myopia, astigmatism, hyperopia… personalized treatment bernard mathys, md secretary-general of the...
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MYOPIA, ASTIGMATISM, HYPEROPIA…MYOPIA, ASTIGMATISM, HYPEROPIA…
PERSONALIZED PERSONALIZED TREATMENTTREATMENT
Bernard Mathys, MDBernard Mathys, MD
Secretary-general of the Belgian Society of Cataract & Refractive Surgery
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Refractive surgery in 2004Refractive surgery in 2004
• How can we do this?
• Better instruments, new lasers, well-trained surgeons, improvement of post-op treatments… and new algorithms?
Today we use mostly PRK (surface treatment) and Today we use mostly PRK (surface treatment) and Lasik to perform surgery and our desire is to Lasik to perform surgery and our desire is to improve our resultsimprove our results
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Algorithm factorAlgorithm factor
Different steps are needed:
• Improve the treatment itself: -3 of X is not Improve the treatment itself: -3 of X is not necessarily -3 of Ynecessarily -3 of Y
• Personalize treatment =>Improve quality of Personalize treatment =>Improve quality of visionvision
• Possibility to help people with thin corneas, Possibility to help people with thin corneas, large pupils, high ametropialarge pupils, high ametropia
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Carefull preop examinationCarefull preop examination
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Technologically advanced Laser Technologically advanced Laser
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Zyoptix: the name of the systemZyoptix: the name of the system
The laser custom treatmentThe laser custom treatment
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LasikLasik
The interventionThe intervention - - making the flapmaking the flap
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LasikLasik
ClosingClosing the flap the flap
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HOW DOES HOW DOES «PERSONALIZED «PERSONALIZED
TREATMENT»TREATMENT»WORK ?WORK ?
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The ideaThe idea
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The ideaThe idea
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Wavefront analyseWavefront analyse
Reconstruction of wavefront by CCD-imageReconstruction of wavefront by CCD-image> Zernike coefficient> Zernike coefficient
CCD-Image
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Hartmann-Shack WavefrontHartmann-Shack Wavefront MeasurementMeasurement
Perfect Eye
Aberrated Eye
Lenslet Array
CCD Array
Wave Aberration
Spot Array
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Wave Aberration of a SurfaceWave Aberration of a Surface
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The shape of the wavefront is depicted in Zernike The shape of the wavefront is depicted in Zernike coefficient, each shape describes a deformationcoefficient, each shape describes a deformation
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trefoil coma coma trefoil
quadrafoilsecondary
spherical
2nd
3rd
4th
5th
radialorder
secondaryquadrafoil
pentafoil secondary secondarysecondarypentafoilsecondary
defocusastigmatism astigmatism
astigmatism astigmatism
trefoiltrefoil comacoma
Z20
Z 2-2 Z2
2
Z 3-1 Z3
1Z 3-3 Z3
3
Z40
Z42Z 4
-2 Z44
Z 4-4
Z51
Z 5-1 Z5
3Z 5-3 Z5
5Z 5-5
ConventionalRefraction
Higher OrderAberrations
Zernike ModesZernike Modes
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Point Spread Function (PSF)Point Spread Function (PSF)
Point Spread Function: is the representation of an Point Spread Function: is the representation of an optical system of a punctual and distant light optical system of a punctual and distant light source ( star in the sky)source ( star in the sky)
Airy Disc
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Point Spread Function vs. Pupil SizePoint Spread Function vs. Pupil SizePerfect EyePerfect Eye
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Point Spread Function vs. Pupil SizePoint Spread Function vs. Pupil SizeTypical EyeTypical Eye
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Each eye has different patternsEach eye has different patternsof High Order Aberrations.of High Order Aberrations.
Wave Aberration
PointspreadFunction
Retinal Image
Perfect eye(diffraction limited) MRB GYY MAK
5.7 mm pupil
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Encouraging resultsEncouraging results
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Encouraging resultsPreop –6.5 D Encouraging resultsPreop –6.5 D ZyoptixZyoptix
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Postop Plano 6M VA 13/10Postop Plano 6M VA 13/10
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Zyoptix System – Clinical OutcomesZyoptix System – Clinical Outcomes
Quality of Vision after surgery % (n)
No improvement 0,3% (1)
Slight improvement 1,2% (4)
Moderate improvement 1,8% (6)
Marked improvement 12,1% (41)
Extreme improvement 84,7% (288)
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Night visionNight vision
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HaloesHaloes
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Custom treatmentCustom treatment
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NEW SCALE ?NEW SCALE ?
• Contrast & low-contrast sensitivity
•Different lightning conditions
•Color vision
•Glare & haloes
• VA is a less sensitive measure of the correction VA is a less sensitive measure of the correction of high-order aberrationsof high-order aberrations
• Increase the quality of the retinal imageIncrease the quality of the retinal image
• We need to assess quality of vision in true-life We need to assess quality of vision in true-life conditions:conditions:
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Custom treatment: the future ?Custom treatment: the future ?
• AberrometryAberrometry
•TopographyTopography
•Linked to the laser, to achieve personal Linked to the laser, to achieve personal treatmenttreatment
•Must improve our actual results in all casesMust improve our actual results in all cases
•Must be safeMust be safe
•Not a higher complication rateNot a higher complication rate
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20/20/20/2020/20/20/20
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THANK YOU FOR THANK YOU FOR YOUR ATTENTIONYOUR ATTENTION
Bernard Mathys, MDBernard Mathys, MDSecretary-general of the Belgian Society of Cataract & Refractive Surgery