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Jack T. Holladay, MD, MSEE, FACS 2006
Optomized PROLATE Topographic & Wavefront Guided Ablations Page 1 of 4
7/6/20067/6/2006 JTHJTH 11
Jack T. Holladay, MD, MSEE, FACSJack T. Holladay, MD, MSEE, FACS
Clinical Professor of OphthalmologyClinical Professor of Ophthalmology
Baylor College of MedicineBaylor College of Medicine
Houston, Texas, USAHouston, Texas, USA
Optimized Prolate
Ablations Using
Ocular and
Topographic Wavefront
Optimized Prolate
Ablations Using
OcularOcular andand
TopographicTopographic WavefrontWavefront
Learn from NatureLearn from Nature
Learn fromLearn fromNormal EyesNormal Eyeswithwith
excellentexcellent PerfomancePerfomancePrimates BinocularPrimates BinocularStereoStereo
Vision haveVision have ProlateProlateCorneasCorneas
Primates with BinocularPrimates with BinocularNonNon--
StereoStereo360360 Fields areFields are OblateOblate
ProlateProlate
s SSpherical AAberration forBEST CENTRAL VISIONBEST CENTRAL VISION
7/6/20067/6/2006 JTHJTH 5577
ProlateProlate Eagles, manEagles, man
QQavgavg == --0.260.26
Ref: May 1999 JCRSRef: May 1999 JCRS
Vol. 25 pp.663Vol. 25 pp.663--669669
QQnono SASA== --0.520.52
OblateOblate
s SSpherical AAberration but BEST PERIPHERAL VISIONBEST PERIPHERAL VISION
7/6/20067/6/2006 JTHJTH 7777
OblateOblateFrogs,Frogs,
Q = +0.25Q = +0.25
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Jack T. Holladay, MD, MSEE, FACS 2006
Optomized PROLATE Topographic & Wavefront Guided Ablations Page 2 of 4
Halos and Glare Today's CustomizedToday's CustomizedRefractive SurgeryRefractive Surgery
Requires Excellence inRequires Excellence in
Diagnostic MeasurementsDiagnostic Measurements
Surgical PlanningSurgical Planning
Surgical ProcedureSurgical Procedure
Laser AblationLaser Ablation
Ocular, Corneal &Ocular, Corneal &LenticularLenticular WFWF
Corneal AberrationsCorneal Aberrations
TopographyTopography
TomographyTomography PentacamPentacam
Ocular AberrationsOcular Aberrations
OPD Scan (D)OPD Scan (D) NidekNidek
ShackShack--Hartman (Hartman ())
TscherningTscherning (())
LenticularLenticularAberrationsAberrations
OcularOcular -- CornealCorneal
Measure Ocular and Topographical AberrationsMeasure Ocular and Topographical Aberrations
QuantitateQuantitate LenticularLenticular and Corneal Aberrationsand Corneal Aberrations
Corneal orCorneal or LenticularLenticular Surgery Best?Surgery Best?
Early Cataract orEarly Cataract or LenticularLenticular IrregularitiesIrregularities
Crystalline Lens RemovalCrystalline Lens Removal
match aspheric IOL tomatch aspheric IOL to cornealcorneal powerpower
andand shape (spherical aberration)shape (spherical aberration)(AMO(AMO TecnisTecnis IOL, Alcon HO, B&L WF)IOL, Alcon HO, B&L WF)
Surgical PlanningSurgical Planning
If Corneal ProcedureIf Corneal Procedure TREATTREAT Ocular: Refractive Error, SA, ComaOcular: Refractive Error, SA, Coma
Corneal: All HO AberrationsCorneal: All HO Aberrations
LenticularLenticularOnly SA & Coma, other HO aberrations areOnly SA & Coma, other HO aberrations are
unstable and unpredictableunstable and unpredictable
LenticularLenticular SASAs with agewith age
OverOver--correctcorrect SA (create ocular negative SA)SA (create ocular negative SA)
Negative SA Improves Near visionNegative SA Improves Near vision
(similar to Hyperopic Rx with negative SA)(similar to Hyperopic Rx with negative SA)
Surgical PlanningSurgical Planning Top View
Nodal Point
Visual AxisVisual Axis
OpticalAxisOpticalAxis
EE
Horizontal AngleHorizontal Angle == --5.25.2`
EE
FoveolaFoveola
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Jack T. Holladay, MD, MSEE, FACS 2006
Optomized PROLATE Topographic & Wavefront Guided Ablations Page 3 of 4
Center Procedure on Visual AxisCenter Procedure on Visual Axis
Compensation ofCompensation ofRadial Energy LossRadial Energy Loss
Function ofFunction of
Distance fromDistance fromvertex normalvertex normal perpendicularperpendicular
Curvature of CorneaCurvature of Cornea steep or flat Curvaturesteep or flat Curvature
Asymmetric due to Angle KappaAsymmetric due to Angle Kappa
Different for Right and Left EyesDifferent for Right and Left Eyes
Surgical ProcedureSurgical Procedure
LOS Alignment
Visual AxisLOS
VisualVisualAxisAxisAlignmentAlignment
The only Reference Axis is the Visual AxisThe only Reference Axis is the Visual Axis
Time to move away from pupil center!Time to move away from pupil center!
