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

2. 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

3. 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

4. Carefull preop examination

5. Technologically advanced Laser

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

7. Lasik Lasik The intervention - making the flap

8. Lasik Lasik Closing the flap

9. HOW DOES «PERSONALIZED TREATMENT» WORK ?

10. The idea

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

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

14. Wave Aberration of a Surface

15. 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

16. 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

17. 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

18. Point Spread Function vs. Pupil Size Perfect Eye

19. Point Spread Function vs. Pupil Size Typical Eye

20. 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

21. Encouraging results

22. Encouraging resultsPreop –6.5 D Zyoptix

23. Postop Plano 6M VA 13/10

24. Zyoptix System – Clinical Outcomes

25. Night vision

26. Haloes

27. Custom treatment

28. 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:

29. 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

30. 20/20/20/20

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