This document discusses various options for treating presbyopia, including corneal inlays. It provides details on three types of corneal inlays - Raindrop, Flexivue Microlens, and Kamra. Raindrop uses a hydrogel implant to change corneal curvature and improve near vision. Flexivue Microlens is a removable hydrogel lens that creates two focal points for bifocal vision. Kamra utilizes a small aperture to increase depth of focus by blocking peripheral light rays. Both Flexivue and Kamra are approved in Europe but still in clinical trials in the US, while Raindrop is also in US trials and approved in Europe.
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
Real pediatric refraction and spectacle power prescription in pediatrics.Bipin Koirala
The document discusses pediatric refraction and spectacle prescription. It covers several topics including emmetropization, refractive changes with age, types of pediatric refraction such as near retinoscopy and cycloplegic refraction, and considerations for spectacle prescription in children. Cycloplegic refraction is recommended for all non-verbal children to fully paralyze the ciliary muscles and determine the total refractive error, as the eye's refraction can change dramatically during development. The challenges of pediatric refraction include a child's ability to accommodate and their lack of cooperation, emphasizing the need for objective refraction techniques.
Visual acuity assessment in paediatric patients.pptx2222Anisha Rathod
This document provides information on visual acuity assessment in pediatric patients. It discusses visual development from gestation through childhood. It outlines requirements for normal visual development and visual milestones. Methods of assessing visual acuity are described for preverbal, preliterate, and verbal pediatric patients using techniques such as fixation preference, optokinetic testing, preferential looking tests, and visual acuity charts. Factors to consider when performing assessments and recording vision are also reviewed.
This document provides guidelines for prescribing glasses in children. It discusses that the pediatric eye is different from the adult eye in terms of axial length, corneal curvature, and lens power. The goals of prescribing glasses in children are to provide a focused retinal image and achieve optimal balance between accommodation and convergence. It is more difficult to prescribe glasses for children due to lack of subjective response and poor attention. American guidelines provide recommendations on refractive errors that warrant correction at different ages. Factors like emmetropization, amblyopia risk, and presence of strabismus are considered. Frame selection depends on the child's condition and age, aiming for correct fit, comfort, safety, and not hindering nasal development.
This document describes the process of hand neutralization to determine the power of an unknown lens. Hand neutralization involves using a lens of known power to neutralize an unknown lens, where neutralization occurs when movement of the image through the lens is eliminated, indicating the lenses have cancelling powers. The steps include drawing a cross, determining lens orientation and optical center, neutralizing each meridian by finding the lens power that eliminates movement, recording the results as a power cross, and converting to a spherocylindrical formula.
Contact lens options in keratoconus hiraHira Dahal
Rigid gas permeable lenses are commonly used to correct vision in keratoconus, though some patients cannot tolerate them. Piggyback or hybrid lens systems can improve comfort by combining a rigid lens with a soft lens. Newer options like mini-scleral lenses and Rose K lenses are designed specifically for keratoconus, vaulting the irregular cornea to improve vision. The Boston PROSE treatment also creates a new smooth optical surface over the cornea using customized prosthetic lenses. While fitting lenses for keratoconus can be challenging, contact lenses are often able to restore vision without surgery.
Real pediatric refraction and spectacle power prescriptionSrijana Lamichhane
This document discusses pediatric refraction and spectacle prescription. It begins with background information on the development of the eye in childhood and importance of early detection and management of refractive errors. It then covers topics such as age groups in pediatrics, emmetropization, objectives of pediatric refraction, challenges, changes in refractive error with age, types of pediatric refraction including near retinoscopy, static retinoscopy, and cycloplegic refraction. Cycloplegic refraction is emphasized as the standard approach, with discussion of indications, principles, drugs used, and example calculations.
This document discusses pediatric refraction and various techniques used for refracting children. Pediatric refraction is different from adult refraction due to active accommodation in children. Cycloplegic refraction is preferable to paralyze accommodation. Different techniques are used based on the age of the child, including near retinoscopy, dynamic retinoscopy, and book retinoscopy. Cycloplegics help obtain an accurate refraction by paralyzing accommodation.
Update knowledge about Muntifocal IOL made by Asaduzzaman
Working as Associate Optometrist in Ispahani Islamia Eye Institute &Hospita, Dhaka 1215
Email:asad.optom92@yaho. com
Real pediatric refraction and spectacle power prescription in pediatrics.Bipin Koirala
The document discusses pediatric refraction and spectacle prescription. It covers several topics including emmetropization, refractive changes with age, types of pediatric refraction such as near retinoscopy and cycloplegic refraction, and considerations for spectacle prescription in children. Cycloplegic refraction is recommended for all non-verbal children to fully paralyze the ciliary muscles and determine the total refractive error, as the eye's refraction can change dramatically during development. The challenges of pediatric refraction include a child's ability to accommodate and their lack of cooperation, emphasizing the need for objective refraction techniques.
Visual acuity assessment in paediatric patients.pptx2222Anisha Rathod
This document provides information on visual acuity assessment in pediatric patients. It discusses visual development from gestation through childhood. It outlines requirements for normal visual development and visual milestones. Methods of assessing visual acuity are described for preverbal, preliterate, and verbal pediatric patients using techniques such as fixation preference, optokinetic testing, preferential looking tests, and visual acuity charts. Factors to consider when performing assessments and recording vision are also reviewed.
This document provides guidelines for prescribing glasses in children. It discusses that the pediatric eye is different from the adult eye in terms of axial length, corneal curvature, and lens power. The goals of prescribing glasses in children are to provide a focused retinal image and achieve optimal balance between accommodation and convergence. It is more difficult to prescribe glasses for children due to lack of subjective response and poor attention. American guidelines provide recommendations on refractive errors that warrant correction at different ages. Factors like emmetropization, amblyopia risk, and presence of strabismus are considered. Frame selection depends on the child's condition and age, aiming for correct fit, comfort, safety, and not hindering nasal development.
This document describes the process of hand neutralization to determine the power of an unknown lens. Hand neutralization involves using a lens of known power to neutralize an unknown lens, where neutralization occurs when movement of the image through the lens is eliminated, indicating the lenses have cancelling powers. The steps include drawing a cross, determining lens orientation and optical center, neutralizing each meridian by finding the lens power that eliminates movement, recording the results as a power cross, and converting to a spherocylindrical formula.
Contact lens options in keratoconus hiraHira Dahal
Rigid gas permeable lenses are commonly used to correct vision in keratoconus, though some patients cannot tolerate them. Piggyback or hybrid lens systems can improve comfort by combining a rigid lens with a soft lens. Newer options like mini-scleral lenses and Rose K lenses are designed specifically for keratoconus, vaulting the irregular cornea to improve vision. The Boston PROSE treatment also creates a new smooth optical surface over the cornea using customized prosthetic lenses. While fitting lenses for keratoconus can be challenging, contact lenses are often able to restore vision without surgery.
Real pediatric refraction and spectacle power prescriptionSrijana Lamichhane
This document discusses pediatric refraction and spectacle prescription. It begins with background information on the development of the eye in childhood and importance of early detection and management of refractive errors. It then covers topics such as age groups in pediatrics, emmetropization, objectives of pediatric refraction, challenges, changes in refractive error with age, types of pediatric refraction including near retinoscopy, static retinoscopy, and cycloplegic refraction. Cycloplegic refraction is emphasized as the standard approach, with discussion of indications, principles, drugs used, and example calculations.
