1. Evaluation of Enhancement Rates following Hyperopic LASIK with Femtosecond versus Microkeratome Assisted Flap Creation Raj Rajpara, BS * Richard M. Awdeh, MD * Bryan C. Hainline, MD * William W. Culbertson, MD ** Sonia H. Yoo, MD ** Bascom Palmer Eye Institute *No financial interests **Consultants for AMO

2. Purpose To evaluate the rate of enhancement following hyperopic LASIK in patients who underwent femtosecond laser assisted flap creation versus traditional microkeratome assisted flap creation.To evaluate the rate of enhancement following hyperopic LASIK in patients who underwent femtosecond laser assisted flap creation versus traditional microkeratome assisted flap creation. 2

3. Microkeratome 3 Advantages: Faster Cheaper No alternative in past Disadvantages: Flap is not reproducible Variability in flap thickness Partial Flap; Buttonhole Increase rate of enhancement surgery 1 1 Stonecipher K. Advances in refractive surgery: microkeratome and femtosecond laser flap creation in relation to safety, efficacy, predictability, and biomechanical stability. Current Opinion in Ophthalmology, August 2006

4. Methods Retrospective Chart review of 83 eyes from 45 patients who underwent Hyperopic LASIK at Bascom PalmerRetrospective Chart review of 83 eyes from 45 patients who underwent Hyperopic LASIK at Bascom Palmer Microkeratome Group: (Moria) Microkeratome Group: (Moria) 44 eyes of 23 consecutive patients treated between 2002 and 2004 44 eyes of 23 consecutive patients treated between 2002 and 2004 Femtosecond Laser Group: (Intralase 15 kHz) Femtosecond Laser Group: (Intralase 15 kHz) 39 eyes of 22 consecutive patients treated between 2004 and 2006 39 eyes of 22 consecutive patients treated between 2004 and 2006 4

5. Methods Patients who did not receive a manifest refraction at the POM # 1 visit were excluded from this analysis, leaving:Patients who did not receive a manifest refraction at the POM # 1 visit were excluded from this analysis, leaving: Microkeratome group: 21 eyes of 11 patients Microkeratome group: 21 eyes of 11 patients Femtosecond laser group: 24 eyes of 13 patients. Femtosecond laser group: 24 eyes of 13 patients. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), predictability of target spherical equivalent versus achieved spherical equivalent, complication rate, and rate of enhancement were analyzed for each groupUncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), predictability of target spherical equivalent versus achieved spherical equivalent, complication rate, and rate of enhancement were analyzed for each group 5

6. Post Operative Month # 1 #MeanMinMax Age (yr)2453.382366 Preop UCVA (logmar) 240.57801.301 Preop Mrx (SE) 241.880.55.25 Target Refrac- tion (SE) 24-0.656-1.875.5 6 #MeanMinMax Age (yr)21584668 Preop UCVA (logmar) 210.580.0971.301 Preop Mrx (SE) 211.48-0.253 Target Refrac- tion (SE) 21-0.893-2.50 Femtosecond Laser GroupMicrokeratome Group

7. Post Operative Month # 1 7 Target Refraction (SE) Preop UCVA 20/x MK FS MK

8. Post Operative Month #1 Results 8 Femtosecond LaserMicrokeratome

9. Post Operative Month #3 Results 9 MicrokeratomeFemtosecond Laser

10. Post Operative Month #6 Results 10 Microkeratome Femtosecond Laser

11. Rate of Enhancements Microkeratome GroupMicrokeratome Group 9 eyes out of 21 (42.9%) needed enhancement in the microkeratome group 9 eyes out of 21 (42.9%) needed enhancement in the microkeratome group Femtosecond Laser GroupFemtosecond Laser Group Zero patients out of 24 eyes in the intralase group needed enhancements Zero patients out of 24 eyes in the intralase group needed enhancements 11

12. Conclusion Both groups had relatively good predictability in terms of post-operative spherical equivalent compared to pre- operative target spherical equivalentBoth groups had relatively good predictability in terms of post-operative spherical equivalent compared to pre- operative target spherical equivalent The enhancement rate was greater in the microkeratome group (9 of 21 eyes) versus the femtosecond laser group (0 of 24 eyes) in this analysis.The enhancement rate was greater in the microkeratome group (9 of 21 eyes) versus the femtosecond laser group (0 of 24 eyes) in this analysis. 12