VISX Presbyopia treatment- Dr. Jeff Machat

Visx Presbyopia trial : 

Visx Presbyopia trial TLC Toronto

Study Centers and Investigators : 

Study Centers and Investigators University of Ottawa Eye Institute W. B. Jackson, MD G. Mintsioulis, MD TLC, Toronto J. Machat, MD Image Plus Laser Eye Center J. Wiens, MD

Multifocality – What Does it Mean? : 

Multifocality – What Does it Mean? Optics before hyperopic presbyopia treatment

Multifocality – What Does it Mean? : 

Modify optics for long depth of focus Multifocality – What Does it Mean?

VISX Multifocal Treatment Design : 

VISX Multifocal Treatment Design Central zone provides near correction The diameter of the central zone is proportional to the pupil size (wavefront driven) The combination of the central zone, peripheral zone, and the LASIK flap produces an aspheric curve that expands the depth of focus distance correction near correction

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VISX® Hyperopic PresbyopiaAblation Profile

Corneal Topography Case Study : 

Corneal Topography Case Study ID#14115: OS Pre-Op 20/50 uncorrected distance J7 uncorrected near J5 distance corrected near At 3 months 20/20 uncorrected distance J1 uncorrected near J1 distance corrected near

Slide 8: 

Corneal Topography Case Study(14115: OS) Processed topography maps shows mean curvature within optical zone area at pre and 3 months Post-op central region is steepened as intended Pre-op 3 months post-op

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Volumetric PSF Simulation

PSF Simulation : 

PSF Simulation

Baseline Characteristics : 

Baseline Characteristics 75 eyes of 43 hyperopic presbyopic subjects Ottawa Eye Institute: 54 eyes of 27 subjects TLC, Toronto: 16 eyes of 12 subjects Image Plus Laser Eye Center: 5 eyes of 4 subjects Pre-Op Refractions Sphere: 1.70 D ± 0.58 (range 0.5 to 3.5 D) Cylinder: 0.43 D ± 0.35 (range 0.00 to 1.5 D) Age: 56 ± 5 (range 47 to 68) 60% Female

Monocular Uncorrected Distance Vision : 

Monocular Uncorrected Distance Vision Percent of Eyes

Binocular Uncorrected Distance Vision : 

Binocular Uncorrected Distance Vision Percent of Subjects

Monocular Uncorrected Near Vision : 

Monocular Uncorrected Near Vision Percent of Eyes

Binocular Uncorrected Near Vision : 

Binocular Uncorrected Near Vision Percent of Subjects

Reading Performance Test : 

Reading Performance Test Functional vision test measured monocularly Endpoints: Reading Acuity - based on number of words read correctly Maximum Reading Speed Critical print size – smallest font at which maximum speed is possible

Reading Performance ResultsPre-op distance-corrected vision compared to post-op uncorrected vision : 

Reading Performance ResultsPre-op distance-corrected vision compared to post-op uncorrected vision Maximum Reading Speed was maintained post-operatively Reading Acuity Critical Print Size Percent of Eyes Percent of Eyes

MRSE Over Time : 

MRSE Over Time MRSE (Diopters) Pre 1M 3M 6M 12M 9M ± 0.59 ± 0.71 ± 0.54 ± 0.55 ± 0.41 ± 0.38

6M Intended vs. Achieved : 

6M Intended vs. Achieved 73% of eyes are within ±0.5 D of emmetropia at 6M Post-op

12M Intended vs. Achieved : 

12M Intended vs. Achieved 82% of eyes are within ±0.5 D of emmetropia at 12M Post-op

Monocular Simultaneous Uncorrected Distance and Near Vision @ 6 month : 

Monocular Simultaneous Uncorrected Distance and Near Vision @ 6 month 20/25 or better J3 or better 77% of eyes achieve both 20/25 distance and J3 near or better

Binocular Simultaneous Uncorrected Distance and Near Vision @ 6 mth : 

Binocular Simultaneous Uncorrected Distance and Near Vision @ 6 mth 20/25 or better J3 or better 96% of subjects achieve both 20/25 distance and J3 near or better

Functional Near Vision Scores : 

Functional Near Vision Scores

Questionnaire ResultsSatisfaction with Overall Visual Sharpness & Clarity : 

Questionnaire ResultsSatisfaction with Overall Visual Sharpness & Clarity Percent of Eyes

Questionnaire ResultsSatisfaction with Distance Vision (Bright) : 

Questionnaire ResultsSatisfaction with Distance Vision (Bright) Percent of Eyes

Questionnaire ResultsSatisfaction with Near Vision (Bright) : 

Questionnaire ResultsSatisfaction with Near Vision (Bright) Percent of Eyes

Questionnaire ResultsSatisfaction with Vision at Night : 

Questionnaire ResultsSatisfaction with Vision at Night Percent of Eyes

Questionnaire ResultsSpectacle Use : 

Questionnaire ResultsSpectacle Use Percent of subjects

Best Corrected Visual Acuity * : 

Best Corrected Visual Acuity * Distance: loss of > 2 lines 3 eyes of 2 subjects at 6M, associated w/ SPK 1 eye of 1 subject at 12M No eye worse than 20/25-2 Near: loss of > 2 lines 3 eyes of 3 subjects at 6M, associated w/ dry eye 2 eyes of 2 subjects at 12M No eye worse than J1+ *Under Photopic conditions

Dim Contrast Sensitivity : 

Dim Contrast Sensitivity Contrast sensitivity scores are within population norms for 50-75 year age group (shown in gray) Cycles per Degree 3 6 12 18

Summary of Long Term Results : 

Summary of Long Term Results 96% of subjects achieve simultaneous 20/25 distance vision and J3 near vision at 6M Spectacle independence is achieved and maintained Patient satisfaction is good Loss of contrast sensitivity within normal limits 73% of eyes at 6M and 82% of eyes at 12M within ±0.5 D of emmetropia Follow-up is ongoing Myopic trials now being conducted

Toronto Case StudyS.A.-54 yo : 

Toronto Case StudyS.A.-54 yo Pre-op Rx: O.D. +2.50/-0.50 x 120 20/20 O.S. +2.25/-0.50 x 067 20/20 +2.00 add Successful bifocal SCL wearer Surgery done Sept 13/04

Bilateral presbyopic ablation1 year results : 

Bilateral presbyopic ablation1 year results UCVA: O.D. 20/20-1 plano/-0.25 x 20 20/20 O.S. 20/20+ plano/-0.25 x 180 20/20+ @ 40cm UCVA O.D.: J3 O.S.: J3 O.U.: J1 negative SA

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