This document discusses pediatric refraction and various techniques used for refracting children. Pediatric refraction is different from adult refraction due to active accommodation in children. Cycloplegic refraction is preferable to paralyze accommodation. Different techniques are used based on the age of the child, including near retinoscopy, dynamic retinoscopy, and book retinoscopy. Cycloplegics help obtain an accurate refraction by paralyzing accommodation.
Ultrasound is useful for evaluating ocular structures. It uses sound waves above the audible range that are reflected by tissues. The transducer produces pulses and detects echoes to create images. Different scan types provide 1D (A-scan) or 2D (B-scan) views. A-scans show acoustic density as spikes while B-scans show shape, location and extent of structures. Proper technique and interpretation of features like reflectivity, mobility and shadowing allow ultrasound to diagnose conditions like retinal detachment, tumors, inflammation and optic nerve diseases.
The document discusses wavefront aberrometry, which is a technique used to measure aberration in the eye by analyzing wave fronts. It is used for refractive surgery, contact lens fitting, early diagnosis of keratoconus, and to measure lower order and higher order of aberration. Wavefront aberrometry provides information about aberrations in the eye beyond what a standard eye exam can detect.
The LogMAR chart is designed to provide a more accurate measurement of visual acuity compared to other charts like the Snellen chart. Each line of the LogMAR chart contains the same number of letters and the letter sizes decrease logarithmically between lines, making it easy to use at different distances. The LogMAR chart is now commonly used in clinical settings and recommended for research due to its improved accuracy over other charts, especially for testing children's vision. Visual acuity is scored on the LogMAR chart by referring to the logarithm of the minimum angle of resolution, with more positive values indicating poorer vision.
This document discusses the optics of contact lenses. It begins with a brief history of contact lenses and an introduction to basic optics concepts for thick lenses. It then covers various optical properties of contact lenses like vertex distance correction, magnification, accommodation, convergence, and aberrations. Key advantages of contact lenses are discussed, such as producing a more natural retinal image size for myopes and hyperopes compared to spectacles. Factors affecting spectacle and contact lens magnification are also presented.
Scleral lens is a large rigid contact lens with a diameter range of 15mm to 25mm. Its resting point is beyond the
corneal borders, and are believed to be among the best vision correction options for irregular corneas. Wearing scleral lens also can postpone or even prevent surgical intervention as well as decrease the risk of corneal scarring.
Optics of contact lens and nomenclature copy [repaired] (1)Manjusha Lakshmi
A contact lens is an artificial device placed on the cornea or sclera for optical or therapeutic purposes. Contact lenses are classified based on their anatomical location, nature of material, and wearing schedule. Key parameters of contact lenses include the base curve, diameter, power, edge clearance, and central thickness. Contact lenses provide vision correction and can also be used for therapeutic reasons like drug delivery or treating corneal diseases.
This document provides an overview of astigmatism including its definition, causes, types, signs and symptoms, diagnosis, and treatment. Astigmatism is a refractive error where the eye focuses light on multiple points rather than a single point due to an irregularly shaped cornea. It is usually caused by corneal abnormalities and can be classified based on the axis of refractive error, degree of refractive error, and type of focal points. Common signs include blurred vision, eye strain, and tilting of the head. Diagnosis involves visual acuity tests, keratometry, and refraction tests. Treatment options include spectacle lenses, contact lenses, refractive surgery, and keratoplasty.
The retina is the innermost layer of the eye that converts light into neural signals. It contains several layers of tissue and cell types that carry out this visual transduction process. The outermost layer contains pigmented cells, followed by photoreceptor cells (rods and cones), bipolar and ganglion cells that transmit signals to the brain. Within the retina, the macula provides high-acuity central vision and the optic disc is where retinal ganglion cell axons exit as the optic nerve. The retina receives its blood supply from the central retinal artery and precise vascular architecture is important for normal visual function.
This presentation include what are the pre-assessment required for fitting Contact lens in children and process of insertion and removal with a small knowledge about different lens that we can use for pediatric Contact lens
OCT allows for high-resolution cross-sectional imaging of the retina. It provides micron-level resolution, enabling visualization of the retinal layers. OCT is a non-contact, non-invasive technique useful for qualitative and quantitative analysis of the retina and monitoring of morphological changes. It can detect and measure retinal thickness, volume, and parameters like RNFL thickness. While it provides advantages over other modalities, OCT also has limitations like difficulty imaging through opaque media. It operates using low-coherence interferometry and is useful for evaluating a variety of posterior segment diseases.
This document provides information on contact lens options for managing keratoconus. It discusses various soft lens designs, scleral lenses, corneal lenses, and hybrid lens systems. For corneal lenses, it describes two fitting philosophies - apical bearing and apical clearance. Specific lens designs are also outlined, including Soper, McGuire, NiCone, and ROSE K lenses, which are designed to closely fit the irregular shape of the cornea in keratoconus. The document provides details on parameters like total diameter, base curve radius, optic zone diameter, and materials for fitting these specialized lenses.
This document discusses low vision and provides definitions, classifications, common causes, and management strategies.
[1] Low vision is defined as visual impairment even after treatment that results in visual acuity worse than 6/18 but ability to use vision. It can be caused by conditions like macular degeneration, retinitis pigmentosa, cataract, and glaucoma.
[2] Low vision affects people's ability to perform visual tasks and can cause blurry or decreased vision, loss of peripheral vision, and light sensitivity. Evaluation involves assessing vision and goals, while management includes low vision devices and counseling.
[3] Common low vision devices include telescopes, magnifiers, and electronic
This document discusses various vitreous substitutes and intraocular gases used to replace the vitreous humor after surgery. It describes the anatomy and composition of the natural vitreous and ideal properties for substitutes. Common substitutes discussed include gases like air, sulfur hexafluoride and perfluorocarbons; liquids like silicone oil, perfluorocarbon liquids and semi-fluorinated alkanes; and experimental polymers and implants. The document compares different options and provides details on how each works, associated complications, and appropriate uses.
This document discusses accommodative esotropia, a condition where excessive accommodation effort causes the eyes to turn inward. It is most often caused by uncorrected hyperopia. If left untreated in a visually immature child, it can lead to loss of binocular vision and amblyopia. Treatment involves full refractive correction through glasses to relax accommodation and restore binocular vision. The timing between onset and treatment determines the visual outcome.
This document provides guidance on selecting eyeglass frames. It discusses that the primary purposes of frames are to hold lenses to provide optimal vision and be physically comfortable. Additional considerations for frame selection include appearance, fashion, prescription needs, face shape, coloring, nose shape, hairline, image, work environment, habits, budget, and fashion trends. General guidelines are to ensure proper positioning of lenses within the frames based on factors like face shape, width, brow position, and proportion. Color and frame style should complement the face. Frame material and design should account for prescription, activities, and durability needs. Fashion has also become an important factor in frame selection.
Duane syndrome, also called Duane retraction syndrome (DRS), is a congenital and non-progressive type of strabismus due to abnormal development of the 6th cranial nerve.
It is characterized by difficulty rotating one or both eyes outward (abduction) or inward (adduction).
On the other hands Duane Retraction Syndrome is a congenital strabismus syndrome occurring in isolated or syndromic forms. It presents with a variety of clinical features including diplopia, anisometropia, and amblyopia.
Multifocal contact lenses can correct both near and distance vision and are an alternative to bifocal glasses for people with active lifestyles. There are several types of multifocal contact lens designs, including soft, gas permeable, and hybrid lenses. The most common design is a diffractive lens with concentric circles of different optical powers. Multifocal contact lenses provide clear vision at multiple distances but may cause glare or hazy vision during adjustment. They also have advantages like less need for extra eyewear but disadvantages such as greater difficulty adapting to them.
