Learning What is truly important in Laser Vision Correction by Dr. Jeff Machat

1. Learning what is truly
important in Laser Vision
Correction
Jeffery J. Machat MD

2. I have been around the block, close
to 50,000 laser procedures …
…had 4 lasersof
myself,achat.
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7 ilasers
systems
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Dr.
Jeffery
J.
M used 17 models, use
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3. I have been using Wavefront for 6 YEARS !
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4. Laser Vision Correction Market
in USA
LASIK Market Highly Fragmented
n 63% Independent Surgeons
n 26% Corporate Centers
n 11% Hospitals/Universities
Independent
Surgeons
Corporate
Hospitals &
Univ
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5. Laser Vision Correction Market
There was a market decline post 9/11 but it has rebounded since 2004
Ø 55 million Potential Candidates – 7% Penetration
1,800,000
1,600,000
1,400,000
1,200,000 1.63M 1.69M
1.57M (est.) (est.)
1.37M 1.31M 1.51M (est.)
1,000,000 (est.)
1.25M 1.30M 1.41M
800,000 1.12M (est.)
.9M
600,000
400,000
200,000 .4M
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Procedures (U.S.)
* Market Scope 2004 comprehensive report on the refractive market
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6. 10 million people have had LVC
over the last 20 years !
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7. Research says...
The number one issue that keeps
consumers from getting laser
vision correction...
FEAR
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8. 2004 LVC Market Assessment
Cost 78%
Unfavorable 57%
Outcomes
Side Effects 54%
77% of concerns accounted for
combined fear component
Lack of
53%
Information
Fear of 7000 surveyed (age 25-54)
49% >$30K household income
Surgery
that use vision correction
to explore why they haven t
Timing 35% had the LASIK procedure
Harris Interactive®
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9. That is why not only Technology
Innovations, but Every Aspect of
the Patient Journey is CRITICAL !
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10. Windsor 1993
n You are so lucky …
n When you sit up…
n Perfect, Perfect, Perfect…
n Smile at the Slit Lamp
n Ask and they shall come..
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11. Who Candidates are Listening To…
Eye doctor 36%
People who've had
27%
surgery
Family and friends 11%
Specialist/refractive
8%
surgeon
Internet 7% Among respondents who
have already scheduled, will
definitely have, will probably
Newspapers/magazines 5% have or may have surgery
Other 7%
VisionWatch US Study 2004
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12. Removing FEAR...
Wavefront Error Physician: Operator: Ann
Mary
*************, *************
Patient:
0-343-91-63
Patient ID:
Notes:
OD 14-Dec-2001 20:26(mm): Hi Order: %
Eff. Blur (D):
4.25
Pupil 6.00 8.7 OS
-4.49 DS +0.48 DC x 136° @ 12.5 mm (4.0 Pupil)-4.14 DS +0.80 DC x 51° @ 12.5 mm (4.0 Pupil)
14-Dec-2001 20:27 (mm): Hi Order: %
Eff. Blur (D):
3.66
Pupil 6.00 6.2
All Grid Spacing: 1 mm.
Acuity
microns Map 90
Rms Err.(µ):
5.52 Acuity Map
microns 90
Rms Err.(µ):
4.76
28.00 120 60 28.00 120 60
24.00 24.00
20.00 20.00
16.00 150 30 16.00 150 30
12.00 12.00
8.00 8.00
4.00 4.00
0.00 180 0 0.00 180 0
-4.00 -4.00
-8.00 -8.00
-12.00 -12.00
-16.00 -16.00
-20.00 -20.00
-24.00 -24.00
-28.00 -28.00
Bille Aberration Map
microns 90
Rms Err.(µ):
0.48 Bille Aberration Map
microns 90
Rms Err.(µ):
0.29
1.75 120 60 1.75 120 60
1.50 1.50
1.25 1.25
1.00 150 30 1.00 150 30
0.75 0.75
0.50 0.50
0.25 0.25
0.00 180 0 0.00 180 0
-0.25 -0.25
-0.50 -0.50
-0.75 -0.75
-1.00 -1.00
-1.25 -1.25
-1.50 -1.50
-1.75 -1.75
© Copyright 2001, VISX Inc.
