1. Brian S. Boxer Wachler, MD Ten Year Followup of First Reported Case of Intacs for Keratoconus in North America BEVERLY HILLS, CA

2. Financial Disclosure Consultant to Addition Tech and Staar Surgical

3. First Reported Case in North America Intacs ® for Keratoconus: A Promising New Option? In the first case of its kind in the United States, off-label implantation of KeraVision's intracorneal rings improved vision from 20/160 to 20/25 in the operative eye. Brian Chou,O.D. Brian S. Boxer Wachler, M.D. et al Review of Optometry April 15, 2000

4. My Background I had been performing Intacs for myopia Just returned from AAO where I presented a poster on LASIK study While standing by my poster, Joseph Colin, MD from France had a poster on Intacs for Keratoconus Which gave me an idea for the patient I was to see 1 week later…

5. History In 1999, a 49 year old life guard with unilateral KC x 10 years presented to me Initially came in for LASIK in 1999

6. Clinical Data MRX OD -1.75 D -2.25 D x 5, BCVA 20/60 UCVA OD 20/160 Pachymetry OD 475 microns K values steep 47.54 D and flat 46.85 D

7. Surgery Plan Insert thicker Intacs 0.35 inferior and thinner 0.25 mm superior, incision 67% depth

10. 10 year post-op

11. I asked this patient to write forward to this book to honor him as first patient in North America to have Intacs for KC

12. Conclusions No complications for entire 10 year follow up from procedure Mild regression in postop period UCVA remaining at 20/70 BCVA remains improved at 20/40 Refractive cyl stable at -1.25 D