1. Jocelyn Newton Swetha Velpula Jo Ellery Anil Arora Central Coast Optometrist Conference 2/3/14

2. 1% 22% 13% 8% 11% 10% 17% 8% 6% 3% 0% 5% 10% 15% 20% 25% 0-19 20-29 30-34 35-39 40-44 45-49 50-54 55-59 60-69 >70 LaserVisionClinic CentralCoast Age Distribution - Percentage pre op (226) month (eyes) 3. 1% 2% 3% 4% 15% 33% 34% 6% 2% 1% 0% 5% 10% 15% 20% 25% 30% 35% LaserVisionClinicCentralCoast < -2,00 -2,00 to -1,51 -1,50 to -1,01 -1,00 to -0,51 -0,50 to -0,126 +-0,125 +0,126 to + 0,5 +0,51 to +1,00 +1,01 to +1,50 +1,51 to +2,00 > +2,00 0.50 D: 82% 1.00 D: 92% D: Refractive outcome - Percentage within Attempted 1 m (177) month (eyes) 4. number of eyes pre OP: 227 average age@surgery: 42 years (range 19 to 76) gender female: 55.1% or 125 eyes male: 44.5% or 102 eyes eye left: 48.9% or 111 eyes right: 51.1% or 116 eyes pre SR equiv: mean -1.71 D 2.89 D (range -11.13 to 4.75) pre SR sph: mean -1.24 D 2.82 D (range -10.75 to 5.25) pre SR cyl: mean -0.94 D 0.87 D (range -4.25 to 0.00) number of eyes 1 m: 177 (follow up rate 78.0%) post SR equiv: mean -0.32 D 0.95 D (range -2.50 to 2.00) post SR sph: mean -0.13 D 0.93 D (range -2.50 to 2.25) post SR cyl: mean -0.39 D 0.34 D (range -1.50 to 0.00) 1 standard deviation Laser Vision Clinic Central Coast 5. number of eyes pre OP: 221 average age@surgery: 42 years (range 19 to 76) gender female: 56.1% or 124 eyes male: 43.4% or 97 eyes eye left: 49.3% or 109 eyes right: 50.7% or 112 eyes pre SR equiv: mean -1.62 D 2.71 D (range -8.88 to 4.75) pre SR sph: mean -1.17 D 2.64 D (range -8.00 to 5.25) pre SR cyl: mean -0.90 D 0.85 D (range -4.25 to 0.00) number of eyes 1 m: 172 (follow up rate 77.8%) post SR equiv: mean -0.31 D 0.95 D (range -2.50 to 2.00) post SR sph: mean -0.11 D 0.93 D (range -2.50 to 2.25) post SR cyl: mean -0.40 D 0.34 D (range -1.50 to 0.00) 1 standard deviation Laser Vision Clinic Central Coast 6. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 33% 83% 92% 100% LaserVisionClinicCentralCoast Refractive outcome - Percentage within | Attempted | 1 m (174) month (eyes) 7. 34% 84% 93% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% LaserVisionClinicCentralCoast +-0,125 +-0,5 +-1,0 +-2,0 Refractive outcome - Percentage within | Attempted | 1 m (172) month (eyes) 8. 46% 77% 77% 95% 97% 3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 6/3,8 orbetter6/4,8 orbetter 6/6 orbetter6/7,5 orbetter6/9,6 orbetter6/12 orbetter6/15 orw orse LaserVisionClinic CentralCoast Cumulative UDVA - Percentage 1 m (145) month (eyes) 9. 46% 79% 79% 95% 97% 3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 6/3,8 orbetter6/4,8 orbetter 6/6 orbetter6/7,5 orbetter6/9,6 orbetter6/12 orbetter6/15 orw orse LaserVisionClinic CentralCoast Cumulative UDVA - Percentage 1 m (140) month (eyes) 10. 168 eyes - 1 m postOP y = 1.06x R2 = 0.890 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Laser Setting SEQ [D] AchievedchangeinSEQRefraction[D] avg. deviation 0.41 D (from 0.00 to 2.74) LaserVisionClinicCentralCoast overcorrected undercorrected 11. 11 eyes - 1 m postOP y = 1.24x R2 = 0.87 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Laser Setting SEQ [D] AchievedchangeinSEQRefraction[D] avg. deviation 0.75 D (from 0.00 to 2.72) LaserVisionClinicCentralCoast overcorrected undercorrected 12. 35 eyes - 1 m postOP y = 1.04x R2 = 0.40 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Laser Setting SEQ [D] AchievedchangeinSEQRefraction[D] avg. deviation 0.66 D (from 0.00 to 2.74) LaserVisionClinicCentralCoast overcorrected undercorrected 13. 