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13. Always think what would I
want if it were yourself or
someone you cared about
n Alwaystalk to a patient in
personal terms. If it were
my eyes,
Ø I would have …
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14. Vision Correction
n Vision is clearly the most precious
sense
n Laser Vision Correction is now
commonplace worldwide and
accepted as the third option:
1. Specs,
2. Contacts,
3. Laser Vision Correction.
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15. Vision Correction
n But Laser Vision Correction is an
emotional issue for many
n That is why it means so much to
patients – it is Life Changing !
n When was the last time you received a
card, flowers, gift, chocolates after
selling someone specs or contacts ?
n Was there a first time ?
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16. For Every Customer
n Spectacles
n Contact Lenses
n Laser Vision Correction
n Eye doctors poor at predicting who is
interested
n Laser Vision correction is something
wonderful we offer
n It is safe and effective !
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17. Understanding Technologies
Visx CustomVue: WaveLight “Prolate”:
Wavefront Guided Wavefront Optimized
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18. Wavefront Fundamentals
1st order: Tilt ( testing artifact often / prism)
2nd order: Defocus & Astigmatism 75%
3rd & 5th order: Coma (localized aberration)
4th & 6th order: Spherical Aberration
Conventional Lasik treats 2nd order
aberrations but induces Coma and
especially Spherical aberrations
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19. Effects of Spherical Aberrations
Increasing Aberrations
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20. WaveLight Allegretto Wavefront
Optimized
Aspheric Ablation Profile
200
150
100
50
]
Z Axis [µm
0
-50 10
-100 8
-150 6
m]
is [m
-200 4
2
Y Ax
4
X Axis 6 2
[mm] 8
10
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21. WaveLight Allegretto Wave
Classic Software Program
Ø Aspheric or Prolate program for refractive
error corrections up to – 6.00D
Ø Wavefrontoptimized using an
averaged amount of spherical
200
aberration
150
100
50
0
Z Axis
-50
-100 10
-150 8
-200 6
2
is
Ax
4 4
Y
XA 6
xis
8 2
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22. WaveLight Wavefront Optimized
Profile
Ø No correction of
Coma or Trefoil
Ø No adjustment for
degree of Spherical
Aberration
Ø No compensation for
Negative Spherical
Aberration (1:10)
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23. Patient JM: WFO Tx
Negative spherical aberration !
Ø Postoperatively
negative spherical
aberration
Ø OD: -0.33
Ø OS: -0.29
Ø Very Unhappy !
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24. Patient KB: WFO Tx
Untreated Coma
Pre-op:
OD: -4.75/-1.25 x 165 20/20-1
OS: -4.00/-0.25 x 045 20/20
Post-op:
OD -0.75 20/20-2
OS: -0.25/-0.75 x 009 20/25+
Minor loss of BCVA and complaints
of poor visual quality
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25. All decreased with CustomVue
Retreatment OS
Ø Coma increased from .19 to .40
and decreased to .23 after
CustomVue
Ø Trefoil increased from .04 to .34
and decreased to .19 after
CustomVue
Ø SA increased from .07 to .31 and
decreased to .20 after CustomVue
Ø BCVA back to a sharp 20/20
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26. Conclusions
Several distinct advantages of Wavefront
Guided ablations with CustomVue:
Company Goal is > 70% CustomVue
1. Correction of Coma and Trefoil
2. Correction of the correct and appropriate
amount of Spherical Aberration
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27. Conclusions
3. Correction of spherical aberration for
higher degrees of myopia
4. Ability to retreat induced HOA
5. Reduced enhancement rates
6. Improved Night Vision
7. Better safety profile for preserving bcva
8. Better potential for gaining bcva
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28. Conclusions
• Wavefront is a safety feature
• Wavefront can give vision that
spectacles cannot
• LASIK requires a team approach
• Each patient needs and demands
warmth, compassion and high clinical
standards
• P.S. Don t confuse a good visual outcome
with a positive patient experience
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29. It takes more than a good
visual outcome to have a
truly Happy Patient
It takes a
Positive Patient Experience
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30. The information provided in this PowerPoint presentation is
for your personal informational purposes only. It is not
medical advice, medical diagnosis or treatment, or
recommendation for medical care or treatment. All medical
questions or concerns about a medical condition, care,
diagnosis or treatment should be presented to a medical
physician, health care provider, or health care professional.
You acknowledge that your use of this information is at your
sole risk, and that you assume and accept full responsibility
for all risk associated with any reliance upon the information
presented.
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