Este documento presenta un estudio sobre las características topográficas de pacientes diagnosticados con queratocono utilizando datos de un topógrafo corneal ubicado en la Universidad de La Salle. El estudio analiza las características del mapa topográfico como colores, tamaño, forma y posición de la ectasia, así como índices topográficos. El objetivo es describir las propiedades del queratocono a través de la topografía corneal.
Este documento resume las complicaciones de la cirugía de catarata, enfocándose en la endoftalmitis postoperatoria. Explica que la endoftalmitis es una complicación grave e infrecuente de la cirugía de catarata, con una incidencia de 0.1-0.3%. Identifica factores de riesgo como la edad avanzada, diabetes, ruptura de la cápsula posterior e infecciones intraoperatorias. Finalmente, cubre temas como diagnóstico, tratamiento con antibióticos intravitreos y sistémicos, y pre
Ultrasound is useful for evaluating ocular structures. It uses sound waves above the audible range that are reflected by tissues. The transducer produces pulses and detects echoes to create images. Different scan types provide 1D (A-scan) or 2D (B-scan) views. A-scans show acoustic density as spikes while B-scans show shape, location and extent of structures. Proper technique and interpretation of features like reflectivity, mobility and shadowing allow ultrasound to diagnose conditions like retinal detachment, tumors, inflammation and optic nerve diseases.
The document discusses wavefront aberrometry, which is a technique used to measure aberration in the eye by analyzing wave fronts. It is used for refractive surgery, contact lens fitting, early diagnosis of keratoconus, and to measure lower order and higher order of aberration. Wavefront aberrometry provides information about aberrations in the eye beyond what a standard eye exam can detect.
The LogMAR chart is designed to provide a more accurate measurement of visual acuity compared to other charts like the Snellen chart. Each line of the LogMAR chart contains the same number of letters and the letter sizes decrease logarithmically between lines, making it easy to use at different distances. The LogMAR chart is now commonly used in clinical settings and recommended for research due to its improved accuracy over other charts, especially for testing children's vision. Visual acuity is scored on the LogMAR chart by referring to the logarithm of the minimum angle of resolution, with more positive values indicating poorer vision.
This document discusses the optics of contact lenses. It begins with a brief history of contact lenses and an introduction to basic optics concepts for thick lenses. It then covers various optical properties of contact lenses like vertex distance correction, magnification, accommodation, convergence, and aberrations. Key advantages of contact lenses are discussed, such as producing a more natural retinal image size for myopes and hyperopes compared to spectacles. Factors affecting spectacle and contact lens magnification are also presented.
Scleral lens is a large rigid contact lens with a diameter range of 15mm to 25mm. Its resting point is beyond the
corneal borders, and are believed to be among the best vision correction options for irregular corneas. Wearing scleral lens also can postpone or even prevent surgical intervention as well as decrease the risk of corneal scarring.
Optics of contact lens and nomenclature copy [repaired] (1)Manjusha Lakshmi
A contact lens is an artificial device placed on the cornea or sclera for optical or therapeutic purposes. Contact lenses are classified based on their anatomical location, nature of material, and wearing schedule. Key parameters of contact lenses include the base curve, diameter, power, edge clearance, and central thickness. Contact lenses provide vision correction and can also be used for therapeutic reasons like drug delivery or treating corneal diseases.
This document provides an overview of astigmatism including its definition, causes, types, signs and symptoms, diagnosis, and treatment. Astigmatism is a refractive error where the eye focuses light on multiple points rather than a single point due to an irregularly shaped cornea. It is usually caused by corneal abnormalities and can be classified based on the axis of refractive error, degree of refractive error, and type of focal points. Common signs include blurred vision, eye strain, and tilting of the head. Diagnosis involves visual acuity tests, keratometry, and refraction tests. Treatment options include spectacle lenses, contact lenses, refractive surgery, and keratoplasty.
The retina is the innermost layer of the eye that converts light into neural signals. It contains several layers of tissue and cell types that carry out this visual transduction process. The outermost layer contains pigmented cells, followed by photoreceptor cells (rods and cones), bipolar and ganglion cells that transmit signals to the brain. Within the retina, the macula provides high-acuity central vision and the optic disc is where retinal ganglion cell axons exit as the optic nerve. The retina receives its blood supply from the central retinal artery and precise vascular architecture is important for normal visual function.
This presentation include what are the pre-assessment required for fitting Contact lens in children and process of insertion and removal with a small knowledge about different lens that we can use for pediatric Contact lens
OCT allows for high-resolution cross-sectional imaging of the retina. It provides micron-level resolution, enabling visualization of the retinal layers. OCT is a non-contact, non-invasive technique useful for qualitative and quantitative analysis of the retina and monitoring of morphological changes. It can detect and measure retinal thickness, volume, and parameters like RNFL thickness. While it provides advantages over other modalities, OCT also has limitations like difficulty imaging through opaque media. It operates using low-coherence interferometry and is useful for evaluating a variety of posterior segment diseases.
This document provides information on contact lens options for managing keratoconus. It discusses various soft lens designs, scleral lenses, corneal lenses, and hybrid lens systems. For corneal lenses, it describes two fitting philosophies - apical bearing and apical clearance. Specific lens designs are also outlined, including Soper, McGuire, NiCone, and ROSE K lenses, which are designed to closely fit the irregular shape of the cornea in keratoconus. The document provides details on parameters like total diameter, base curve radius, optic zone diameter, and materials for fitting these specialized lenses.
This document discusses low vision and provides definitions, classifications, common causes, and management strategies.
[1] Low vision is defined as visual impairment even after treatment that results in visual acuity worse than 6/18 but ability to use vision. It can be caused by conditions like macular degeneration, retinitis pigmentosa, cataract, and glaucoma.
[2] Low vision affects people's ability to perform visual tasks and can cause blurry or decreased vision, loss of peripheral vision, and light sensitivity. Evaluation involves assessing vision and goals, while management includes low vision devices and counseling.
[3] Common low vision devices include telescopes, magnifiers, and electronic
This document discusses various vitreous substitutes and intraocular gases used to replace the vitreous humor after surgery. It describes the anatomy and composition of the natural vitreous and ideal properties for substitutes. Common substitutes discussed include gases like air, sulfur hexafluoride and perfluorocarbons; liquids like silicone oil, perfluorocarbon liquids and semi-fluorinated alkanes; and experimental polymers and implants. The document compares different options and provides details on how each works, associated complications, and appropriate uses.
This document discusses accommodative esotropia, a condition where excessive accommodation effort causes the eyes to turn inward. It is most often caused by uncorrected hyperopia. If left untreated in a visually immature child, it can lead to loss of binocular vision and amblyopia. Treatment involves full refractive correction through glasses to relax accommodation and restore binocular vision. The timing between onset and treatment determines the visual outcome.
This document provides guidance on selecting eyeglass frames. It discusses that the primary purposes of frames are to hold lenses to provide optimal vision and be physically comfortable. Additional considerations for frame selection include appearance, fashion, prescription needs, face shape, coloring, nose shape, hairline, image, work environment, habits, budget, and fashion trends. General guidelines are to ensure proper positioning of lenses within the frames based on factors like face shape, width, brow position, and proportion. Color and frame style should complement the face. Frame material and design should account for prescription, activities, and durability needs. Fashion has also become an important factor in frame selection.
Duane syndrome, also called Duane retraction syndrome (DRS), is a congenital and non-progressive type of strabismus due to abnormal development of the 6th cranial nerve.
It is characterized by difficulty rotating one or both eyes outward (abduction) or inward (adduction).
