Amo presbyopia training course

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Training regarding LASIK correction using physician adjustment to achieve monovision to help with reading vision in presbyopic patients

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Amo presbyopia training course

  1. 1. Physician CertificationPhysician Certification forfor CustomVueCustomVue™™ Presbyopic AblationsPresbyopic Ablations
  2. 2. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations  Presbyopic corrections are enabledPresbyopic corrections are enabled only in combination withonly in combination with CustomVueCustomVue hyperopichyperopic corrections with or withoutcorrections with or without astigmatism and Iris Registrationastigmatism and Iris Registration
  3. 3. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations  Recommended TreatmentRecommended Treatment Parameters:Parameters: – Maximum WaveScanMaximum WaveScan™™ spheresphere ++4.504.50DD – Maximum WaveScan cylinderMaximum WaveScan cylinder ++1.501.50DD – Maximum SEMaximum SE ++44..5050DD
  4. 4. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations  PPresbyopic correction creates a multifocalresbyopic correction creates a multifocal ablation thatablation that provides for a pupil-basedprovides for a pupil-based central corneal steepening of approximatelycentral corneal steepening of approximately 1.0 D1.0 D  This central cornealThis central corneal steepening has asteepening has a variable effect on the patient’svariable effect on the patient’s readingreading visionvision
  5. 5. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations  Patented VISX™ multifocal ablation profile  VSS™ and VRR™ ablation technology used to create subtle ablation shape change to subject’s wavefront map  Central zone steepened to provide near vision  Peripheral zone targeted for distance vision
  6. 6. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Patented VISX™ multifocal ablation profile The combination of the pupil-size dependent central zone, the peripheral zone, and the LASIK flap produces an aspheric curve that expands the depth of focus
  7. 7. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Pre-operativePre-operative EvaluationEvaluation
  8. 8. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Pre-operative ExaminationPre-operative Examination  WaveScanWaveScan™™ SystemSystem – WaveScan exams with 6.0 mm pupils areWaveScan exams with 6.0 mm pupils are preferred for treatmentspreferred for treatments  The minimum pupil size of the wavefront-The minimum pupil size of the wavefront- measurement must be > 5.0 mm to calculate ameasurement must be > 5.0 mm to calculate a CustomVue treatmentCustomVue treatment  Measurements with a pupil size < 5.0 mm will beMeasurements with a pupil size < 5.0 mm will be unavailable for selectionunavailable for selection  Wavefront diameter captures of greater than 7.0Wavefront diameter captures of greater than 7.0 mm will not allow presbyopic shape creation ormm will not allow presbyopic shape creation or treatmenttreatment
  9. 9. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations WaveScanWaveScan™™ AcquisitionAcquisition  Users are warned to carefully monitor the wavefront diameter when using the presbyopia software  WaveScan measurements for presbyopia should be done with a dark-adapted physiologic pupil  Pharmacologic pupil manipulation is specifically NOT recommended as the treatment is calculated as a percentage of physiologic pupil size
  10. 10. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Pre-operative ExaminationPre-operative Examination  Contact Lens Use:Contact Lens Use: – Soft contact lenses - discontinue lens wear atSoft contact lenses - discontinue lens wear at leastleast twotwo weeks prior to examinationweeks prior to examination andand treatmenttreatment – Hard (PMMA) or RGP lenses - discontinue lensHard (PMMA) or RGP lenses - discontinue lens wear at leastwear at least threethree weeks prior to examinationweeks prior to examination andand treatment with stable keratometry andtreatment with stable keratometry and refractionrefraction  3 central keratometry readings and MR taken at 1 week3 central keratometry readings and MR taken at 1 week intervals. The last two readings must not differ by > 0.5Dintervals. The last two readings must not differ by > 0.5D – The WaveScanThe WaveScan™™ measurements should be stablemeasurements should be stable prior to the treatmentprior to the treatment
  11. 11. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Pre-operative ExaminationPre-operative Examination  Visual AcuityVisual Acuity – UCVA, BSCVAUCVA, BSCVA  RefractionRefraction – Manifest Refraction –Manifest Refraction –  Hyperopia – Pushed plus techniqueHyperopia – Pushed plus technique  Astigmatism - Jackson Cross Cylinder -Astigmatism - Jackson Cross Cylinder - maximize magnitude of cylindermaximize magnitude of cylinder
  12. 12. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Pre-operative ExaminationPre-operative Examination  When comparing Manifest Refraction toWhen comparing Manifest Refraction to WaveScanWaveScan™™ Refraction use the 4 mmRefraction use the 4 mm diameter WaveScan datadiameter WaveScan data – This most closely approximates the MRThis most closely approximates the MR
  13. 13. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Pre-operative ExaminationPre-operative Examination Refraction TechniquesRefraction Techniques  Cycloplegic Refraction (1% cyclopentolate)Cycloplegic Refraction (1% cyclopentolate)  True cycloplegia eliminates accommodation andTrue cycloplegia eliminates accommodation and allows appropriate refractive evaluation of:allows appropriate refractive evaluation of: – Latent hyperopiaLatent hyperopia  Critical in all HyperopesCritical in all Hyperopes
