Presbyopia – New Technologies & Treatments

Excimer Lasers and Multifocal Corneal Ablations

Alarcón et al evaluated different theoretical models of a multifocal cornea for the correction of presbyopia by laser ablation using ray tracings. Because the pupil’s size decreases with accommodation, the investigators preferred the central model to obtain optimal multifocality with the achievement of a 2.4-mm central zone diameter to the peripheral model with a 2.9-mm central zone. It should be noted that, although near vision is better, the quality of distance vision provided by these models is worse than that of a presbyopic emmetropic eye.

In a clinical trial conducted over 12-months showed results of aspheric wavefrontguided LASIK to treat hyperopic presbyopia. They treated 66 eyes of 33 patients using the Visx Star S4 IR (Abbott Medical Optics Inc.). Six months postoperatively, mean corrected distance visual acuity was 20/20+1, and distance corrected near visual acuity was 2.7 ±1.7, with a maximum of a 6-line improvement in near vision. At 12 months, 100{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of patients achieved a binocular simultaneous UCVA of 20/25 or better and J3. Negative spherical aberration highly correlated with a postoperative improvement in distance corrected near visual acuity. In their conclusions, the researchers stated that patients who had a larger amount of preoperative hyperopia or a greater decrease in preoperative distance-corrected near visual acuity were more likely to have overall satisfaction.

A chart review of 178 consecutive patients underwent bilateral presby-LASIK (or progressive multifocal LASIK) using the WaveLight Allegretto excimer laser (Alcon Laboratories, Inc.). The patients had a preoperative refractive error of emmetropia, myopia of up to -5.00 D, or hyperopia of up to +3.00 D and no more than 3.00 D of astigmatism. Of 102 patients with at least 3 months’ postoperative follow-up, 81{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} had a binocular distance UCVA of 20/20 or better, and 98{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} saw 20/25 or better. Additionally, 44{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} achieved J1 binocular near acuity, 60{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} J2, and 96{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} J3 or better.

Another clinical trial presented early outcomes of Intracor femtosecond laser treatment for presbyopia. The investigators treated the nondominant eye of 25 patients using the Technolas Perfect Vision femtosecond laser (Technolas Perfect Vision GmbH). The procedure involves the creation of five consecutive intrastromal rings around the line of sight. Treatment times were approximately 20 seconds. The mean gain in UCVA was 4.42 lines, with a range of 0 to 9 lines of improvement. The mean loss of distance BCVA was -0.46 ±0.83.9 Similarly, Ruiz et al evaluated 83 eyes of 45 patients with 6- to 12-month follow-up. Of the 83 eyes, 89.2{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} achieved both J2 and 20/25 or better, and 69.9{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} achieved a near UCVA of J1. This technology has the advantage of being minimally invasive, with a rapid effect manifesting within minutes to several hours. Further investigation of long-term stability is ongoing.

Related data from a safety study performed in the Philippines by Harvey S. Uy, MD. Fourteen patients were between 45 and 60 years of age with 20/40 or better BCVA, had no greater than grade 2 cataracts, and had originally consented to cataract surgery. All underwent unilateral treatment with the option to proceed to cataract surgery after 1 month of follow-up. Early results showed no progressive cataract formation at 1 month.

