was done for patients who had Implantable Collamer Lens (ICL) implantation surgery from January 2013 to August 2024. 96 Eyes underwent ICL exchange out of total 22,518 primary ICL implantation surgery. Among these cases, we conducted a study on eyes which the vault measurements were available both before and after the exchange using anterior segment optical coherence tomography (AS-OCT) and excluded cases where ICL was exchanged with the same size to adjust refractive outcome.
Results
Overall ICL exchange rate was 0.48% (110/22739) including up size same size, and down size exchange. 24 eyes (35%) underwent lens exchange to correct low vault. When a one-step larger lens was used for exchange, the vault increased by an average of 222 � 263 microns (p < 0.05). 44 eyes (63.77%) underwent lens exchange to treat rotation of the toric axis despite an acceptable vault. When 1 step larger ICL was used for exchange, the vault increased by an average of 237.36 � 163.38 microns (p < 0.005). 14 eyes (12.73%) underwent lens exchange. When a one-step smaller lens was used for ICL exchange, the vault decreased by an average of approximately 684 microns (p < 0.001)
Conclusion
It can be predicted that exchange to smaller ICL to correct high vault results in a decrease of 684 microns. Upsizing ICL exchange tends to result in higher vault of 230 but predictability is less accurate, especially for patients who requires upsize exchange to treat low vault.
Presenting Author
Seyed Javad Hashemian, MD
Purpose
To compare lower and higher order aberrations (HOA) and wavefront refractometry measurements between Zywave� and PERAMIS�, in refractive surgery candidates.
Methods
203 consecutive patients were studied. Inclusion criteria were age ? 18 years old, ? 8 D myopia, ? 6 D hyperopia and ? 6 D astigmatism. A thorough comprehensive ophthalmic examination, corneal tomography by Orbsan�, and ocular wavefront aberrometry were performed for all patients.The degree of agreement between measurements was evaluated by intra class correlation (ICC).
Results
188 eyes of 188 patients were studied. In terms of wavefront refractometry, high degree of agreement was found between sphere, cylinder and cylinder axis (ICCs were 0.97, 0.97 and 0.7 respectively). The degree of agreement between total root RMS was high (ICC=0.9). The ICC for measurement of HOA RMS, vertical coma, vertical trefoil and spherical aberration RMS was 0.64, 0.6, 0.5 and 0.58 respectively.
Conclusion
Zywave� and PERAMIS� showed a high level of agreement in wavefront refractometry and total wavefront measurements. Measurements of HOA are not interchangeable according to low levels of agreement found in the study.
Presenting Author
Jay S. Pepose, MD, PhD, ABO
Co-Authors
Marguerite McDonald MD, James Katz MD, Konstantinos Charizanis MBA, PhD, Mitchell Brigell PhD
Purpose
To determine the efficacy of moderate pupil constriction with 0.75% phentolamine ophthalmic solution (POS) in improving mesopic low contrast vision (mLCVA) and photic phenomena in patients status post keratorefractive surgery.
Methods
A phase 3 trial, enrolling subjects at 19 US sites, was conducted in subjects with night vision disturbances (glare, halos, starburst) and decreased mLCVA. 143 subjects, 25 post-keratorefractive surgery, were randomized 1:1 to receive POS or placebo for 14 consecutive evenings. The primary endpoint was the percentage subjects with ?3 lines of improvement in mLCVA. Subjects had mesopic pupil diameter of ?5mm and ?30 ETDRS letters (20/63) mLCVA in at least one eye and were stratified for iris color. A second phase 3 trial is underway enrolling approximately 200 subjects with reduced mLCVA and photic complaints S/P keratorefractive surgery randomized 1:1 between POS and placebo.
Results
At day 8, there was a statistically significant difference (p<0.05) between="" pos="" vs="" placebo="" (13%="" vs="" 3%)="" with="" 5="" letter="" improvement="" in="" mclva="" and="" 21%="" vs="" 3%=""><0.01) at="" day="" 15.="" subjective="" improvement="" in="" glare,="" halos="" and="" starburst="" was="" noted="" at="" days="" 8="" and="" 15=""><0.01). among="" post-keratorefractive="" subjects,="" 29%="" vs="" 9%="" gained="" lines="" of="" mlcva="" at="" day="" 8="" and="" 21%="" vs="" 0%="" at="" day="" 15.="" we="" will="" be="" reporting="" results="" of="" the="" second="" phase="" 3="">
Conclusion
POS may reduce photic complaints and increase mLCVA following keratorefractive surgery. A second phase 3 trial is underway.
Presenting Author
Yugandhara Patade, MS, MBBS
Co-Authors
Supriya Sri Ganesh MBBS, MS, Sri Ganesh DNB, MS, FRCS, Savio Pereira MS, DNB
Purpose
To compare amount of vertical coma aberrations in patients undergoing SMILE surgery on Visumax 500 and Visumax 800
Methods
A total 128 eyes, 64 each from patients undergoing SMILE surgery on Visumax 500 and Visumax 800 were included. Patients were examined for UCVA, manifest refraction, slit lamp examination , Pentacam, MS 39, A.TLAS topography, ITrace, HD Analyser, WASCA aberrometery at pre operatively and post operatively at day 1 , 15 & 3 months INCLUSION: 1. Patients with myopia <10D 2. Patients with Myopic Astigmatism SE <10D EXCLUSION: 1. Corneal opacity, inflammatory conditions of the cornea or Evidence of acute or chronic corneal infection. 2. Cataractous changes in crystalline lens. 3. Angle kappa >0.5mm SMILE surgery was performed using VISUMAX 800 in 1 group and VISUMAX 500 in other group.