  14. 14. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Pre-operative ExaminationPre-operative Examination  The anticipated post-operative keratometryThe anticipated post-operative keratometry value in any meridian must bevalue in any meridian must be << 50 D50 D  To calculate the anticipated postoperative K’s add the Mean Pre-Op Keratometry to the Pre-Op MRSE – Use Manual or Auto K’s – Do not use “Sim K’s”
  15. 15. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Pre-operative ExaminationPre-operative Examination  KeratometryKeratometry – K1 is the flat KK1 is the flat K – K2 is the steep KK2 is the steep K – K2 Axis is the axis of the steep KK2 Axis is the axis of the steep K  Pupillary ExamPupillary Exam – Bright and dim illumination measurementBright and dim illumination measurement  Corneal Topography -Corneal Topography - necessarynecessary in allin all patientspatients – R/O Keratoconus or any other abnormalityR/O Keratoconus or any other abnormality – R/O CL related abnormalitiesR/O CL related abnormalities – Verify post-operative resultsVerify post-operative results
  16. 16. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Pre-operative ExaminationPre-operative Examination  Slit Lamp ExamSlit Lamp Exam  TonometryTonometry  PachymetryPachymetry – Ultrasonic pachymetry required for LASIKUltrasonic pachymetry required for LASIK  Dilated Media and Fundus ExamDilated Media and Fundus Exam
  17. 17. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Surgical PlanningSurgical Planning Surgical TechniqueSurgical Technique
  18. 18. CustomVue™ PresbyopicCustomVue™ Presbyopic AblationsAblations Treatment Design ScreenTreatment Design Screen You must select LASIK or Surface PRK in theYou must select LASIK or Surface PRK in the TREATMENT TYPE fieldTREATMENT TYPE field The Presbyopia ablation is differentThe Presbyopia ablation is different in LASIK vs. Surface PRKin LASIK vs. Surface PRK
  19. 19. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Treatment Design ScreenTreatment Design Screen Check theCheck the ENABLEENABLE box to enablebox to enable a presbyopic correctiona presbyopic correction
  20. 20. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Environmental ConditionsEnvironmental Conditions  CustomVueCustomVue PresbyopicPresbyopic procedures areprocedures are done with Variable Spot Scanningdone with Variable Spot Scanning (VSS(VSS™™ ) and Variable Repetit) and Variable Repetitiion Rateon Rate (VRR(VRR™™ )) – Even though the repetition rate varies fromEven though the repetition rate varies from 6 to 20 Hz these treatments tend to be6 to 20 Hz these treatments tend to be longer in duration than myopic treatmentslonger in duration than myopic treatments  It is important to pay careful attention toIt is important to pay careful attention to environmental conditionsenvironmental conditions
  21. 21. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Environmental ConditionsEnvironmental Conditions  Control of environmental conditions during CustomVueControl of environmental conditions during CustomVue treatments is important. In previous U.S. FDA Multi-treatments is important. In previous U.S. FDA Multi- Center Clinical Trials, the room conditions were:Center Clinical Trials, the room conditions were: – Temperature ranged from 68ºF to 72ºFTemperature ranged from 68ºF to 72ºF (20(20ººC to 22.2C to 22.2ººC)C) – Relative humidity ranged from 40% to 45%Relative humidity ranged from 40% to 45% – Treatments performed atTreatments performed at >>75º were associated with less75º were associated with less accurate outcomesaccurate outcomes  Stability of temperature and humidity is importantStability of temperature and humidity is important
  22. 22. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Iris Registration  Iris pattern is uniqueIris pattern is unique to each eyeto each eye  IR aligns theIR aligns the preoperativepreoperative WaveScanWaveScan™™ SystemSystem and intra-operativeand intra-operative STAR S4 IRSTAR S4 IR™™ System iris imagesSystem iris images
  23. 23. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Iris Registration Diagnostic measurement (mesopic)Diagnostic measurement (mesopic) LVC Treatment (photopic)LVC Treatment (photopic) As the pupil changes size, its centroid may not remainAs the pupil changes size, its centroid may not remain stationary, relative to the outer iris boundarystationary, relative to the outer iris boundary Outer Iris BoundaryOuter Iris BoundaryFor International Use Only
  24. 24. CustomVueCustomVue™™ PresbyopicPresbyopic AblationsAblations Iris Registration (IR)  IR is a critically important componentIR is a critically important component of Presbyopia treatmentsof Presbyopia treatments – Proper registration of wavefront-guidedProper registration of wavefront-guided ablationablation – Proper placement of the pupil-sizeProper placement of the pupil-size dependent central zone relative to thedependent central zone relative to the pupil centroidpupil centroid
  25. 25. CustomVueCustomVue™™ HyperopiaHyperopia Surgical TechniqueSurgical Technique  Do not use a Chayet drain or similar deviceDo not use a Chayet drain or similar device  Create and lift flapCreate and lift flap  Align limbal marks with reticle hash marksAlign limbal marks with reticle hash marks  Dry exposed stromal bed if there is fluidDry exposed stromal bed if there is fluid accumulationaccumulation  Perform ablationPerform ablation  Interrupt ablation only if there is fluidInterrupt ablation only if there is fluid accumulationaccumulation  Replace flapReplace flap
  26. 26. VISXVISX™™ HyperopicHyperopic Presbyopia Completion ofPresbyopia Completion of CertificationCertification Acknowledgement of Understanding:Acknowledgement of Understanding: By checking the box below, IBy checking the box below, I acknowledge I have read andacknowledge I have read and understood this materialunderstood this material

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