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The Basics of Lasik

LASIK stands for Laser-Assisted In Situ Keratomileusis and simply put is a procedure using an excimer laser that permanently changes the shape of the eye. A small flap is cut into the cornea and folded over to allow access to the part of the eye called the stroma, where the laser is used to reshape the cornea and the flap is closed.
The WaveScan Wavefront System used by many specialists in LASIK eye surgery works by creating a map that shows how your optical system, as a whole, processes light. This results in something similar to a fingerprint of each eyes unique vision profile, which allows patients to be treated for their own special imperfections during the LASIK eye surgery. WaveScan technology was originally developed for use in high-powered telescopes to reduce distortions when viewing distant objects in space. This technology has now been applied to laser vision correction, measuring imperfections in the eye never before measured using only standard methods for vision correction.
The VISX Star S4 laser, according to many of its proponents, brings a new standard of accuracy to laser vision correction with a combination of two different systems known as Variable Spot Scanning and 3D ActiveTrak. With a laser calibrated to .25 microns, this hybrid system offers amazing precision, and can treat many borderline conditions that were once beyond the scope of other technologies. Just for comparison, human hairs are 60-80 microns in diameter. The VISX Star S4 is capable of performing both a standard (non-wavefront) treatment and a CustomVue (Wavefront guided) treatment. The CustomVue treatment provided by the VISX Star S4 Laser utilizes information regarding the distortion of light as it passes through each person’s eye and attempts to reduce those that may be causing symptoms such as glare and halos.
CustomVue systems match a specially created profile (again, a kind of fingerprint of your vision to an ideal optical system. Once again using the VISX Star S4 laser, this profile data ensures precise, uniquely personalized LASIK eye surgery. If you are one of the particular LASIK patients who qualify for this kind of procedure, CustomVue allows the surgeon to eliminate microscopic flaws in your vision that cannot be corrected with either glasses or contact lenses.
The IntraLase laser is a technology used to replace the metal mechanical blade microkeratome traditionally used to cut the necessary corneal flap during a laser vision correction procedure. Rather than creating a flap with a blade, the IntraLase laser uses laser energy to make a quick, painless incision that is more precise.
For top name manufacturers you can trust, like Acon, Nidek, and Lumenis for precision Lasik surgical equipment contact us at and let one of our equipment experts help.

LASIK is more than just seeing better- it’s choosing better as well

Refractive surgical procedures have increased significantly in the past few years. The most recent surveys from the American Academy of Ophthalmology report that there were approximately 800,000 refractive surgical procedures performed in 2010, up more than 50,000 from 2009. As refractive and laser vision correction procedures continue to rise, choosing with the proper doctor is essential to achieving the best results for improving your vision. With procedures like LASIK and cataract surgery so popular, quality vision correction requires exact precision from a surgeon who is educated and knowledgeable of the latest technology.

Thanks to recent developments in laser correction technology, LASIK and refractive eye surgeons are able to significantly reduce the risks and side effects of procedures to a minimal amount. According to the U.S. Food and Drug Administration, LASIK surgery complications now occur in less than 5{0730eed075b45d9e50c00d6cd42dd08773e0164f29a45151808bf89051290974} of all cases. But in order to maintain such a high degree of success, surgeons must pursue continued education in techniques and procedures in addition to their normal patient care. Patients should be sure to choose a qualified and experienced surgeon who is active in the ophthalmologic community Society of Refractive Surgery) and who has a strict attention to detail, patient safety and health.

Another important step to take in your search for the right eye doctor is taking time to meet a surgeon and his or her staff while researching their credentials before undergoing any procedure. Through individualized and personal attention of each patient’s needs, while maintain open communication, is the best way to achieve the right results for each individual.

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Accelerated Corneal Crosslinking Procedure Receives CE Approval

A procedure designed to strengthen the cornea after LASIK called LASIK Xtra, has received CE approval for marketing in Europe and was just approved in Canada as well.

Marketed by Avedro, Inc., Lasik Xtra is an accelerated corneal crosslinking procedure that applies Avedro’s VibeX riboflavin ophthalmic solution to the cornea, and then uses it’s KXL System to irradiate the cornea with UV-A rays that only takes two minutes to apply, making it a good solution to combine with LASIK. Avedro said their studies show the procedure has helped people who received hyperopic LASIK, which tends to regress more than myopic LASIK, and will help patients maintain their vision correction they received from LASIK.

Although corneal crosslinking has not received FDA approval yet, Avedro’s VibeX solution has received orphan drug approvals from the agency. Orphan drug status is usually conferred on treatments for rare medical conditions, in this case, keratoconus, which is a gradual thinning of the cornea.


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