respectively) to be higher than the subjective refractive sphere and cylinder (-5.59D and -0.90D, respectively). There were also different gaps in the type of astigmatism between the two refractions. “Use of wavefront-based objective refraction and whole eye ray-tracing customized ablation can further improve uncorrected VA (UCVA) and visual quality,” he said. A. John Kanellopoulos, MD (Greece) told attendees that previous refractive surgery techniques negatively impacted the cornea as an optical surface even when providing spectacle independence. “Ray-tracing is a different story. This device uses data from epithelial remodeling according to the spherical equivalent you’re treating,” he said. “WaveLight Plus has its own algorithm through the Eyevatar to calculate the low-order myopia and astigmatism as well as the higher order aberrations (HOAs) automatically.” Surgeons do not need to make any nomogram adjustments as a result, and the device recommends the optimal treatment. Plus, the WaveLight Plus technology “takes into account the tilt between the cornea’s elliptical system and the lens’ elliptical system,” Prof. Kanellopoulos said. A multicenter, multinational published study2 found “a significant reduction of the astigmatism to essentially nil,” Prof. Kanellopoulos said. Some eyes even gained 2 lines of vision, he added. Another paper3 showcased Prof. Kanellopoulos’ own ray-tracing cohort outcomes postoperatively and “established that the data are stable even 2 years out,” he said. “Postop contrast sensitivity is better than the preop.” In short, he said, “we have the opportunity to improve the visual optics of the eye for the rest of the patient’s life.” Personalized plans improve visual outcomes Fengju Zhang, MD, PhD (China) showed results from her real-world clinical study (51 patients, 99 eyes). She included patients with a pupil size >4.5 mm, and used the Sightmap to evaluate anterior chamber depth, central corneal thickness, wavefront refraction, and topography. She used the WaveLight FS200 to make the customized flaps on her patients, with a thickness of 110 µm and a diameter ranging from 8.6 mm to 8.8 mm (depending on the customized ablation profile). She used the WaveLight EX500 to create optical zones of 6.0 mm to 6.7 mm. “If the difference between the subjective refraction and the wavefront-measurement was more than 0.5 D to 0.75 diopters, I will make a little bit of adjustment,” she said. At postop Month 1 (n=44 patients/87 eyes), 56% of the eyes gained ≥1 line of CDVA, she said, adding that UDVA was better than 20/20 in 99% of eyes, was 20/16 in 66% of eyes, and 20/12.5 in 15% of eyes. Further, UDVA was within 1 line of preop CDVA in all eyes. Spherical equivalence was within ±0.5 D of target in 77% of eyes and was within ±1.00 D of target in 98% of eyes. At postop Month 1, 75% of eyes were within ±0.25 D of cylinder. The mean difference vector was 0.05D, and the correction index was 0.98, she said. At postop Month 3 (n=30 patients/59 eyes), “the refraction remained quite stable,” she said; UDVA was ≥20/20 in 98% of eyes, ≥20/16 in 64% of eyes, and ≥20/12.5 in 15% of eyes. When the InnovEyes manifest refraction is “a bit high compared to the cycloplegic refraction, I will reduce the spherical correction,” she said. In younger eyes that may have postop regression, “I keep the cycloplegic refraction the same in the dominant eye.” WaveLight Plus is “truly an incredible driver for personalized myopia correction,” said Pierce Lin, MD, PhD (Taiwan), and the InnovEyes Sightmap leverages the unique ray-tracing technology by iteratively tracing 2,000 rays of light. “This allows us to measure from the cornea to the crystalline lens, then to the retina, creating a personalized 3D eye model to help identify the best ablation profile for our patients,” Dr. Lin explained in a video. Dr. Lin presented unpublished data comparing outcomes with the WaveLight Plus (n=58) and Alcon’s Contoura (n=106). Gender and age distribution was similar between the two groups, but the Contoura group had much higher spherical equivalent (-6.83±1.89 D) than the WaveLight Plus group (-4.66±1.55 D). At postop month 1 there was “excellent efficacy” in UCVA, with 41% of eyes in the WaveLight Plus group and 10% of eyes in the Contoura group achieving 20/12.5. The predictability was also excellent in both groups, with “a majority of patients within 0.5 D,” Dr. Lin said: 96.6% of patients in the WaveLight Plus group were within ±0.5 D, compared to 89.4% of patients in the Contoura group. Dr. Lin said surgeons should think of traditional lenticular extraction as buying a suit “off the rack,” whereas the WaveLight Plus is more like “having a suit custom-made for the buyer.” Copyright 2024 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. All other trademarks are the intellectual property of their respective owners. © Alcon 2024 08/24 ASIA-WL5-2400001 No longer do we need to treat their glasses; we’re treating each and every dot on their cornea as an individual dot. It’s truly personalized to their eye. Chandra Bala, PhD, BSc(Med) “ ” Reference: 1. He G and Bala C. Ray-tracing-guided myopic LASIK: real-world clinical outcomes. J Cataract Refract Surg. 2023;49:1140-1146. doi.org/10.1097/j.jcrs.0000000000001286 2. Kanellopoulos AJ, Maus M, Bala C, Hamilton C, Lemonis S, Jockovich ME, Khoramnia R. International Multicenter, Myopic and Myopic Astigmatism Femto LASIK, Customized by Automated Ray-Tracing Ablation Profile Calculation: A Postmarket Study. Clin Ophthalmol. 2024 Feb 20;18:525-536. doi: 10.2147/OPTH. S435581. 3. Kanellopoulos AJ. Ray-Tracing Customization in Myopic and Myopic Astigmatism LASIK Treatments for Low and High Order Aberrations Treatment: 2-Year Visual Function and Psychometric Value Outcomes of a Consecutive Case Series. Clin Ophthalmol. 2024 Feb 22;18:565-574. doi: 10.2147/OPTH.S444174. 4. InnovEyes™ Sightmap Diagnostic Device User Manual 5. RFP911-P001 Postmarket Study of Outcomes from WaveLight EX500 InnovEyes Media placement sponsored by ALCON Carl Zeiss Meditec AG
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