18 eyes - 1 m postOP y = 0.90x R2 = 0.54 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Laser Setting SEQ [D] AchievedchangeinSEQRefraction[D] avg. deviation 0.40 D (from 0.00 to 2.63) LaserVisionClinicCentralCoast overcorrected undercorrected 14. 87 eyes - 1 m postOP y = 1.05x R2 = 0.97 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Laser Setting SEQ [D] AchievedchangeinSEQRefraction[D] avg. deviation 0.30 D (from 0.00 to 1.38) LaserVisionClinicCentralCoast overcorrected undercorrected 15. Overall excellent and on par or better than larger centres who have published their results (Singapore National Eye Centre results of 37,932 myopic LASIK surgeries over a 10 year period) 84% within +/- 0.5 D of target (SNEC 80%) 93% within +/- 1D of target (SNEC 93%) 79% 6/6 or better UDVA at 1 month (SNEC 72.8%) 95% 6/9 or better UDVA at 1 month (SNEC 92%) Slight tendency for overcorrection in hyperopes Overall retreatment rate 7% (SNEC 3.8% but their study was on myopes only). Our retreatment rate for myopes about 4% 16. Trial of PRESBYOND software from Carl Zeiss Aim is to increase depth of field in each eye by inducing an increase in corneal spherical aberration. Monovision created by making dominant eye emmetropic and non-dominant eye slightly myopic (default setting -1.5D) Greater depth of field in each eye results in a greater blend zone and greater patient acceptance 17. 17 without spherical aberration with spherical aberration 18. Far distance (landscape) Distance (car driving) Intermediate (computer screen, dashboard) Near (books, cell phone) Right Eye Left Eye 19. 19 Right Eye Left Eye Far distance (landscape) Distance (car driving) Intermediate (computer screen, dashboard) Near (books, cell phone) 20. 20 Dominant Eye Non-dominant Eye Far distance (landscape) Distance (car driving) Intermediate (computer screen, dashboard) Near (books, cell phone) Blend Zone 21. 21 Dominant Eye Non-dominant Eye Far distance (landscape) Distance (car driving) Intermediate (computer screen, dashboard) Near (books, cell phone) Blur Zone 22. 22 23. 23 Preoperative spherical aberration Functional age Selection of optical zone 24. Software installed Training presentations given by Zeiss consultants Beginning patient recruitment for a 6 month trial Excellent results and high patient satisfaction rates reported in other centres all over the world who have this software and technology Exciting potential for the management of presbyopic patients who wish to be spectacle or contact-lens independent 25. Q1) Which of the following describes the optical characteristics of the anterior surface of the average human cornea: a) prolate and positively aspheric b) prolate and negatively aspheric c) oblate and positively aspheric d) oblate and negatively aspheric 26. Q2) Regarding aberrations in the human eye, all the following are true except: a) lower order aberrations - spherical defocus (myopia, hyperopia) and astigmatism account for about 90% of the total aberrations b) spherical aberration and coma are the clinically most relevant higher order aberrations c) higher order aberrations are not affected by laser vision correction or cataract surgery d) the total higher order aberrations increase with increasing pupil size 27. Q3) The following strategies can be used to try to treat presbyopia except: a) increasing spherical aberration to produce an increased depth of focus b) offsetting the two eyes to create monovision with one eye for distance and one for near c) creating multiple retinal images at different focal points as occurs with multifocal IOLs d) consuming foods that are rich in antioxidants, lutein and xeaxanthin 28. Correct answers: Q1 - a, Q2 - c, Q3 - d