On the other hands Duane Retraction Syndrome is a congenital strabismus syndrome occurring in isolated or syndromic forms. It presents with a variety of clinical features including diplopia, anisometropia, and amblyopia.
Multifocal contact lenses can correct both near and distance vision and are an alternative to bifocal glasses for people with active lifestyles. There are several types of multifocal contact lens designs, including soft, gas permeable, and hybrid lenses. The most common design is a diffractive lens with concentric circles of different optical powers. Multifocal contact lenses provide clear vision at multiple distances but may cause glare or hazy vision during adjustment. They also have advantages like less need for extra eyewear but disadvantages such as greater difficulty adapting to them.
Este documento presenta un estudio sobre las características topográficas de pacientes diagnosticados con queratocono utilizando datos de un topógrafo corneal ubicado en la Universidad de La Salle. El estudio analiza las características del mapa topográfico como colores, tamaño, forma y posición de la ectasia, así como índices topográficos. El objetivo es describir las propiedades del queratocono a través de la topografía corneal.
Este documento resume las complicaciones de la cirugía de catarata, enfocándose en la endoftalmitis postoperatoria. Explica que la endoftalmitis es una complicación grave e infrecuente de la cirugía de catarata, con una incidencia de 0.1-0.3%. Identifica factores de riesgo como la edad avanzada, diabetes, ruptura de la cápsula posterior e infecciones intraoperatorias. Finalmente, cubre temas como diagnóstico, tratamiento con antibióticos intravitreos y sistémicos, y pre
El documento describe la topografía corneal convencional, que consiste en proyectar sobre la córnea la imagen de un disco de Plácido compuesto por anillos concéntricos. La imagen reflejada se fotografía para estudiar las deformaciones de la curvatura corneal y detectar anomalías como astigmatismos o ectasias. El topógrafo corneal Magellan utiliza este método para mapear la superficie corneal mediante imágenes digitalizadas del disco de Plácido.
Este documento resume la definición, historia, epidemiología, factores de riesgo, patogenia, manifestaciones clínicas, diagnóstico y clasificación del queratocono. El queratocono es una ectasia corneal primaria caracterizada por el adelgazamiento del estroma corneal central que causa una protrusión irregular de la córnea en forma de cono, llevando comúnmente a defectos astigmáticos irregulares y mala visión. Su diagnóstico se realiza principalmente mediante topografía corneal y su clasificación se basa en
Este documento describe el queratocono, una ectasia corneal no inflamatoria que causa protusión y adelgazamiento de la cornea en forma de cono. Define el queratocono, discute su etiología, características clínicas, diagnóstico, clasificación, tratamiento con lentes de contacto y complicaciones. También cubre otras ectasias corneales como el queratocono posterior y la degeneración marginal pelúcida.
Advances in IOL calculation now offer more accurate results due to improvements in calculation strategies, devices, and formulas. Raytracing calculations that trace individual rays through the eye provide a more realistic model compared to the thin lens and Gaussian optics approximations used by current formulas. The Okulix raytracing calculator and ORA intraoperative wavefront aberrometer utilize raytracing to reduce error in IOL power prediction, especially for patients with previous refractive surgery or atypical corneal shapes. Further advances in measurement devices and the incorporation of OCT and topography are helping to optimize IOL calculations.
El Queratocono es un trastorno de la córnea que causa su adelgazamiento y forma cónica, lo que distorsiona la visión. Sus causas son desconocidas pero se cree que involucra defectos en el colágeno. Los síntomas incluyen empañamiento de la visión que empeora con el tiempo. Los tratamientos son lentes de contacto y, en casos graves, trasplante de córnea. Las personas deben consultar a un oftalmólogo si notan cambios en su visión que no se corrigen con anteoj
The document describes the two main components of phacoemulsification technology - ultrasound power generated by piezoelectric crystals and a fluidics circuit used to remove emulsified lens material while maintaining the anterior chamber. It discusses how power is created and modified through variables like frequency, stroke length, and tip selection, as well as how fluidics are regulated by a pump to balance inflow and outflow via parameters such as sleeve size, aspiration rate, and vacuum level. Proper adjustment of these power and fluidic parameters at different surgical stages helps achieve efficient lens removal while minimizing complications.
Este documento presenta conceptos básicos de geometría y trigonometría utilizados en topografía. Explica los sistemas de coordenadas rectangulares y polares, y las relaciones entre ellos. También cubre temas como cálculo de áreas y volúmenes, ángulos, sistemas de medición angular, relaciones trigonométricas fundamentales, rectas, intersección de rectas, rectas perpendiculares y paralelas. Contiene ejemplos ilustrativos de cada uno de estos conceptos.
Este documento describe la córnea y su evaluación topográfica. La córnea es el elemento de mayor poder refractivo del ojo y está dividida topográficamente en cuatro zonas. Existen diversos métodos para medir la topografía corneal, incluyendo queratoscopios, queratómetros y topógrafos corneales. La topografía corneal proporciona información valiosa para el diagnóstico y seguimiento de varias condiciones oculares.
1. El Pentacam es un sistema de tomografía corneal rotatoria que genera imágenes en corte transversal de la córnea para analizar su forma, poder y posibles anormalidades de manera tridimensional.
2. Proporciona diversos mapas como de curvatura, elevación, paquimetría y Belin-Ambrosio que permiten caracterizar condiciones como queratocono y seguir su progresión o respuesta a tratamientos.
3. Sus principales usos son el tamizaje previo a cirugía refractiva, diagnóstico y seguimiento
The document describes the use of various Pentacam maps and indices for screening patients for keratoconus, including:
1) The standard 4-map composite report, keratoconus map, Holladay report, and Belin/Ambrosio Enhanced Ectasia Display.
2) Key features to examine on each map include anterior and posterior elevation maps, pachymetry maps, curvature maps, and indices values.
3) The Belin/Ambrosio Enhanced Ectasia Display aims to improve sensitivity by calculating an "enhanced" best fit sphere reference surface that excludes the thinnest corneal region, highlighting differences between normal and ectatic corneas.
La presentación introduce la topografía corneal y las principales tecnologías utilizadas como el disco de Plácido y la cámara de Scheimpflug. Explica conceptos básicos como los mapas topográficos, patrones normales y aberrometría. Finalmente, muestra diversos casos prácticos para ilustrar diferentes patrones topográficos.
This document discusses corneal topography, which is the examination and mapping of the shape and curvature of the cornea. It describes different techniques for measuring corneal topography including keratometry, photokeratoscopy, and videokeratography. It outlines the major regions of the cornea and indices used to characterize topography maps. Examples of topography patterns are shown for normal, astigmatic, and diseased corneas. Clinical applications of topography including refractive surgery planning and evaluation, contact lens fitting, and diagnosing corneal conditions are also summarized.
This document provides information about corneal topography and keratometry. It defines the cornea and its dimensions. It describes the historical evolution of keratometry from its first description in 1619 to modern computerized corneal topography systems. The document explains the principles, procedures, techniques, and applications of keratometry and corneal topography in evaluating the cornea. It also discusses the limitations and assumptions of keratometry measurements.
The document discusses the five layers of the cornea - epithelium, Bowman's membrane, stroma, Descemet's membrane, and endothelium. It describes the function of each layer. It also discusses corneal topography, which provides a 3D view of the cornea and is used to diagnose corneal conditions. Key measurements from topography include K readings to determine astigmatism and pachemetry readings to measure corneal thickness. Abnormal topography findings can indicate conditions like keratoconus, where the cornea protrudes in a cone shape. The document demonstrates how to properly perform corneal topography and pachymetry ultrasound scans.
