Eyeworld

SUMMER 2026 | EYEWORLD | 53 R References 1. FDA Summary of Safety and Effectiveness Data. https://www. accessdata.fda.gov/cdrh_docs/ pdf2/P020050S043B.pdf. Accessed April 21, 2026. 2. Sitto MM, et al. Comparison of U.S. FDA premarket approval studies between ray tracing- guided LASIK with InnovEyes Sightmap versus topography- guided LASIK using custom ablation treatment (T-CAT). Ophthalmol Ther. 2025;14:2983– 3005. 3. Waring GO, et al. Safety and effectiveness of laser in situ ker- atomileusis using the Teneo 317 Model 2 for correcting myopia and myopic astigmatism: results of the U.S. FDA clinical trial. J Re- fract Surg. 2024;40:e544–e553. from Novartis in 2019, it brought more work into the device, eventually receiving FDA ap- proval in March 2025. The technology is now a single device (Sightmap) that combines all three necessary measurements to create each patient's digital eye model, and the treatment that used to take 6 hours to calculate by the sys- tem now takes 30 seconds. The algorithm also accounts for biomechanical effect of different treatment levels and epithelial remodeling that occurs after treatment, Dr. Cummings said. "[In the treatment plan,] if all the rays are converging on the macula, on the fovea, then you've got the perfect ablation profile. If they're not, those rays that are aberrant and not focusing on the macula are traced back through the eye … and adjustments are made on the appropriate point of the cornea to alter that point so that the ray focuses in the right place on the macula. That iterative process is where the magic happens," Dr. Cummings said. The treatment is perfected on the model and once finalized, applied to the patient's eye. The number one thing about this technol- ogy, Dr. Cummings said, is that any surgeon using it now gets the same outcomes as others using it. "It's no longer up to someone who's got a special trick for topo-guided or a special technique," he said. "If you have this technolo- gy, surgeons get the same outcome." Dr. Cummings was also surprised to see the results of this technology in treating lower refractive errors. "The results were spectacular. … No one has seen results like this before." Clinical outcomes with ray tracing-guided treatment According to the 3-month postoperative results from the pivotal study with the WaveLight Plus platform, 100% of eyes achieved UCDVA of 20/40 or better and 92% 20/20 or bet- ter. 1 MRSE within ±0.5 D of target was 92% and 98.4% within ±1 D of target. Astigmatic predictability was 88.4% within ±0.5 D cylin- der and 96.1% within ±1 D cylinder. After 12 months postop, 94.4% of eyes achieved 20/20 or better. 1 Other studies on the same platform, including the European post-market study, achieved the same outcomes. With these technologies, it examines how light travels through the eye and creates a treat- ment plan based on what it has calculated and iteratively improved for the patient. Prior to ray tracing-guided LASIK, Dr. Lobanoff said wave- front data was applied to a generic eye model that was the same for every person. When ray tracing LASIK was being tested in the late 2000s, Dr. Cummings said the technol- ogy took 6 hours to calculate the treatment, which was then sent to the surgeon to down- load onto a USB drive that was plugged into the laser. It was originally thought that ray tracing LASIK would be most beneficial for eyes that were furthest away from the Gullstrand model —those that were higher myopes and/or with lots of astigmatism. He noted that any LASIK treatment not performed with WaveLight Plus uses the Gullstrand model, which is based on average population-based axial length, corneal curvature, and other refractive indices. Dr. Cummings said the ray tracing technol- ogy showed promise for treatment personaliza- tion, but it was initially stalled after Novartis acquired Alcon in 2011. When Alcon spun off continued on page 54 Using the Teneo excimer laser at OVO LASIK + LENS Source: Mark Lobanoff, MD

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