Results
It was observed that the total mean vertical coma aberration induced at post op 3 months was 0.020+/-0.052 in patients who underwent SMILE surgery on the Visumax 500 and -0.029+/-0.060 in those who underwent the surgery on Visumax 800. The results were also compared based on the angle kappa values in both groups. In the Visumax 500 group, <0.3 angle kappa had a mean vertical coma of 0.022+/-0.054 and that >0.3 angle kappa comprising 16 eyes had a mean value of vertical coma of 0.013 +/- 0.047 at post op 3 months. In the Visumax 800 group, vertical coma mean value in <0.3 angle kappa was -0.032+/-0.063 and that >0.3 angle kappa was -0.009+/-0.031. These values were statistically significant.
Conclusion
This study demonstrates that SMILE surgery performed with Visumax 800 results in lower vertical coma aberration compared to the Visumax 500. additionally , the OSI values observed were lesser in Visumax 800 suggesting improved optical quality.
Presenting Author
Yugandhara Patade, MS, MBBS
Co-Authors
Supriya Sri Ganesh MBBS, MS, Sri Ganesh DNB, MS, FRCS, Savio Pereira MS, DNB
Purpose
To compare FS-LASIK centration aided by pupil center to SMILE PRO aided by centration guide i.e. proposed corneal vertex/visual axis based on the preoperative x and y coordinates from ATLAS tomography. To compare induced aberrations affecting the quality of vision in both groups.
Methods
This is a retrospective, interventional non-randomized comparative study with a total of 60 age matched subjects, 30 each from FS-LASIK and SMILE PRO groups for varying degrees of myopia. Follow-up visits were at day 1 , 2 weeks and 3 months. The spherical equivalent (SE), OSI using HDA and aberrations using ITRACE were compared between the two groups.
Results
The residual SE in the FS LASIK group on POD 15 was -0.033 +/-0.092 while in SMILE group it was none which was statistically significant. On POD 15 SMILE group had x and y coordinates 0.008 +/- 0.153 and 0.049 +/- 0.10 respectively while in FS LASIK it was 0.017 +/-0.169 and 0.031 +/-0.79 respectively. The OSI in SMILE group was 0.7 +/-0.48 while in FS LASIK were 0.42+/- 0.29. Higher order aberrations in SMILE group on POD 15 were 0.160 +/- 0.135 while in FS LASIK group were 0.09 +/- 0.06 on POD 15.
Conclusion
SMILE PRO was found to show better results in terms of treatment centration and residual spherical equivalent while FS LASIK showed better results in terms of induced aberrations and OSI. As patient satisfaction is most important in refractive surgery, quality of vision assessment offers a more detailed evaluation of patient outcomes.
Presenting Author
Avinoam Shye, MD, PhD
Co-Authors
Eyal Cohen MD, Michael Mimouni MD, Gur Munzer BA, Igor Kaiserman MD, Tzahi Sela BScOptom
Purpose
To compare the visual and refractive outcomes of Femtolaser in situ keratomileusis (Femto-LASIK) surgery and microkeratome assisted LASIK in patients with very low myopia.
Methods
: A retrospective study was conducted on 537 eyes with very low myopia (defined as up to 1 diopter, and up to 1 diopter of cylinder) from 270 patients who underwent LASIK surgery at Care-Vision Laser Centers, Tel Aviv, between January 2012 and June 2022. Patients were categorized into two groups based on type of surgery: microkeratome assisted LASIK and Femto-Lasik. Preoperative and postoperative outcomes, including uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent (SEQ), and cylinder measurements, were compared between the groups. Data were analyzed using R program, and adjustments were made for baseline and intraoperative differences.
Results
432 eyes (80%) underwent microkeratome assisted LASIK surgery and 105 (20%) eyes underwent Femto-LASIK surgery. The microkeratome assisted LASIK group demonstrated significantly higher preoperative spherical equivalent (-0.98D vs -0.8, p < 0.02) and steeper postoperative corneas (average K 42.43D vs 42.01D, p < 0.02; maximum K 42.78D vs 42.29D, p < 0.02) Postoperatively, the microkeratome assisted LASIK group had worse UCVA (0.92 vs. 0.98, p < 0.001) and BCVA (0.96 vs. 1.01, p < 0.0001) and more myopic SEQ (-0.09 D vs. -0.01 D, p < 0.05) Furthermore, the microkeratome assisted LASIK group had worse efficacy index (0.95 vs 1.01 p < 0.02) and similar safety index (1.03 vs 1.05 p = 0.42).
Conclusion
Femto-LASIK surgery provides significantly better outcomes for very low myopia, with higher postoperative UCVA and BCVA, higher efficacy index and similar safety index.
Presenting Author
Raghav Malik, MD
Co-Authors
Mahipal Sachdev MD
Purpose
This study aims to compare the visual outcomes, incidence of dry eye, and contrast sensitivity in patients undergoing SMILE and SILK lenticule extraction procedures. By evaluating these metrics at a 3-month follow-up, the study seeks to determine the relative efficacy and safety of these two advanced refractive surgeries.
Methods
A prospective, comparative study was conducted involving patients who underwent SMILE (n=50) or SILK (n=50) procedures for myopic correction. All subjects were assessed at a single 3-month follow-up visit. The primary outcomes included uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA). Secondary outcomes involved the evaluation of dry eye symptoms using the Ocular Surface Disease Index (OSDI) and Schirmer's test, and contrast sensitivity measured under photopic and mesopic conditions. Data were collected and analyzed using appropriate statistical methods to compare the two groups, focusing on differences in visual acuity, dry eye symptoms, and contrast sensitivity.
Results
All subjects have undergone the procedure, and are yet to come for 3-month follow-up, where the examination will be conducted.
Conclusion
TBD
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