Este documento resume el diagnóstico y tratamiento del queratocono. En 3 oraciones o menos:
El queratocono es una ectasia progresiva de la córnea que causa astigmatismo irregular. Se diagnostica clínicamente y con topografía corneal, y su tratamiento depende de la gravedad e incluye gafas, lentes de contacto, anillos corneales, cross-linking y queratoplastia. La topografía corneal es el método más sensible para el diagnóstico temprano y seguimiento de la progresión de la enfermedad.
Richard L. Lindstrom, MD's "Thoughts on Corneal and Lens based Refractive Surgery to Enhance Near Vision in the USA: 2015" presentation from OIS@ASCRS 2015
Non incisional, non laser refractive surgeryAnkit Gupta
This document discusses various refractive surgical procedures including:
1. Epikeratophakia and intracorneal rings for corneal refractive procedures
2. Clear lens extraction and phakic IOLs for lenticular refractive procedures
It provides details on indications, contraindications, surgical techniques and complications for these procedures.
Presbyopia is the loss of accommodation that occurs with aging. It results in a decreased ability to focus on near objects and is caused by lenticular and extralenticular changes within the eye. Symptoms typically begin around age 40 and accommodation is completely lost by ages 50-60, affecting 100% of the population. Treatment options include reading glasses, bifocal and multifocal contact lenses, refractive surgery such as LASIK, and intraocular lens implants. Newer treatments being researched include corneal inlays and injectable accommodating intraocular lenses.
This document discusses cataracts and cataract surgery. It provides an overview of cataract anatomy, symptoms, and surgery. It describes the risks factors for developing cataracts and recommendations for cataract screening and treatment. The document then focuses on how using a femtosecond laser during cataract surgery can improve precision for steps like corneal incisions, anterior capsulotomy, and lens fragmentation compared to traditional manual techniques. This precision is said to allow for more consistent outcomes and reduced risks.
The document discusses various surgical and non-surgical treatment modalities for presbyopia including corneal procedures, scleral procedures, intraocular implants, and laser treatments. It provides details on specific procedures and technologies such as conductive keratoplasty, PRK and LASIK ablation patterns, intracorneal inlays, scleral expansion bands, and accommodating, multifocal, and refractive diffractive intraocular lenses. The advantages and disadvantages of different approaches are summarized.
The document provides an introduction to refractive surgery. It discusses different vision conditions like myopia, hyperopia and presbyopia. It explains how these conditions can be corrected through glasses, contact lenses or refractive surgery options like LASIK and PRK. It addresses common myths about refractive surgery, discussing the safety, effectiveness and long-term outcomes of these procedures.
This study evaluated the long-term safety and efficacy of Ferrara intrastromal corneal ring segments for keratoconus treatment. The records of 36 eyes of 30 patients who received ICRS from 1996-2002 were reviewed. At the 5-year follow-up, uncorrected and corrected visual acuity significantly improved, and keratometry and corneal thickness values significantly decreased. At the 10-year follow-up, these improvements were maintained without significant changes, demonstrating the long-term effectiveness and stability of ICRS for keratoconus. This is the longest reported follow-up of ICRS for keratoconus correction.
The document discusses preoperative evaluation and measurements for cataract surgery, including biometry. It covers evaluating the general health and ocular history of the patient, performing visual acuity testing, refraction, and other objective tests. It then describes methods of measuring the eye, including A-scan biometry to determine axial length using ultrasound, and optical biometry using light waves. Factors that can influence biometry measurements and techniques like keratometry are also discussed. The document concludes by covering intraocular lens power calculation and selection, noting the importance of accurate measurements and various generation of formulas used.
The perioscope is a tiny camera that attaches to dental instruments allowing dentists and hygienists to visualize the subgingival root surfaces. It provides high magnification views of the root and pocket in real time on a monitor. This allows for more accurate diagnosis and complete removal of tartar and bacteria compared to traditional methods. The perioscope has increased the effectiveness of non-surgical treatments and improved outcomes for both non-surgical and surgical periodontal therapies.
This journal club discussed a study that evaluated the visual outcomes of binocular implantation of a new extended depth of focus intraocular lens called the Supraphob Infocus IOL. The study aimed to assess the safety and efficacy of this lower cost IOL in patients undergoing cataract surgery compared to the FDA approved TECNIS Symfony IOL. The study found that the Supraphob Infocus IOL provided good visual acuity, contrast sensitivity, and stereoacuity outcomes comparable to the TECNIS Symfony IOL. It also induced less ocular aberrations. Based on its safety, efficacy and lower cost, the study concluded that the Supraphob Infocus IOL can
The document discusses the importance of magnification in endodontics. It begins by explaining how endodontic procedures were previously done without visualization and relied solely on tactile sensitivity. The introduction of the operating microscope 15 years ago revolutionized the field by allowing endodontists to visualize the root canal system. The document then discusses the relative sizes of bacteria, cells, and other microscopic structures to emphasize the limitations of the unaided human eye. It explains how magnification tools like microscopes, loupes, and lights allow dentists to see structures smaller than what the naked eye can see and improve clinical outcomes. Finally, it describes different types of loupes and their optical configurations, working distances, and magnification ranges.
Th e use of premium IOLs requires more specifically than standard monofocal IOLs a thorough clinical and para clinical examination using modern equipments.
We will only mention micro-incision premium IOLs that are used
in our daily practice. All information regarding the characteristics of all available and especially multifocal IOLs are available in the SFO 2012 Report on presbyopia
An Optometrist S Personal Perspective Of Aspects Of Refractive SurgeryErin Taylor
- Refractive surgery has evolved significantly over the past century and become a viable alternative to contact lenses or glasses. Techniques like LASIK have improved outcomes and reduced complications compared to earlier methods.
- A prospective study of 104 eyes undergoing LASIK for high myopia found good outcomes with few complications. At 1 year post-op, most patients achieved 6/12 or better vision without aids. Residual error was greatest for those with extreme pre-op myopia.
- While results are encouraging, the author notes limitations remain for treating extreme myopia due to restrictions from minimum safe corneal thickness requirements. Subjective factors also impact patient satisfaction beyond objective visual outcomes.
Comparative Study of Visual Outcome between Femtosecond Lasik with Excimer La...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The Implantable Collamer Lens (ICL) is a soft, flexible, posterior chamber phakic intraocular lens made of collagen-copolymer material called Collamer. Studies have shown ICL implantation is safe and effective for correcting myopia between -3 to -25 diopters and astigmatism up to -6 diopters. It provides stable refractive results with few complications over 4 years. Toric ICL models were found to be superior to LASIK in safety, efficacy, predictability and stability for high myopic astigmatism. The procedure is reversible and preserves corneal tissue, reducing risks compared to LASIK.
National Ocular Biometry Course (NOBC) 2015 An echoslide presentation Anis Suzanna Mohamad
This powerpoint presentation is basically about ocular biometry. Echo presentation is one of the method to deliver infomation that obtain from the course we attend to other staff in our Ophthalmology Department.
This document provides an overview of corneal transplantation techniques from their origins to recent advances. It discusses:
- The first corneal transplant in 1905 and subsequent developments like operating microscopes, finer sutures, and corticosteroids which improved outcomes.
- Why lamellar keratoplasty fell out of favor for decades due to interface irregularities causing poor vision, but has made a comeback as techniques improve vision.
