EyeWorld Asia-Pacific September 2014 Issue

51 EWAP REFRACTIVE September 2014 The current state of topography-guided ablations by Ellen Stodola EyeWorld Staff Writer continued on page 52 Approvals and patient selection recommendations differ depending on where topography-guided ablation is being used T opography-guided ablation has different applications around the world. It was only recently U.S. Food and Drug Administration approved, specifically for patients who have not undergone previous surgery. In Europe, it has been used for the past 10 years, and its applications expand to patients who are undergoing retreatments. Arthur Cummings, MB ChB, MMed(Ophth), FRCSEd, Wellington Eye Clinic, Dublin, discussed the use of topography-guided ablations and his experiences, while Daniel Durrie, MD , Durrie Vision, Leawood, Kan., U.S., discussed the recent approval in the U.S. and how it will come into play in the future. Uses Topography-guided ablations can be useful in various types of cases. “We’ve had them since 2004, so the last 10 years, we’ve used them mostly for complicated Figure 2. The same ablation in Figure 1 but the refractive data has been removed. This is the topography-derived data (higher order ablation pro le) only, and the surgeon needs to determine what effect this ablation will have on the refraction and then modify the refractive data to be used in the ablation. Source (all): Arthur Cummings, MB ChB, MMed(Ophth), FRCSEd Figure 1. This ablation includes the topography data as well as the refractive data of –1.25 D sphere. The ablation is clearly not symmetrical. cases,” Dr. Cummings said. It’s generally used for retreatments in someone who has had previous LASIK or PRK and who has a small or decentered optical zone, he said. Topography- guided ablations can help to recenter or reenlarge the optical zone. Dr. Cummings also uses topography-guided ablation for select keratoconus patients, combining it with simultaneous crosslinking. Topography-guided ablation may be used slightly differently in Europe than in the U.S., in part because of its recent approval for first time treatments only in the U.S. What the public needs to understand about the U.S. clinical study and approval is that it was done on eyes that did not have previous surgery, Dr. Durrie said. This means that the topography- guided ablation trial targeted eyes that are the standard myopic eyes with astigmatism that are having surgery all the time, with the goal of seeing if it is comparable to the standard treatment and if there are any advantages. The trial focused on patients coming in for regular surgery, and they did extremely well, Dr. Durrie said.