1. Omni-Focal Treatment for Correction of Presbyopia in Hyperopes: 1 Year Results Efekan Coskunseven, Baha Toygar, Serife Atun, Haluk Talu, Ebru Arslan Dunya Eye Hospital, Istanbul, Turkey ASCRS Chicago 2008

2. The Omni-Focal Approach Combines the VISX® Aspherical Ablation algorithm with the CustomVue Hyperopic algorithm –Customized, wavefront-guided, pupil-size dependent treatment corrects refractive errors and higher order aberrations –Designed to provide hyperopic presbyopes with improvement in near, intermediate and distance vision

3. Advanced CustomVue Aspheric Algorithm This algorithm utilizes 4 components: –Variable Spot Scanning (VSS) ablation technology: Creates changes to the ablation based on patient’s wavefront map –Central zone is steepened –Peripheral zone maintains distance vision –Intermediate vision is created by combining the central and peripheral ablation profiles for a multifocal effect

4. Advanced CustomVue Aspheric Algorithm WaveScan Aberrometry with Hartmann- Shack and Fourier technology –Enables greater wavefront-guided treatment possibilities Pre-op WaveScan Map Post-op Rx Correction Map showing Myopic central zone

5. Iris Recognition (IR) –Fully automated IR aligns and registers the wavefront correction during the excimer ablation –Critical component of presbyopic treatments Proper registration of wavefront-guided ablation Proper placement of the pupil-size dependent central zone relative to the pupil centroid Iris Registration ensures proper placement of add zone both rotationally and with respect to pupil centroid shifts

6. Advanced CustomVue Aspheric Algorithm Variable Repetition Rate (VRR) –Aids in precise placement of the ablation –Works with VSS to make certain that the complicated ablation shapes are precisely placed by the VISX® Star S4 IR Excimer Laser System

7. Purpose To evaluate the clinical results of combined aspherical and costumvue hyperopic presbyopia treatment.

8. Patient Demographics Single center – Dunya Eye Hospital 19 patients, 38 eyes –Mean age: 51 ± 4 (Range of 47 to 56) –Pre-op refractions: Sphere: +1.27 D ±0.56 (0 to +2.75 D) Cylinder: -0.37 D ±0.28 (0 to -1 D) Bilateral aspheric, hyperopic presbyopia treatment IR used in all cases Follow up schedule was post operative days 1, 3, 6 and 12 monthsFollow up schedule was post operative days 1, 3, 6 and 12 months

9. Binocular Uncorrected Distance Vision 21% had pre-op BUDVA of 20/20 or better vs. 84% 1 year post-op

10. Monocular Distance Corrected Near Vision 16% had pre-op distance corrected near vision of J3 vs. 87% at 1 year post-op

11. Binocular Uncorrected Near Vision 0% had a pre-op UNVA of J3 or better vs. 89% at 1 year post-op

12. Conclusions Initial results show positive outcomes –Combination of aspheric algorithm and hyperopic ablation improves near vision Patients report high degree of satisfaction with vision Some decline in distance vision, but often not recognized by patients –No eyes lost more than 2 lines of BCVA at 6 months Longer-term follow-up is required