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Customized program allows surgeon to treat each eye individually
Surgeon shares the evolution he has experienced over the past 3 years with customized ablation.
KUALA LUMPUR — When it comes to refractive laser surgery, each patient’s eye is individual, and it must be individually treated, Michael A. Lawless, MD, said here in an interview with Ocular Surgery News.
Dr. Lawless described his experiences using wavefront-customized LASIK for more than 2 years with the Alcon LADARVision system with CustomCornea.
“You can’t do custom in a generic way,” Dr. Lawless said at the Asia-Pacific Academy of Ophthalmology meeting. “You have to target the individual eye, and that is what this system tries to do.”
Dr. Lawless’ clinic began using LADARVision about 4 years ago, he said, and the company’s wavefront customization options in January 2003.
From May to December 2003, the clinic treated about 2,500 eyes, and about 29% of those received customized wavefront surgery, he said.
“We were getting low to moderate uncorrected visual acuity in the range of 90% to 95% with 20/20, and about half of those were 20/15.”
Treatment range
“The people who didn’t get custom were those outside the treatment range and people with hyperopia,” he said. In addition, patients with thin corneas were at first not selected for the custom program because early algorithms removed more tissue than those now available, he said.
While he was happy with the results of those treated with customized treatments, Dr. Lawless said he was not happy with only being able to custom-treat 29% of patients. Dr. Lawless said the new algorithm his clinic started using in February 2004, the M3plus, instituted a generational change.
Each new algorithm has been “always better than the previous version,” he said. “They’re better at saving tissue, better at targeting spherical aberration and remain a very good treatment for coma and other higher-order aberrations.”
“This marked the introduction of a true individualized customized ablation,” Dr. Lawless said.
“In calendar year 2004, 47% of our eyes were treated with custom as opposed to 29% prior to the new algorithm,” he said.
Nomogram changes
In addition to the algorithm change, Dr. Lawless described what he called “an improved user-interface change,” which allows the surgeon to create his own nomogram to further customize the treatment to the individual.
“Even with custom you still need your own nomogram for personalized data,” Dr. Lawless said. “So with nomogram adjustments we could offset a small dioptric plus or minus, and we built that into our treatment, Dr. Lawless said.”
“We are able to look at what we’ve done and evolve the nomogram over time, so it’s like a living thing,” he said.
Dr. Lawless said an added bonus of the new user interface is that it allows the surgeon to program the treatment for monovision as well, with up to 2.5 D difference between eyes.
Before the nomogram adjustment, Dr. Lawless said, “if we wanted to do monovision we had to do custom in one eye and conventional in the other eye.”
For Your Information:
- Michael A. Lawless, MD, can be reached at Eye Institute, 270 Victoria Ave., Chatswood, NSW 2067 Australia; +61-29-424-9999; fax: +61-29-410-3000; e-mail: mlawless@theeyeinstitute.com.au. Dr. Lawless is a member of Alcon’s medical advisory board.
- Alcon can be reached at 6201 South Freeway, Fort Worth, TX 76134; +1-817-293-0450; fax: +1-817-568-6142; Web site: www.alconlabs.com.
- David W. Mullin is Managing Editor of OSN Europe/Asia-Pacific Edition.