MYOPIA, ASTIGMATISM, HYPEROPIA… PERSONALIZED TREATMENT Bernard Mathys, MD Secretary-general of the Belgian Society of Cataract & Refractive Surgery

Refractive surgery in 2004 How can we do this? Better instruments, new lasers, well-trained surgeons, improvement of post-op treatments… and new algorithms? Today we use mostly PRK (surface treatment) and Lasik to perform surgery and our desire is to improve our results

Algorithm factor Different steps are needed: Improve the treatment itself: -3 of X is not necessarily -3 of Y Improve the treatment itself: -3 of X is not necessarily -3 of Y Personalize treatment =>Improve quality of vision Personalize treatment =>Improve quality of vision Possibility to help people with thin corneas, large pupils, high ametropia Possibility to help people with thin corneas, large pupils, high ametropia

Carefull preop examination

Technologically advanced Laser

Zyoptix: the name of the system Zyoptix: the name of the system The laser custom treatment

Lasik Lasik The intervention - making the flap

Lasik Lasik Closing the flap

HOW DOES «PERSONALIZED TREATMENT» WORK ?

The idea

Wavefront analyse Wavefront analyse Reconstruction of wavefront by CCD-image > Zernike coefficient CCD-Image

Hartmann-Shack Wavefront Measurement Perfect Eye Aberrated Eye Lenslet Array CCD Array Wave Aberration Spot Array

Wave Aberration of a Surface

The shape of the wavefront is depicted in Zernike coefficient, each shape describes a deformation The shape of the wavefront is depicted in Zernike coefficient, each shape describes a deformation

trefoil coma trefoil quadrafoil secondary spherical 2 nd 3 rd 4 th 5 th radial order secondary quadrafoil pentafoil secondary pentafoil secondary defocus astigmatism trefoil coma Conventional Refraction Higher Order Aberrations Zernike Modes

Point Spread Function (PSF) Point Spread Function: is the representation of an optical system of a punctual and distant light source ( star in the sky) Airy Disc

Point Spread Function vs. Pupil Size Perfect Eye

Point Spread Function vs. Pupil Size Typical Eye

Each eye has different patterns of High Order Aberrations. Wave Aberration Pointspread Function Retinal Image Perfect eye (diffraction limited) MRBGYY MAK 5.7 mm pupil

Encouraging results

Encouraging resultsPreop –6.5 D Zyoptix

Postop Plano 6M VA 13/10

Zyoptix System – Clinical Outcomes

Night vision

Haloes

Custom treatment

NEW SCALE ? Contrast & low-contrast sensitivity Different lightning conditions Color vision Glare & haloes VA is a less sensitive measure of the correction of high-order aberrations VA is a less sensitive measure of the correction of high-order aberrations Increase the quality of the retinal image Increase the quality of the retinal image We need to assess quality of vision in true-life conditions: We need to assess quality of vision in true-life conditions:

Custom treatment: the future ? Aberrometry Aberrometry TopographyTopography Linked to the laser, to achieve personal treatmentLinked to the laser, to achieve personal treatment Must improve our actual results in all casesMust improve our actual results in all cases Must be safeMust be safe Not a higher complication rateNot a higher complication rate

20/20/20/20

THANK YOU FOR YOUR ATTENTION Bernard Mathys, MD Secretary-general of the Belgian Society of Cataract & Refractive Surgery