Avoid INDUCING ComaAvoid INDUCING Coma
Reference: Visual AxisReference: Visual Axis
LOSLOSAlignmentAlignment
NO YES
Radial Energy CompensationRadial Energy Compensation
nasaltemporal ODtemporal OS
Differences between Intended vs. AchievedDifferences between Intended vs. AchievedAblationAblation There is noThere is noone size fits allone size fits allcompensation matrixcompensation matrix
Radial energy fall off is not symmetricalRadial energy fall off is not symmetrical
Needs to be different for OD and OSNeeds to be different for OD and OS
Needs to be different for steep and flat eyesNeeds to be different for steep and flat eyes
Results so farResults so far
Surgeon: MohamedSurgeon: MohamedAlaaAlaa ElEl DanasouryDanasoury, MD, MD
JeddaJedda, Saudi Arabia, Saudi Arabia
Diagnostics: OPD ScanDiagnostics: OPD Scan
Laser: NIDEK ECLaser: NIDEK EC--5000 LASER5000 LASER
8 patients will be presented at ASCRS 20068 patients will be presented at ASCRS 2006
PreOPPreOP DataData
OPAS (OptimizedOPAS (Optimized ProlateProlateAblation System) on RIGHT EYEAblation System) on RIGHT EYE
A.A. Best Final Refraction @Best Final Refraction @VTXVTX = 14 mm= 14 mm
OD:OD: --6.506.50 --1.25 x 180 = 20/20+2 (1.2)1.25 x 180 = 20/20+2 (1.2)
OS:OS: --6.506.50 --1.00 x 180 = 20/20+1 (1.2)1.00 x 180 = 20/20+1 (1.2)
B.B. Target Refraction:Target Refraction: planoplano
C.C. Pach'sPach's OD: 558OD: 558 OS: 559 micronsOS: 559 microns
D.D. ScotopicScotopic Pupil Size:Pupil Size: OD: 7.31mOD: 7.31m OS: 7.07 mmOS: 7.07 mm
Treatment OZ Right Eye =Treatment OZ Right Eye = 7.3 mm7.3 mm and blend to 9.0 mmand blend to 9.0 mm..
PRE-OPERATIVE OD
12 MO POST-OPERATIVE Prolate RX
Instantaneous Refractive Wavefront
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Jack T. Holladay, MD, MSEE, FACS 2006
Optomized PROLATE Topographic & Wavefront Guided Ablations Page 4 of 4
PRE-OPERATIVE OS
12 MO POST-OPERATIVE Standard RX
Instantaneous Refractive WavefrontSummarySummary
All RXsAll RXs will ultimately usewill ultimately use TopographyTopography
andand Ocular WavefrontOcular Wavefront ... The latter... The latter mustmust
in Resolutionin ResolutionAll cornealAll corneal andand some lenticularsome lenticular
aberrationsaberrations will bewill be treatedtreated andand
anticipated (SA)anticipated (SA)
RXs will beRXs will be centered on Visual Axiscentered on Visual Axis toto
avoid INDUCING aberrations (Coma,avoid INDUCING aberrations (Coma,
Tilt)Tilt)
SummarySummary
Iris registrationIris registration will become thewill become the
standard of carestandard of care
Asymmetric Radial CompesationAsymmetric Radial Compesation
Functions unique to patientFunctions unique to patient and willand will
improve, so that theimprove, so that the IntendedIntended andand
ActualActual areare equalequal..
MakeMake
Eagles!Eagles!
NotNot
Frogs!Frogs!Ribbit
&
Thank you !