- Recent advances like Descemet's Stripping Endothelial Keratoplasty (DSAEK) and Deep Anterior Lamellar Keratoplasty (DALK) which replace less of the cornea and have benefits like quicker recovery time and less rejection risk compared to
Intracorneal ring segments, such as INTACS, are thin plastic rings that are implanted into the corneal stroma to flatten the cornea and reduce myopia. They are placed in a lamellar channel using either a mechanical or laser procedure. Thicker rings provide greater flattening and myopia correction. Potential risks include visual disturbances and complications requiring removal. Intracorneal rings have been used off-label to treat conditions like post-LASIK ectasia and keratectasia with some success in improving vision.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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3. Presbyopia Concept
Presbyopic patients often believe that the gradual loss of near
vision represents a visual impairment that will degrade the
quality of their lives.
In actuality, the inevitable loss of accommodative power in
human visual systems begins as early as infancy, with virtually
everyone fully realizing its adverse effects by 50 years of age.
4. Presbyopia Concept
Presbyopia can be a shocking and frustrating occurrence in the
busy, productive, and fulfilling lives of today's patients
Presbyopia has historically been a challenge for
ophthalmologists as well, due to the limited number of optimal
solutions for treatment that were previously available.
5. Presbyopia Market
The global market for presbyopia currently includes 1.7 billion
people—typically between the ages of 40 and 60 years—and it is
expected to increase to 2.1 billion by 2020
The projected magnitude of this phenomenon underlies the
attention devoted to pursuing innovative surgical approaches to
manage this treatable condition.
Recent data show that people between the ages of 47 and 65 years
represent nearly 50% of all consumer spending, and the spending
power of those over age 50 years is estimated to be in the trillions by
2015
6. Presbyopia Market & U.S. Statistics
80 million baby boomers began turning 60 in 2006
In 2012 43 million > age of 65
By 2020 will increase to 55 million > 65
By 2025 ~ 60% of US population > 55
Over 50% > age 65 have visually significant cataracts
Currently estimated that cataracts affect > 22 million in US
Currently 3 million+ cataract surgeries per year in US
That number is expected to increase to > 30 million by 2020
7. Presbyopia Market & U.S. Statistics
Incidence of cataract surgery dramatically increasing
• Improved access to surgery
• More surgeons
• Adoption of widening indications for surgery
Between 1998–2004 28% of patients had 2nd eye sx by 90 d
Between 2005-2011 increased to 60%
8. Surgical Presbyopia Options
Monovision
LASIK and PRK
CK (Conductive Keratoplasty) Has FDA approval
Monofocal ICLs
Monofocal IOLs
Multifocal Implants (PC-IOLs) On the horizon
Multiple new designs of PC-IOLs
Multifocal excimer ablations – presbyLASIK
Corneal inlays
○ Kamra ( AcuFocus , Inc., Irvine, CA)
○ Raindrop (formerly Vue+, PresbyLens; ReVision Optics, Inc. Lake Forest, CA),)
○ Flexivue Microlens (Presbia Coöperatief UA, Amsterdam, Netherlands)
9. Inlay Concept
The concept behind intracorneal implants is not new;it has been reported on since
the late i1940s,and Professor José Barraquer s generally credited with the original
idea
These inlays were originally used to treat Fuchs dystrophy, high myopia, and
aphakia, but the materials were neither optically ideal nor permeable.
Common problems with earlier iterations of the technology included
Decentration,
Kertolysis, and
Opacification.
But modern designs are highly permeable, and they have small diameters and thin
profiles.
Surgical technique has been modified, because centration is now recognized as
critical to the devices’ proper performance
10. Corneal Inlays
Corneal inlays are small artificial implants that are inserted into the
cornea via either a femtosecond laser-created pocket or corneal flap to
alter the optics of the eye and improve near vision.
Several inlays are in development or in use globally but are unavailable
in the United States, including
Raindrop (formerly Vue+ ,PresbyLens; ReVision Optics, Inc. Lake Forest, CA),
Flexivue Microlens (Presbia Coöperatief UA, Amsterdam, Netherlands)
Kamra (AcuFocus, Inc., Irvine, CA).
13. Flexivue Micro-Lens
(Presbia)
KAMRA
(formerly ACI 7000)
(Acufocus)
Vue+
(formerly Presbylens)
(ReVision)
Procedure Modified monovision Modified monovision Modified monovision
Mechanism of action Changes the refractive index Increases the depth of focus Changes the anterior corneal curvature
Surgery Pocket Flap or Pocket Flap
Stromal Depth 280-300 microns 200 microns 120 microns
Biocompatible YES YES YES
Inlay Thickness 15-20 microns 10 microns 20-40 microns
Diameter 3.2 mm 3.8 mm 2 mm
Nutrient flow
YES
(Central hole)
YES (Micropores)
Yes
(Hydrogel permeable material)
FDA Approved
NO
(Clinical trials)
NO
(Phase III)
NO
(Clinical trials)
CE Mark YES YES YES
INLAYS CHARACHTERISTICS
14. The Raindrop inlay (Corneal Reshaping Inlays)
A 2-mm hydrogel corneal implant indicated for the correction of presbyopia.
Its functionality is based on the principle of multifocality.
is 30 µm thick under a 130 -to 150 μm LASIK flap is designed to change the curvature
of the central cornea of one eye to add near and intermediate focusing power.
The implant is removable.
Is in US clinical trials, has CE Mark approval, and is available for sale in Europe.
Six-month data on 34 patients who received the implant were
The mean uncorrected near visual acuity in the implanted eyes was J1 (ie, a 4-line
improvement).
Intermediate visual acuity improved by a mean of 2 lines, and
distance visual acuity decreased by a mean of 1.5 lines.
Binocularly, no patient saw worse than 20/25.
15. 15
Inlay Thickness
30 µm Flap Bed
Bowman’s
Layer
Stromal Cushion
100 µm
Inlay has same refractive index as cornea but
increases curvature in the center of the pupil
The Raindrop inlay (Corneal Reshaping Inlays) How It Works
17. MicroLens Flexivue
Hydrogel corneal microlens implanted after creating a
femtosecond flap
Restores near and intermediate vision in patients with
myopic, hyperopic, and emmetropic presbyopia
Transparent, biocompatible and mimics a healthy
cornea
Removal with reversible vision
17
2 mmdiameter, ~30 μmthickness VUE+ Inlay
18. MicroLens Flexivue
The Flexivue MicroLens is a refractive corneal inlay based on the multifocal (bifocal)
principle.
This removable inlay is 3 mm wide, is approximately 15 µm thick, 0.15 mm opening in
the center to facilitate fluid and nutrient flow.and is made of a hydrophilic polymer.
add power from +1.25 to +3.5 D, in 0.25D steps
implantation in a corneal pocket at a depth of 280 -300
Recent studies of the Flexivue Microlens lens performed by Ioannis Pallikaris,
Postoperative uncorrected near visual acuity was 20/25 or better in 77% of the patients.
Ninety-two percent of the patients did not use reading glasses, and 8% used reading glasses
for less than half of their near activities after surgery.
Of the patients with 15 months' follow-up, 77% saw 20/16 at near, and their operative eye
showed a slight decrease in distance vision.
19. MicroLens Flexivue( how it works)
Bifocal design produces two images at the Foveal level
one image results from the combined refractive effects of area of
the cornea that surrounds the lens and the central zone of the
lens
one image from the peripheral zone of the lens
Neuroadaptation aids in using both images by choice
Disadvantag
pupil smaller than 3.0 mm = the peripheral plus power of the
lens obstructed by iris
21. Microlens Setting of the laser parameters iFS 150
iPockets software
– Depth: 280-300
– Diameter: 4 mm
– Bed energy: 0.60-0,70
– Spot-LineSep: 2-2 (or 3-3)
– Side cut energy: 1.6-1.7
– Side cut angle: 160
22. Kamra inlay
The Kamra inlay has CE Mark approval and is in US IDE clinical trials for the
treatment of presbyopia.
