evolution of refractive surgery...

26
Evolution of Refractive Surgery 2003 Daniel S. Durrie, MD Overland Park, Kansas USA

Upload: others

Post on 04-Aug-2020

4 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Evolution of Refractive Surgery 2003

Daniel S. Durrie, MDOverland Park, KansasUSA

Page 2: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Surgical Options

2. change the lens2. change the lens

3. add a lens

1. corneal1. corneal curvaturecurvature

Page 3: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Evolution of Refractive Surgery

Page 4: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Evolution of Refractive Surgery

Page 5: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Evolution of Refractive Surgery

Surface Ablation Lamellar Ablation

Page 6: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 7: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 8: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Evolution of Refractive Surgery: - Technique 1991

LamellarSurface

PRKBroad beam laserMechanical debridment5.0 mm OZNo transition zonesUnilateral surgery

LASIKHinged flapStromal ablationNo sutures neededNasal hingeBarraquer Keratome

Page 9: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 10: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 11: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 12: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 13: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 14: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 15: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 16: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 17: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 18: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 19: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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

Page 20: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Lamellar

LASIK Technique 2003

Page 21: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Revolutionary Ultra FastMicron Level PrecisionSafety Platform

Software Controlled Laser

Optimal PrecisionEase of UseCustomizable

Breakthrough Safety Technology Platform

Single Use DisposableSterileSimple

Patient InterfaceINTRALASE FS Laser

Page 22: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Evolution to IntraLASIK

Page 23: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Evolution to IntraLASIK

Page 24: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

IntraLASIK Technique 2003

Lamellar

Page 25: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

Surface AblationTechnique 2003

Surface

Page 26: Evolution of Refractive Surgery 2003voi.opt.uh.edu/VOI/WavefrontCongress/2003/presentations...Evolution of Refractive Surgery: - Technique 2001 Surface Lamellar LASEK Broad beam, scanning

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