Jack T.

Holladay, MD, MSEE, FACS

2006

Optimized Ablations Ocular Topographic

Prolate Using and Wavefront

Learn from Nature

Learn

7/6/2006 JTH 1

Jack T. Holladay, MD, MSEE, FACS Clinical Professor of Ophthalmology Baylor College of Medicine Houston, Texas, USA

from Normal Eyes with excellent Perfomance Primates Binocular Stereo Vision have Prolate Corneas Primates with Binocular NonStereo 360 Fields are Oblate

Qavg = -0.26
s Spherical Aberration for BEST CENTRAL VISION

Prolate

Qno SA= -0.52 Prolate Eagles, man Ref: May 1999 JCRS
Vol. 25 pp.663pp.663-669
7/6/2006
JTH

Oblate

Q = +0.25

s Spherical Aberration but BEST PERIPHERAL VISION

Oblate Frogs,
7/6/2006
JTH

Optomized PROLATE Topographic & Wavefront Guided Ablations

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Jack T. Holladay, MD, MSEE, FACS

2006

Halos and Glare

Today's Customized Refractive Surgery Requires Excellence in Diagnostic Measurements Surgical Planning Surgical Procedure Laser Ablation

Ocular, Corneal & Lenticular WF

Corneal Aberrations

Surgical Planning

Measure Ocular and Topographical Aberrations Quantitate Lenticular and Corneal Aberrations Corneal or Lenticular Surgery Best?

Topography Tomography Pentacam OPD Scan (D) Nidek ShackShack-Hartman ( () Tscherning () Ocular - Corneal

Ocular Aberrations

Early Cataract or Lenticular Irregularities

Crystalline Lens Removal

Lenticular Aberrations

match aspheric IOL to corneal power

and shape (spherical aberration) (AMO Tecnis IOL, Alcon HO, B&L WF)

Surgical Planning

Top View
Foveola
Horizontal Angle = -5.2 5.2`

If Corneal Procedure TREAT

Ocular: Refractive Error, SA, Coma Corneal: All HO Aberrations Lenticular

Only

Lenticular

SA s with age

OverOver-correct SA (create ocular negative SA)

Negative SA Improves Near vision
(similar to Hyperopic Rx with negative SA)

Nodal Point

Optomized PROLATE Topographic & Wavefront Guided Ablations

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SA & Coma, other HO aberrations are unstable and unpredictable

Visual Axis Optica l Axis

Jack T. Holladay, MD, MSEE, FACS

2006

Surgical Procedure

Reference: Visual Axis

The only Reference Axis is the Visual Axis

Center Procedure on Visual Axis Compensation of Radial Energy Loss Loss

Time to move away from pupil center! Avoid INDUCING Coma

Function of

LOS Alignment

Visual Axis Alignment

Distance from vertex normal normal perpendicular Curvature of Cornea steep or flat Curvature Asymmetric due to Angle Kappa

NO

LOS Alignment

YES
Visual Axis LOS

Different for Right and Left Eyes

Radial Energy Compensation

Differences between Intended vs. Achieved Ablation

There is no one size fits all all compensation matrix Radial energy fall off is not symmetrical Needs to be different for OD and OS Needs to be different for steep and flat eyes

Results so far

Surgeon: Mohamed Alaa El Danasoury, Danasoury, MD Jedda, Jedda, Saudi Arabia Diagnostics: OPD Scan Laser: NIDEK ECEC-5000 LASER 8 patients will be presented at ASCRS 2006

temporal OS

nasal

temporal OD

PreOP Data
OPAS (Optimized Prolate Ablation System) on RIGHT EYE A. Best Final Refraction @ VTX = 14 mm OD: -6.50 -1.25 x 180 = 20/20+2 (1.2) OS: -6.50 -1.00 x 180 = 20/20+1 (1.2) B. Target Refraction: plano C. Pach's D. Scotopic Pupil Size: OD: 558 OD: 7.31m OS: 559 microns OS: 7.07 mm

Instantaneous

Refractive

Wavefront

PRE-OPERATIVE OD 12 MO POST-OPERATIVE Prolate RX

Treatment OZ Right Eye = 7.3 mm and blend to 9.0 mm.

Optomized PROLATE Topographic & Wavefront Guided Ablations

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Jack T. Holladay, MD, MSEE, FACS

Instantaneous Refractive Wavefront

2006

Summary
All RXs will ultimately use Topography and Ocular Wavefront ... The latter must in Resolution All corneal and some lenticular aberrations will be treated and anticipated (SA) RXs will be centered on Visual Axis to avoid INDUCING aberrations (Coma, Tilt)

PRE-OPERATIVE OS 12 MO POST-OPERATIVE Standard RX

Summary
Iris

registration will become the standard of care Asymmetric Radial Compesation Compesation Functions unique to patient and will improve, so that the Intended and Actual are equal. equal.

Ribbit & Thank you !

Make Eagles! Not Frogs!

Optomized PROLATE Topographic & Wavefront Guided Ablations

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