Unlike the other implants described herein, the Kamra inlay utilizes small-aperture
optics to increase the depth of focus by allowing only focused light rays to enter the
eye.
As a result, the inlay continues to provide near vision as the crystalline lens loses its
accommodative function.
The inlay is commercially available in Europe, Asia, Latin America, and the Middle
East.
It is placed in a stromal pocket or under a lamellar flap. The pocket procedure was
used for the 507 emmetropic patients in the manufacturer's current US study,
conducted under an IDE. If necessary, patients who receive the Kamra inlay can
have it removed, and their vision will reportedly revert to base-line
In the clinical trial, on average, patients achieved J2 to J3 for near and maintained
good distance vision at 20/20 out to 18 months .
23. KAMRA Corneal Inlay
3.8mm Diameter 5 Microns Thick - 1/10th the Thickness of a Sheet of Paper
(7.5 mm radius), and flexible enough to bend to different curvatures without Buckling
Mass is 71-142 micrograms - about the Weight of a Salt Crystal
The opaque annulus is incorporated with black carbon particles and has 8,400
perforations of various sizes distributed in random arrangement.
This is designed to counter diffraction issues under mesopic settings and yet allow
nutrient flow and approximately 10% additional light transmission beyond those
passing through the center aperture
KAMRA inlay is estimated to provide presbyopic corrective equivalence of up to
+2.00D.8
25. Kamra Inlay approval
The KAMRA™ inlay received CE mark for use in the European
Union in 2005 and is now approved in 49 countries worldwide.
The KAMRA inlay is an investigational device, limited under
federal (U.S.) law to investigational use and is not available for
sale in the United States.
26. Kamra Inlay Optical Principals
Light Rays Pass through the Small Aperture Over a Small Angle,
Increasing the Depth of Focus by permitting central image rays to project
onto retina while obscuring the transmission of peripheral light rays.
Because peripheral rays create larger blur circles at the retinal plane,
improved depth of focus and image resolution will occur when only central
incident rays are transmitted
Distance Vision is Minimally Affected
3.8mm diameter
1.6mm mm
27. Kamra inlay (Treating A Broad Spectrum Of Patients)
The inlay can be inserted on its own, in combination with
other refractive procedures, or as an enhancement to prior
cataract or refractive surgery.
30. Exclusion Criteria
Prior corneal procedures (Except LASIK and PRK)
Any ocular or systemic disease that is a contraindication for
corneal refractive procedures including:
Keratoconus
Uncontrolled and/or severe dry eye
Cataracts
Macular degeneration
Corneal dystrophy or degeneration
Amblyopia or Strabismus
Patients with unrealistic expectations
Patients with psychological conditions
31. The KAMRA inlay is inserted unilaterally into the patient’s
non-dominant eye in a corneal pocket and is centered over
the visual axis.
Since the inlay works based on small aperture optics rather
than change in refractive power,improved near vision
results remain immune to the progression of presbyopia,
offering patients a lifetime of benefis.
33. Acutarget ( need for it )
Remarkable axes of the eye are due to one of its peculiarities:
lack of a common axis for main refractive structures (ie, cornea and lens).
In addition, the fovea is slightly temporal to the emergence of the optic nerve.
Some axes have a
functional value (eg, visual axis or line of sight), whereas others have a
primarily
anatomical value (eg,pupil axis).
The angle kappa is between the pupil and visual axes, whereas the
angle lambda is between the pupil axis and
line of sight.
Both angles are nearly identical if the point of fiation is not close to the
eye
34. Acutarget ( need for it )
Where to center corneal refractive procedures to maximize visual outcomes remains
controversial
The pupil center is often a reference for refractive procedures. However, corneal light
reflx may be better because it may lie nearer to the corneal intercept of the visual axis
than the pupil center.
Furthermore, compensation for angle kappa is important for optimal correction of
refractive error by either laser ablation or intraocular lenses, especially for hyperopes and
any eyes with large angle kappa.
The AcuTarget (SensoMotoric Instruments, Teltow, Germany) is new and helps identify
both the corneal vertex and pupil center.
It can be used to guide surgeons on proper surgical placement of intracorneal small
aperture inlays, which are new treatment options for presbyopia.
It can also be used for cataract surgery to determine precise placement of a toric
intraocular lens
35. Comprehensive Diagnostic & Surgical Planning
With the AcuTarget HD™ you have the powerhouse of
fit separate diagnostictools combined intoone state-of-the-art
instrument. It’s designed to optimize clinical outcomes by:
• Providing objective and reliable measurements to ensure you
are targeting the right patients
• Identifying unique optical landmarks to assist with inlay
centration planning
• Supporting the management of patient care post-operatively
36. The AcuTarget HD helps identify factors that may impact
visual outcomes by:
• Evaluating the quality of vision, including objective scatter
index(OSI), which is usually unaccounted for by wavefront
aberrometers
• Assessing tear fim quality over time
• Measuring pseudo accommodation to visually demonstrate
depth-of-focus
42. As with other refractive procedures, achieving the best possible
visual outcomes with the small-aperture KAMRA™ inlay requires
precise pre-operative testing, centration and post-operative
monitoring. The AcuTarget HD™ delivers reliable and repeatable
diagnostic information unique to each patient by:
• Capturingthe patient’s estimated line of sight based on
1st Purkinje reflx, pupil boundary and pupil centroid
• Pinpointing the exact inlay position relative to the 1st Purkinje
reflx, pupil center, pupil boundary and limbus
• Reportingactual inlay placement in microns
• Offering real-time information to help manage the patient’s care
43.
44. Acutarget(assesing centration )(Perop)
To determine the centration target, the surgeon first runs the preoperative diagnostics
and planning feature of the diagnostic unit.
The system
captures an image of the eye,
identifies important landmarks with colored rings and crosses, and
displays the distance and direction between the first Purkinje image and the pupil
centroid.
The system also
calculates the distance (in terms of cord length) of the inlay to the center of the
pupil.
○ If the distance is <300 μm, then the inlay should be centered on the first Purkinje
image, and
○ if it is longer than 300 μm, then the inlay is centered between the first Purkinje
image and the pupil centroid.
49. Acutarget(assesing centration )(intraop)
Intraoperatively, the surgeon marks the eye to guide placement
of the inlay.
Different techniques can be used for this step. For example,
surgeons who have access to a certain excimer laser (WaveLight
EX500, Alcon Laboratories) can activate the aiming beam and refer to
its position by shifting it to the first Purkinje image or to any
intermediate point on the chord between it and the center of the
pupil.
With other excimer laser systems, the projection of the illumination
lights can be used as a guide once the inlay has been placed because
the lights are concentric to the first Purkinje image.
50. Acutarget(assesing centration )(postop)
“The image quantifies the location of the inlay relative to the
first Purkinje image and pupil center and allows the surgeon
to compare the postoperative results to the preoperative target,.
“The outcomes are best when the inlay is positioned about
within 300 μm of the target.”
neither slit lamps nor topographers can be used to assess inlay
centration postoperatively.
“A slit lamp cannot be used because its optics are not coaxial,
and topographers also cannot provide accurate quantitative
information aboutinlay location,”.
51. Acutarget(assesing centration )(postop)
the AcuTarget HD will help you manage the patient’s care.
