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Evolution of Refractive Surgery 2003
Daniel S. Durrie, MDOverland Park, KansasUSA
Surgical Options
2. change the lens2. change the lens
3. add a lens
1. corneal1. corneal curvaturecurvature
Evolution of Refractive Surgery
Evolution of Refractive Surgery
Evolution of Refractive Surgery
Surface Ablation Lamellar Ablation
Evolution of Refractive Surgery: - Technique 1989
LamellarSurface
PRKBroad beam laserMechanical debridment4.5 to 5.0 mm OZNo transition zonesUnilateral surgery
Excimer Laser KeratomileusisFree cap – 240 micronsUnderside of the flap ablatedSutured in place
Evolution of Refractive Surgery: - Technique 1990
LamellarSurface
PRKBroad beam laserMechanical debridment4.5 to 5.0 mm OZNo transition zonesUnilateral surgery
Excimer Laser KeratomileusisFree cap – 240 micronsUnderside of the flap ablatedSutured in place
Evolution of Refractive Surgery: - Technique 1991
LamellarSurface
PRKBroad beam laserMechanical debridment5.0 mm OZNo transition zonesUnilateral surgery
LASIKHinged flapStromal ablationNo sutures neededNasal hingeBarraquer Keratome
Evolution of Refractive Surgery: - Technique 1992
LamellarSurface
PRKBroad beam, scanning slit and spot lasersMechanical debridmentUp to 7.0 mm OZUnilateral surgery
LASIKHinged flapStromal ablationNo sutures neededNasal hingeACS Keratome
Evolution of Refractive Surgery: - Technique 1993
LamellarSurface
PRKBroad beam, scanning slit and spot lasersMechanical debridmentUp to 7.0 mm OZMultizone/multipass
LASIKHinged flapNasal hingeACS Keratome
Evolution of Refractive Surgery: - Technique 1994
LamellarSurface
PRKBroad beam, scanning slit and spot lasersAlcohol debridmentUp to 7.0 mm OZBandage contact lenses
LASIKHinged flapNasal hingeACS Keratome
Evolution of Refractive Surgery: - Technique 1995
LamellarSurface
PRK – FDA approvedBroad beam, scanning slit and spot lasersAlcohol debridmentUp to 7.0 mm OZBandage contact lenses
LASIKHinged flapNasal hingeACS Keratome
Evolution of Refractive Surgery: - Technique 1996
LamellarSurface
PRK – FDA approvedBroad beam, scanning slit and spot lasersAlcohol debridmentUp to 7.0 mm OZBandage contact lenses
LASIKHinged flapNasal hingeACS Keratome
Evolution of Refractive Surgery: - Technique 1997
LamellarSurface
PRK – FDA approvedBroad beam, scanning slit and spot lasersLaser scrapeUp to 7.0 mm OZBandage contact lenses
LASIKHinged flapNasal hingeACS Keratome
Evolution of Refractive Surgery: - Technique 1998
LamellarSurface
PRK – FDA approvedBroad beam, scanning slit and spot lasersLaser scrapeUp to 7.0 mm OZBandage contact lenses
LASIKHinged flapSuperior hingeHansatome Keratome
Evolution of Refractive Surgery: - Technique 1999
LamellarSurface
PRK – FDA approvedBroad beam, scanning slit and spot lasersLaser scrapeUp to 7.0 mm OZEye trackers
LASIKHinged flapSuperior hingeHansatome KeratomeNomograms
Evolution of Refractive Surgery: - Technique 2000
LamellarSurface
LASEKBroad beam, scanning slit and spot lasersEpithelial flapUp to 7.0 mm OZEye trackers
LASIK – FDA approvedHinged flapSuperior hingeHansatome KeratomeNomograms
Evolution of Refractive Surgery: - Technique 2001
LamellarSurface
LASEKBroad beam, scanning slit and spot lasersEpithelial flapUp to 7.0 mm OZEye trackers
LASIK – FDA approvedHinged flapHansatome KeratomeNomogramsWavefront custom ablation
Evolution of Refractive Surgery: - Technique 2002
LamellarSurface
Advance Surface AblationFlying spot lasersAlcohol debridment, no flapWavefront custom ablation
IntraLasikPrecision laser flap
Choice of hinge position and flap thicknessCentered on visual axis
Wavefront custom ablation
Lamellar
LASIK Technique 2003
Revolutionary Ultra FastMicron Level PrecisionSafety Platform
Software Controlled Laser
Optimal PrecisionEase of UseCustomizable
Breakthrough Safety Technology Platform
Single Use DisposableSterileSimple
Patient InterfaceINTRALASE FS Laser
Evolution to IntraLASIK
Evolution to IntraLASIK
IntraLASIK Technique 2003
Lamellar
Surface AblationTechnique 2003
Surface
Evolution of Refractive Surgery: 2003
We have worked over the past 10 years to improve safetyWe have improved our techniques, hardware and softwareGoals 2003 and beyond:
Improve the quality, not just Snellen acuityChoose the technology and procedure that is best for the patient, not your pocketbookWork to help those patients that have had previous refractive surgery upgrade to new technology