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A Question for Dr. Doan

Discussion in 'Ophthalmology: Eye Physicians & Surgeons' started by TIGER STYLE, 05.10.04.

  1. TIGER STYLE

    TIGER STYLE Member

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    Hi Dr. Doan,
    Is there a significant perceivable outcome for the patient between regular LASIK and custom cornea correction procedure (WAVEFRONT)? Is the benefit (if any) of Wavefront worth the difference in cost? Wavefront procedure is doubled the price of regular LASIK. Also, how much of the procedures are operator dependent? Do both procedures allow for revision?
    Thank You So Much,
    Tiger Style, MS4
  2. Yogi Bear

    Yogi Bear 2K Member

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    http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15022010
    [Results of wavefront-guided LASIK]

    [Article in German]

    Hammer T, Duncker GI, Giessler S.

    Universitatsklinik und Poliklinik fur Augenheilkunde, Martin-Luther-Universitat Halle-Wittenberg, Halle.

    BACKGROUND. Wavefront-guided LASIK procedures provide patients with customized corneal treatments. The computer ablation profiles correct both spherical and/or cylindrical errors of refraction and aberrations up to the fifth order. METHODS. We performed wavefront-guided LASIK treatments on 62 patients using the Keracor 217 Z. The spherical equivalent was -6.11 +/-2.29 D on the average. Data collected for 3 months were evaluated to determine the predictability, efficacy, stability, and safety of the refractive procedure. RESULTS. We found good predictability of the refractive result after correcting -1 to -6 D of myopia. Beyond -7 D there were over- and undercorrections of +/-2 D in 10% of the procedures. A UCVA of 0.8 or better was observed in 53% of the patients 3 months postoperatively, and 75% of the patients reached a BCVA of 0.8 or better. After 3 months 6% lost 2 lines, 22% lost 1 line, 22% of the patients gained 1-2 lines, and BCVA remained unchanged in 55%. The fluctuation of the refraction was about -0.23 D during the first 3 postoperative months. CONCLUSIONS. The low and middle range of myopia can be corrected very accurately using the wavefront technology. Higher degrees of myopia face both under- and overcorrections. Postoperative refractions become stable very quickly. However, the visual acuity changes even 6 months postoperatively. From our point of view, wavefront correction by LASIK should be more reliable in terms of centration, accuracy, and standardization to get better results.


    ===================

    http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14989952

    Zhonghua Yan Ke Za Zhi. 2004 Jan;40(1):9-12. Related Articles, Links

    [Wavefront-guided laser in situ keratomileusis for myopia]

    [Article in Chinese]

    Wang Z, Yang B, Zhang C, Huang GF, Chen JQ.

    Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China. [email protected]

    OBJECTIVE: To compare the clinical results of wavefront-guided versus conventional LASIK surgery in the treatment of myopia. METHODS: One hundred and thirteen eyes underwent wavefront-guided LASIK (Zyoptix) and 335 eyes were received conventional LASIK surgery (Planoscan). Besides visual acuity and refractions, the higher order aberrations and contrast sensitivity are also compared after surgery. RESULTS: The postoperative refractions were not significantly different between the Zyoptix group and Planoscan group. 33.6% of Zyoptix patient and 17.0% of Planoscan patient respectively, had postoperative uncorrected visual acuity than their preoperative best corrected visual acuity. At 6 mm pupil size, the higher order RMS was increased by 100% in the Planoscan group, while in the Zyoptix group, it was increased only by 35% postoperatively. Six months after operation, the contrast sensitivity of Planoscan patients returned to their preoperative baseline. However, the Zyoptix patients had slightly better contrast sensitivity than their preoperative level. CONCLUSION: Patients undergoing Zyoptix treatment have better quality of vision after surgery than Planoscan patients.

    =======

    http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12699175

    J Refract Surg. 2003 Mar-Apr;19(2 Suppl):S217-20. Related Articles, Links

    Comparison of conventional versus wavefront-guided laser in situ keratomileusis in the same patient.

    Phusitphoykai N, Tungsiripat T, Siriboonkoom J, Vongthongsri A.

    Laser Vision LASIK Center, Bangkok, Thailand.

    PURPOSE: To verify whether there is any difference in visual outcome, including higher order aberrations, after performing laser in situ keratomileusis (LASIK) with conventional ablation and wavefront-guided ablation in myopic eyes of the same patient. METHODS: This was a prospective randomized study of 20 myopic eyes (10 patients) who had LASIK using the Nidek NAVEX excimer laser system. Wavefront-guided customized ablation was used in the first eye of the patient (study group) and the other eye of the same patient was operated with conventional ablation (control group). Mean refractive error was similar between left and right eyes of the same patient. Preoperative examination included higher order aberration by Nidek OPD-Scan. Uncorrected and best spectacle-corrected visual acuity and higher order aberrations were recorded postoperatively. RESULTS: Preoperative and postoperative best spectacle-corrected visual acuity was better than 20/40 (100%) after LASIK in both the conventional ablation and wavefront-guided customized ablation groups. Postoperative refraction was within +/- 0.50 D of emmetropia: 90% in the conventional group and 100% in the wavefront-guided group. No statistically significant difference in postoperative higher order aberrations was found between groups. CONCLUSION: Postoperative visual outcome with both conventional LASIK and wavefront-guided customized ablation was not significantly different. Higher order aberrations did not significantly increase postoperatively in either group.

    Publication Types:

    * Clinical Trial
    * Randomized Controlled Trial

    =====
  3. cmz

    cmz Pathology Wannabe

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    More importantly (and I don't mean to hijack this thread), why do most ophthalmology journals have such a low impact factor (other than IOVS)? Are they just too clinical?
  4. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur Moderator Emeritus Lifetime Donor

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    I think Wavefront has promise. With better understanding and tools to estimate higher order aberrations, Wavefront will be the way to go if we can "correct" for these irregularities.

    In regards to journals, if you want basic research than you go to IOVS. If you want clinical research, then you go to the other journals.

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