And, if optimal outcomes are not achieved, it will help you
identify and address the root cause. Specifially, this
instrument can aid you in:
• Determiningif the patient is compliant with their eye drop
regimen
• Confiming the desired inlay placement was achieved
• Finding other potential reasons for less than desired optical
quality
55. Kamra Inlay result (Seyeddain)
a mean improvement from J6 pre-op to J1 in binocular
uncorrected near acuity (UNVA) in 32 emmetropic presbyopic
subjects,
with 96.9% reported UNVA of J3 or better in the implanted eyes.
No significant change in uncorrected distance acuity (UDVA) was
found at 24 months;
the implanted eye retained a mean UDVA of 20/20.10
56. Kamra Inlay result (Omer Yilmaz)
Mean UNVA was J1 in 22 participants with 96% reading J3 or better;
UDVA in all eyes was 20/40 or better.
The small decrease in both UNVA and UDVA in five eyes was suspected
to be caused by age related cataract progression.
Two patients elected to undergo cataract removal and both reported a
final UNVA of J1 or better with retainment of KAMRA inlays.
Finally, four explantations were performed in this series due to issues
related to two microkeratome flaps and two post-operative refractive
shifts.
All four subjects returned to within +/- 1D of their pre-operative refractive
status with no loss of corrected distance or near acuity
57. on 407 patients with follow-up through month 6. In the non-
dominant eye,
17.9% achieved 20/20 uncorrected near vision,
67.3% were at 20/32, and 83% were 20/40;
93.4% were 20/32 in distance vision, and
97.1% achieved 20/40 or better distance vision.
The Snellen distance vision improves over time but remains
"essentially unchanged.“
Kamra Inlay result (Kevin L. Waltz)
58. Published data from a 24-month study of 32 implanted eyes (32 patients) in
Europe showed an improvement in all tested parameters of reading
performance.
Using the Salzburg Reading Desk,
A change in patients’ mean reading distance from the preoperative value of 48.1 ±5.5
cm to 38.9 ±6.3 cm
Mean reading acuity with best distance correction improved from 0.3 ±0.14 logRAD
to 0.24
±0.11 logRAD
mean reading speed increased from 142 ±13 to 149 ±17 words per minute (P = .029).
There was a mean bilateral improvement in reading distance of 2.7 ±1.6 lines in the
other 30 patients.
Kamra Inlay result (Dexl et al)
59. Kamra Inlay (Grabner et al )
on 32 patients who were presbyopic emmetropes aged between 45 and 55
years of age. All had a spherical equivalent within half a dioptre of
emmetropia, required a reading add between 1.0 D and 2.5 D
mean gain of 4.6 lines of uncorrected near visual acuity from preoperative values in
the implanted eye, with patients reaching J1
one of the FDA’s criterion for approval of the device as a treatment for presbyopia
was that 75 per cent must be J5 or better. In fact, 98 per cent of patients in the study
achieved J3 or better and half achieved J1, he pointed out.
There was a mean gain of 1.6 lines in intermediate visual acuity (20/25) and
Preoperative UCDVA was 20/20 or better in all eyes. However, at six months’ follow-
up it was 20/20 in two thirds of eyes, 20/25 or better in 88 per cent, and 20/32 or
better in all eyes.
a mean loss of 1 line of distance visual acuity
Bilateral uncorrected distance visual acuity remained unchanged at 20/16.
60. In these studies, the inlay is placed under a 200-µm LASIK
flap after excimer laser ablation.
Emerging procedures include the Kamra’s implantation
into pockets for presbyopic patients after previous LASIK
as well as its implantation in monofocal pseudophakic
patients.
To date, the results of these combined procedures have
been promising and could greatly expand potential
candidacy for the Kamra
Kamra Inlay(SimLasik)
61. Kamra Inlay(US IDE Clinical Trial Results)
In the US IDE study, 24 sites have enrolled 508 patients between 45 and 60 years of age.
The results for the implanted eye were
an UCNVAof between J2 and J 3 at 18 months
(n = 243), which remained stable through 24 months
(n = 85).
IVA remained stable as well, with a mean intermediate measurement of 20/25 from
18 to 24 months.
DVA remained stable throughout the study, with a mean uncorrected value of
20/20.
BCDVA was better than 20/20 in the treated eye in all patients.
Uncorrected binocular distance visual acuity improved at 24 months to 20/16.
In mesopic conditions, a slight decrease in contrast sensitivitywas noted compared
with preoperative values, although this parameter remained within normal limits
66. Kamra Inlay ( effect on stereopsis)
Prospective, 6 month study of 60 patients
using the Optec Functional visual analyzer
Stereo test.
Inclusion criteria included
age of 45 – 60 years with
a spherical equivalent between+ 0.50 DS to -
0.75 DS and
an uncorrected near visual acuity (VA) of worse
than 20/40, and better than 20/100 and a best
corrected distance VA > 20/20 in both
eyes.
Inlays were implanted monocularly in the
non-dominant.
Uncorrected (U) near (N) and distance (D)
VA and stereopsis were measured
preoperatively and at 6 months
postoperatively.
67. Kamra Inlay (flap or pocket)
Based on clinical trial results, there appears to be a higher
incidence of SPK (dry eye) after a flap procedure than a
pocket based procedure
68. Kamra inlay (Advantages of Pocket
Procedures)
Significantly improved refractive stability and
predictability
Minimal effect on corneal strength
Simplified procedure
Easy centration
Improved healing and visual outcomes
72. sim-LASIK
Outside the United States, the simultaneous treatment of ametropia and presbyopia using LASIK and a
Kamra inlay is gaining popularity.
In this procedure, called sim-LASIK, the inlay is placed under a LASIK flap immediately following an
excimer laser ablation.
The 1-year results for a series of 1,535 consecutive eyes (1,535 presbyopic patients) in Japan showed that
the mean uncorrected near visual acuity at 30 cm improved by 4 lines from J9 preoperatively to J2.7
The patients' mean uncorrected distance visual acuity improved 8 lines from 20/125 preoper-atively to 20/20.
Ninety percent of the patients were satis-fied with their results.7
The most recent and exciting application for the Kamra inlay is the correction of presbyopia in patients
who have undergone LASIK. The surgeon creates a pocket under the LASIK flap and inserts the corneal
inlay.
A recent study found that a femtosecond laser-created corneal pocket can be created beneath a previous
LASIK flap and a small-aperture corneal inlay can be safely inserted to correct presbyopia.8
Initial results show
improvement in near vis-al acuity with a minimal reduction in distance visual acu-ity.
At 3 months postoperatively, the mean uncorrected near visual acuity improved by 4 lines from J6 preopera-tively to J2
.8
73. This year, Dr. Bond was most intrigued by research on the use of a
presbyopic corneal inlay in the eyes of patients who had undergone RK,
something he had before considered to be “inadvisable if not impossible.”
The investigators, Dr. Bond continued, “described 3-month results in two
patients who underwent Kamra inlay [AcuFocus, Inc.] implantation surgery
after previous RK. The article reported excellent results in this admittedly
small and early study (really a two-case report), with effective near vision
and no impact on the uncorrected distance visual acuity in both patients.
Care was taken in the first patient to not intersect the RK incisions with the
Ziemer [Ophthalmic Systems AG] femtosecond [laser-made] corneal
pockets, which were also created at 270º inferiorly, not temporally as usual.
The second [patient] had a residual refractive error, and a LASIK procedure
was performed on the same day, but immediately prior to, the inlay
implantation surgery. The inlay was implanted under the LASIK flap, also in
the inferior position.12 This is wild stuff.”