Eyeworld

MARCH 2020 | EYEWORLD | 51 R Contact Alio: jlalio@vissum.com Ang: Marcus.Ang@Singhealth.com.sg Durrie: ddurrie@durrievision.com Lin: tclin@shaw.ca Studies like this increase the refractive choices available to carefully selected patients, Dr. Ang said. "I think what's helping us is the increased availability of refractive techniques, which increases the surgical options in suitable patients," Dr. Ang said. Treating highly aberrated corneas Also gaining ground is refractive treatment for abnormal corneas, according to Jorge Alio, MD, PhD. In a study, Dr. Alio and other investiga- tors identified factors linked with a successful, customized, wavefront-guided treatment in a population with significantly aberrated cor- neas. 4 Calculations were done patient by patient. Treatment dealt with total eye aberrations, not just corneal ones, as studied preoperatively with the new technology of pyramidal aberrometry developed by CSO Technology, Dr. Alio said. The study was performed with the customized treatment platform of the Schwind Amaris ex- cimer laser (Schwind eye-tech-solutions) guided by total eye pyramidal aberrometry. Investigators found 72% of eyes achieved uncorrected visual acuity of 0.2 logMAR or better postop. There was a loss of one line or more corrected distance visual acuity in 11% of eyes, Dr. Alio said. Outcomes for patients who had undergone prior refractive treatment varied depending on the type. "Patients who have been the subject of previous hyperopic treatments, decentered treatments, for instance, have a lot of coma and many times have smaller pupils," Dr. Alio said, adding that these patients had the poorest outcomes. Meanwhile, those with a previous myopic surgery and a moderate amount of spherical aberration did well. Dr. Alio hopes practitioners come away from the study with the recognition that there is now a customized treatment for aberrated corneas. However, it is not for everyone. "Some cases are not going to be successfully treated," he said, adding that other tools need to be de- veloped. The study offers practical information about what can be expected today when dealing with a highly irregular cornea, he concluded. References 1. Lin DTC, et al. Immediate and short term visual recovery after SmartSurf ACE photore- fractive keratectomy. J Optom. 2019;12:240–247. 2. Durrie D, et al. More eyes with 20/10 distance visual acuity at 12 months versus 3 months in a topography-guided excimer laser trial: Possible contributing factors. J Cataract Refract Surg. 2019;45:595–600. 3. Ang M, et al. Randomized clin- ical trial comparing femtosecond LASIK and small-incision lenticule extraction. Ophthalmology. 2019. Epub ahead of print. 4. Hanna R, et al. Factors predict- ing successful customized exci- mer laser treatment in irregular corneas. J Cataract Refract Surg. 2020;46:241–249. Relevant disclosures Alio: None Ang: Carl Zeiss Meditec Durrie: Alcon Lin: Schwind eye-tech-solutions Treatment profile With the customized wavefront-guided approach, the treatment addresses total eye aberrations. Source: Jorge Alio, MD, PhD Hyperopic ablation profile with corneal wavefront Myopic ablation profile with ocular wavefront

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