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Less induced spherical aberration with

wavefront-optimised treatments
Dermot McGrath using the population average of
in Paris wavefront-optimised data in the
Allegretto Wave. The Allegretto
TOPOGRAPHY-guided Wave did, however, seem to
treatment using the Allegretto maintain the low preoperative
Wave System (Wavelight spherical aberration,” he said.
Technologie) appears to be very
safe and effective for Minimal spherical aberration
enhancement in eyes with induced in virgin eyes
decentred ablations, small optical In a separate presentation,
zones or irregular corneal Matthias Maus MD agreed that
astigmatism, according to Jérôme the wavefront-optimized ablation
C Vryghem MD, Brussels, of the Allegretto Wave in myopic
Belgium. LASIK treatments typically
Speaking here at the XXII showed zero or minimal
Congress of the ESCRS, Dr induction of spherical
Vryghem said that his own aberrations.
clinical experience with the Stephen F. Brint Jérôme C. Vryghem Matthias J. Maus “We know that spherical
Allegretto Wave and the T-CAT aberrations, especially induced
software suggested that it was a Of 45 eyes that underwent a “There were small differences Patients averaged about –3.0 D ones, may severely impair night
particularly viable option for topography-guided ablation since between the two systems of myopia in the CustomCornea vision capability. In my experience
retreating patients who were June 2003, 22 required an primarily in the amount of group and –3.5 D in the with other laser platforms with
dissatisfied with the outcome of additional retreatment to correct induced HOA; both of them Allegretto Wave group with non-wavefront-optimized profiles,
previous refractive surgery. the residual refractive error or a provided very good safety and similar amounts of low the Allegretto Wave creates a
“In over 80% of cases, the residual corneal irregularity. efficacy and patient satisfaction astigmatism. Predictability was significantly lower induction of
topography-guided treatment Because of this high retreatment was also very high for both sets of very good for both groups, spherical aberration and a minor
with the Wave system resulted in rate LASIK is preferable to patients,” he said. reported Dr Brint, with 90% of increase in RMS values,” he said.
an objective and subjective surface ablations, he said. In Dr Brint’s study, patients the CustomCornea patients Dr Maus reported on a series
improvement of the visual Dr Vryghem noted that the were randomised to either coming within 0.5 D of intended of 50 eyes of 25 myopic patients
functions of the treated eyes. predictability of the results of bilateral treatment with refraction at six months in which both eyes were treated
Many of these patients thought these topography-guided CustomCornea or the Allegretto compared to 85% for the wavefront-optimized with the
that there was no solution treatments should be improved. Wave with a 6.5 mm treatment Allegretto Wave. Allegretto Wave. Follow-up
possible for the visual symptoms Clues for a better predictability zone for both groups, and a blend Uncorrected visual acuity at examinations by an independent
they were experiencing and it are to take account of the zone up to 9.0 mm for the one month was also good for clinician took place at one day,
was gratifying to be able to put a astigmatic values as suggested by CustomCornea treatments and up both groups: 73% of patients one week, and one, three and six
smile back on their faces after the topography and the T-CAT to 7.2 mm for the Allegretto were 20/16 or better and 85% months after surgery.
treatment with the Allegretto,” software, to take account of the wavefront-optimised systems. were 20/20 or better in the After one month, the average
he said. spherical equivalent as suggested Explaining the differences Allegretto Wave group compared uncorrected and best-corrected
Dr Vryghem said that by the clinical refraction and to between the systems, Dr Brint to 70% and 83% respectively for visual acuity was 20/20. Average
topography-guided treatment was match the suggested ablation said that the CustomCornea the CustomCornea patients. preoperative spherical equivalent
an option for patients with highly profile with the initial topography. platform has the capability of Best-corrected visual acuity and was -4.5 D compared to +0.15 D
aberrated eyes where it was In case of doubt the option that registering the wavefront to the photopic and mesopic contrast postoperatively. No eyes lost
difficult to obtain reproducible consumes less tissue is chosen. actual ablation, something that is sensitivity were shown to be BCVA and a significant amount of
images with wavefront analysis or Nevertheless, he noted that not possible with the standard similarly improved for both patients gained at least one or
where the wavefront images safety and efficacy were very Allegretto Wave system. groups postoperatively. more lines. The subjective
were of insufficient quality. satisfactory. “Some patients “The Allegretto Wave treatment Dr Brint noted, however, that perception of quality of night
gained up to five lines of Snellen is designed to correct the lower there was a statistically significant vision improved in 20% of
Two-stage treatments often visual acuity, and even if some order aberrations as well as difference between the two patients at one month. RMS
necessary patients lost lines there was still spherical aberration based on a platforms in terms of the total values showed a minor average
He also stressed the importance a very high level of patient population average.That is postoperative higher order increase postoperatively from
of careful patient selection before satisfaction,” he said. essentially what the wavefront- aberrations. baseline. Spherical aberration was
deciding to proceed with such Of 42 responses received to a optimised system does - it “The total higher order reduced in 30% of the treated
treatments. questionnaire, 80% of patients attempts to minimise spherical aberrations showed a statistically eyes at a 6.5 mm optical zone,
“It is vital to talk to the patient said their problems with halos aberration induced by the excimer significant increase in the reported Dr Maus.
beforehand and explain that were better, much better or laser,” he said. Allegretto Wave group,
there may be a need for further perfect postoperatively, 90% In this context, “wavefront- manifested primarily by an Jérôme C. Vryghem MD
considered their symptoms of optimised” denotes that the increase in coma and also some j.c.vryghem@vryghem.be
treatment if we don’t get the
desired refractive result first glare also improved after Allegretto Wave is a standard trefoil, compared to no real Stephen F. Brint, MD
time. They have to be aware that treatment and almost 75% of LASIK treatment, albeit one change in the CustomCornea brintmd@aol.com
topography guided treatments patients said they were satisfied optimised to avoid the wavefront group,” said Dr Brint.
Matthias J. Maus, MD
are often two-stage treatments with their night vision after error of spherical aberration by He added that the increase in maus@augenzentrum.de
because in the first stage we treatment with the Allegretto. maintaining the natural aspheric aberrations for the Allegretto
want to smooth the surface, shape of the cornea. It is not the Wave group did not include any
recentre the ablation and enlarge Wavefront-optimised versus same as “wavefront-guided” increase for spherical
the optical zone. However, wavefront-guided treatments that attempt to aberrations, which had been
because we are not taking The Allegretto Wave also correct pre-existing higher order effectively treated by the
account of the axial length of the measured up very well in terms aberrations, pointed out Dr Brint. wavefront-optimised software.
eye and are essentially undoing of efficacy and safety in head-to- “The CustomCornea treatment “The CustomCornea system
the problems caused by the initial head trials with the wavefront- is a true wavefront-guided did produce lower postoperative
treatments, the patients guided LadarVision treatment in which we correct higher order aberrations,
sometimes end up with a CustomCornea (Alcon) platform, not only lower order aberrations primarily coma and trefoil, and
refractive surprise which then has reported Stephen F Brint MD, but also third, fourth, fifth and this is because we are actually
to be retreated in the second Metairie, Louisiana, US. sixth order aberrations as well,” measuring and correcting the
phase,” he said. he said. true wavefront as opposed to

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