Wavefront Treatment with CRS-Master and MEL80 Improves Quality of Vision
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Wavefront Treatment with CRS-Master and MEL80 Improves Quality of Vision
- 1. Wavefront Treatment with the Carl Zeiss Meditec CRS-Master and MEL80 Excimer Laser Dan Z Reinstein MD MA(Cantab) FRCSC 1,2,3,4 1. London Vision Clinic, London, UK 2. St. Thomas’ Hospital - Kings College, London, UK 3. Weill Medical College of Cornell University, New York, 4. Centre Hospitalier National d’Ophtalmologie, (Pr. Laroche) , Paris, France
- 3. Night Vision – Starbursts & Haloes
- 4. Night Vision – Starbursts & Haloes
- 5. Reduced Contrast Sensitivity Natural vision contrast
- 7. Pre -3.25-0.50x102 4.63 1.51 Reduce Aberrations 0.55 0.36 Post +0.50-0.50x5
- 9. Can the wavefront add benefit to aspherically optimised sphero–cylindrical treatments?
- 12. Aspheric Alone or Aspheric + Wavefront HO’s? R Spheric Aspheric Aspheric + Wavefront HO’s
- 15. Results: Precision Aspheric Wavefront Guided
- 16. Add Wavefront to Aspheric Treatment? Efficacy
- 17. Add Wavefront to Aspheric Treatment? Accuracy
- 18. Add Wavefront to Aspheric Treatment? Safety
- 19. Average Induction of Seidel Spherical Aberration ~ 20% less Induced Spherical Aberration Add Wavefront to Aspheric Treatment? Significant
- 20. Results: Contrast Sensitivity 6 months 3 months * * Average Post Operative Contrast Sensitivity * *
- 21. Pre-Operative 6 Month Post-Operative Results: Contrast Sensitivity * * * Average Contrast Sensitivity
- 22. Average Contrast Sensitivity Aspheric Aspheric Wavefront Guided Results: Contrast Sensitivity
- 23. Discussion: Pre-op levels of HOAs Average Pre Op Zernike Coefficients Mean HO RMS: 0.30 µm (OSA Notation)
- 25. Benefit of Aspheric-WF over Aspheric Spherical Aberration Z4,0 -50% -50% -50% -50%
Editor's Notes
- Wavefront sensing technology is necessary to improve what we are delivering our patients. For too long we have been judging our success on 100% contrast charts. See how much more difficult it is to see when contrast is low; Instead of gauging our success on the Snellen chart, we are now looking to actually improving the quality of vision.
- Here is a night vision view with good optics
- Here is the same view with added spherical and other aberrations
- Similar issues can arise from high levels of higher order aberrations during the day.
- Multiple claims have been made about wavefront technology, but many. What has wavefront technology really allowed us to do?
- Let me give you a real example.
- Certainly wavefront technology has taught us that Munnerlyn profile based treatments induce considerable amounts of spherical aberration, and that aspherically optimised treatments significantly reduce the induction of spherical aberration. The big question is really: does adding the higher-order aberrations to an aspherically optimized treatment of further benefit?
- Wavefront technology has taught us that Munnerlyn based myopic profiles induce considerable amounts of spherical aberration, and that aspherically optimised treatments significantly reduce the induction of spherical aberration. The big question is really: does adding the higher-order aberrations to an aspherically optimized sphere and cylinder treatment actually provide further benefit?
- To find out, we prospectively studied 25 patients in whom an aspherically optimised profile was used to correct sphere and cylinder in one eye, while the other eye received the same plus the higher order aberrations present in that eye.
- The cohort included myopic eyes evenly distributed between -1 and -7.50 D.
- This is the standard scatter plot, showed a Pearson Correlation coefficient of 0.97 between the attempted and achieved results.
- The first thing we learned was that adding the higher order wavefront components to the aspheric lower order treatment did not increase the scatter in the results: the correlation coefficient for the wavefront eyes was the same at 0.96
- The second thing that we learned was that there was no difference between wavefront and aspheric alone eyes in efficacy, with over 90% achieving 20/20 or better and 20% 20/10.
- Neither was a difference in spherical equivalent accuracy
- Nor safety, both in lines gained or lost. However, when me moved to look at the higher order aberrations, the data was more revealing.
- The wavefront eyes benefited by a 20% lower level of induction of spherical aberration, which was statistically significant.
- For these eyes at 3 months follow-up, there was statistically significant improvement in contrast sensitivity in the wvaefront guided eyes, but by 6 months, this difference was no longer seen.
- This we believed to be due to the very low levels of higher order aberrations in these normal eyes before surgery. In other words: if we are putting only a small amount of higher order aberrations into the treatment of eyes, the wavefront component of the treatment may get overshadowed by the induced aberrations caused by the sphere and cylinder treatment.