1. Steve Schallhorn MD Myth Busters in Patient Selection for LASIK Steve Schallhorn MD

2. DISCLOSURES Consultant to AMO Global Medical Director Optical Express Consultant to AMO Global Medical Director Optical Express

3. Thin Cornea “Patients with a central corneal thickness less than 500 microns should not undergo LASIK because they are much more likely to be abnormal and develop ectasia”

4. Distribution of Preop Central Corneal Thickness thinnest of 3 ultrasonic pachymetry readings Mean:549µ Stdev: 31µ 2 STD below:488µ 81,715 consecutive LASIK – 1 Apr 08 to 31 Mar 09 – IL and mech flaps – 2,181 eyes CCT < 500u – 79,534 eyes CCT >=500u 81,715 consecutive LASIK – 1 Apr 08 to 31 Mar 09 – IL and mech flaps – 2,181 eyes CCT < 500u – 79,534 eyes CCT >=500u

5. Age Distribution

6. Preop Sphere

7. Ectasia has been observed in 3 Patients Pt 1Pt 2Pt 3 Age212331 Preop MRx (R/L) -1.25/-1.0 X 070 -1.25/-0.50 X 010 -6.5/-1.0 X 055 -7.0/-0.50 X 130 -4.0/0.00 -5.75/-0.50 X 095 CCT537 / 527503 / 505521 / 527 Flap methodMoriaIntralaseMoria Est RSB334 / 329270 / 272303 / 281 Preop K 43.5/45 @ 094 43.25/45 @ 094 44.0/45.5 @ 130 44.25/45.25 @ 080 44.5/45.5 @ 156 44.75/45.5 @ 027 Ectasia diagnosis Right eye 11 months postop Right eye 18 months postop Left eye 15 months postop TreatmentCXL

8. Preoperative Sphere “Patients with more than 3D of hyperopia should not undergo LASIK because they are much more likely to be unhappy afterwards”

9. Dissatisfaction as a Function of Treated Hyperopia Average preop sphere: +2.0 ± 0.9D

10. Preoperative Astigmatism “Patients with high cylinder should not undergo LASIK because they are much more likely to be unhappy afterwards”

11. Dissatisfaction as a Function of Treated Astigmatism Average preop cyl: 0.76D Patients

12. Low Light Pupil Diameter “Patients with >=8mm pupils should not undergo LASIK because they are much more likely to be unhappy and have visual symptoms”

13. 1M LASIK Dissatisfaction vs Low Light Pupil Patients

14. 1M LASIK Problems with Daily Activities and Night Driving vs Low Light Pupil Patients

15. Hyperopic Presbyopes “A +2.50D 60 year old should not undergo LASIK. An RLE procedure will result in much higher patient satisfaction and less dry eye”

16. 12 Month Age Stratified Random Sample RLELASIK 112 pts159 pts Gender: M/F(%)41% / 59%43% / 57% Age (years): Mean (SD)60.2 ± 6.259.9 ± 4.8) Min, Max45 to 7050 to 70 Preop Sphere: Mean (SD)+2.55 ± 0.99D+2.24 ± 0.69D Min, Max+1.00 to +4.50 Preop Cylinder: Mean (SD)-0.60 ± 0.47D-0.54 ± 0.43D Min, Max0.0 to -2.50 Preop MSE: Mean (SD)+2.25 ± 0.97D+1.97 ± 0.66D Min, Max0.00 to +4.50+0.63 to +4.25

17. Procedure vs. Satisfaction P = 0.4684

18. “During the past week, how many times a day do you use artificial tears?”

19. Refractive Target “It is best to target a little myopia in presbyopic patients to enhance their satisfaction”

20. Mean 1 M Satisfaction vs Postop Sphere Dominant eye in patients >=40 yrs & patients <=30 yrs 1,643 1,173 2,576 7,338 2,439 8,214 1,648 841 1,425 458 More Satisfied

21. Conclusions Analysis of large patient datasets can provide a unique insight to improve refractive surgery Analysis of large patient datasets can provide a unique insight to improve refractive surgery Patient selection Patient selection Refractive target Refractive target “Myth busters” “Myth busters” Analysis of large patient datasets can provide a unique insight to improve refractive surgery Analysis of large patient datasets can provide a unique insight to improve refractive surgery Patient selection Patient selection Refractive target Refractive target “Myth busters” “Myth busters”