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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”
450 460 470 480 490 500 510 520 530 540 550 560 570 580 590 600 610 620 6300
5,000
10,000
15,000
20,000
25,000
Distribution of Preop Central Corneal Thickness thinnest of 3 ultrasonic pachymetry readings
Mean: 549µStdev: 31µ2 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
Age Distribution
18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 690.0%
1.0%
2.0%
3.0%
4.0% Cornea <500 microns preop
Cornea >=500 microns preop
Age
Preop Sphere
-10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 60%
5%
10%
15%
20%
25%
Cornea <500 microns preop
Cornea >=500 microns preop
Ectasia has been observed in 3 PatientsPt 1 Pt 2 Pt 3
Age 21 23 31
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
CCT 537 / 527 503 / 505 521 / 527
Flap method Moria Intralase Moria
Est RSB 334 / 329 270 / 272 303 / 281
Preop K 43.5/45 @ 09443.25/45 @ 094
44.0/45.5 @ 13044.25/45.25 @ 080
44.5/45.5 @ 15644.75/45.5 @ 027
Ectasia diagnosis Right eye11 months postop
Right eye18 months postop
Left eye15 months postop
Treatment CXL CXL CXL
Preoperative Sphere
“Patients with more than 3D of hyperopia should not undergo LASIK because they are
much more likely to be unhappy afterwards”
Dissatisfaction as a Function of Treated Hyperopia
≤ 0.50D (1,970)
0.75 to 1.50D (1,173)
1.75 to 2.5D (3,005)
2.75 to 3.5D (1,597)
≥3.75D (580)
0%
5%
10%
15%
1.5% 1.6%2.6%
1.9% 1.9%
Preop Hyperopia
% D
issa
tisfie
d w
ithin
eac
h Ca
tego
ry
Average preop sphere: +2.0 ± 0.9D
Preoperative Astigmatism
“Patients with high cylinder should not undergo LASIK because they are much more likely to be unhappy afterwards”
Dissatisfaction as a Function of Treated Astigmatism
0 to 0.5D (12,430)
1D (7,331)
2D (1,695)
3D (480)
4D (176)
5D or higher
(72)
0%
5%
10%
15%
1.1% 1.2% 1.4% 1.5%2.3%
1.4%
Preop Cylinder
% D
issa
tisfie
d w
ithin
eac
h Ca
tego
ry
Average preop cyl: 0.76D
Patients
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”
1M LASIK Dissatisfaction vs Low Light Pupil
4mm (1,703)
5mm (6,831)
6mm (12,937)
7mm (10,963)
8mm (4,519)
9mm (646)
0%
2%
4%
6%
8%
2.0%
1.4%1.2%
1.0% 0.8%
0.1%
Patients
1M LASIK Problems with Daily Activities and Night Driving vs Low Light Pupil
4mm (1,703)
5mm (6,831)
6mm (12,937)
7mm (10,963)
8mm (4,519)
9mm (646)
0%
2%
4%
6%
8%
2.6%
1.8% 1.7%
1.0%1.2%
0.0%
3.1% 3.1% 3.1% 3.1% 2.9% 2.8%
Daily Activities
Night Driving
Patients
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”
12 Month Age Stratified Random Sample
RLE LASIK 112 pts 159 ptsGender: M/F(%) 41% / 59% 43% / 57%Age (years):
Mean (SD) 60.2 ± 6.2 59.9 ± 4.8)Min , Max 45 to 70 50 to 70
Preop Sphere:Mean (SD) +2.55 ± 0.99D +2.24 ± 0.69DMin , Max +1.00 to +4.50 +1.00 to +4.50
Preop Cylinder:Mean (SD) -0.60 ± 0.47D -0.54 ± 0.43DMin , Max 0.0 to -2.50 0.0 to -2.50
Preop MSE:Mean (SD) +2.25 ± 0.97D +1.97 ± 0.66DMin , Max 0.00 to +4.50 +0.63 to +4.25
Procedure vs. Satisfaction
RLE
LASIK
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
94.6%
93.1%
Satisfied
Neither
Dissatisfied
P = 0.4684
“During the past week, how many times a day do you use artificial tears?”
None One time daily Two times daily
Three times daily
Four times or more daily
0%
20%
40%
60%
80%
100%
73.3%
13.5%
4.4% 4.1% 4.7%
65.5%
14.3%10.3%
3.6%6.3%
LASIKRLE
Refractive Target
“It is best to target a little myopia in presbyopic patients to enhance their
satisfaction”
Mean 1 M Satisfaction vs Postop Sphere
Dominant eye in patients >=40 yrs & patients <=30 yrs
-2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5 2 2.50
0.5
1
1.5
2>=40 years, emmetropia target
<=30 years
Postop Sphere
Avera
ge S
ati
sfa
cti
on
Score
1,643
1,173
2,5767,338
2,4398,214
1,648
841
1,425
458More
S
ati
sfied