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Custom vs. Conventional Ablation

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Stephen F. Brint, MD, presented the early results of a study comparing LASIK with the LADARVision System CustomCornea customized platform (Alcon Laboratories, Inc., Fort Worth, Texas) to the Allegretto excimer laser system (WaveLight Laser Technologies AG, Erlangen, Germany) in June 2004.

The WaveLight system, while using conventional technology, has been said to produce results that are equal to those with customized platforms. However, Dr. Brint’s study found that while the WaveLight Allegretto laser provides comparable conventional results to other conventional laser systems, it does not represent a substitute for customized ablation.¹

Technology differences

According to Dr. Brint, the LADARVision System with CustomCornea treats a patient’s individual wavefront errors including sphere and cylinder and higher-order aberrations up to the sixth order. LADARVision provides custom ablation by not only correcting spherical aberration, but also by correcting rotationally asymmetric and other higher-order aberrations.

“LADARVision with CustomCornea can treat coma, trefoil and fourth-order aberrations in addition to spherical aberration,” Dr. Brint said. “It is also capable of treating quadrafoil and secondary astigmatism in the fifth and sixth orders, as demonstrated in the Food and Drug Administration (FDA) studies.”

Dr. Brint added that the LADARVision System with CustomCornea minimized the induction of higher-order aberrations throughout the LASIK procedure and in many cases, reduces that amount of existing aberrations.

On the other hand, said Dr. Brint, the WaveLight system treats only sphere and cylinder and spherical aberration based on population averages.

“The WaveLight system uses a treatment algorithm based on a population average of induction of spherical aberration, not actual wavefront data,” Dr. Brint said.

Study data

In Dr. Brint’s study, patients were treated bilaterally with either the LADARVision System with CustomCornea or the WaveLight Allegretto system. For all patients, a 6.5-mm optical zone was used with a blend to 9 mm for patients undergoing LASIK with LADARVision and a 7.2-mm blend for patients having conventional LASIK with the Allegretto. According to Dr. Brint, registration with the LADAR-Vision was set to the limbus to correspond with the wavefront map registration and only pupil alignment was used for the Allegretto.

The early results of this study showed that the accuracy of treatment was comparable between systems.

“At 1 month postoperative, the achieved refraction was within 0.5 D of the target correction in 83% of eyes treated with CustomCornea and 88% of eyes treated with WaveLight and within 1 D of target correction in 100% of CustomCornea eyes and 94% of WaveLight eyes,” Dr. Brint said.

The uncorrected visual acuity was reported to be good in both groups. For eyes treated with CustomCornea, 75% were 20/15 and 100% were 20/20 1 month postoperatively. For eyes treated with the WaveLight system, 69% were 20/15 and 94% were 20/20 1 month postoperatively (Figure 1).

Patient satisfaction/overall outcomes

“No one felt they had degradation in quality of vision after surgery,” Dr. Brint said.

However 1-month data showed that significantly more higher-order aberrations were induced with the WaveLight system (Figure 2).

“The difference was more remarkable with regard to coma (Figure 3), with a slight reduction in induced coma in the CustomCornea group from preoperative to postoperative and a significant increase in the WaveLight group,” he said.

The WaveLight group also had more induction of overall higher-order aberrations than the CustomCornea group. CustomCornea has the unique ability to measure and treat any abnormal wavefront that is present and while treating spherical aberration, also controls the amount of aberrations induced during LASIK. The WaveLight system, while effective, is not equipped to be more precise than controlling for induction of a population-based average spherical aberration component.

“Alcon’s CustomCornea treatment is the best custom system on the market today and is the only system to demonstrate better quality of vision with any custom treatment currently available,” Dr. Brint said.

Reference

1. Brint SF. Alcon LADARVision vs. WaveLight conventional LASIK treatment: A comparison. Presented at the Laser and Education Development Meeting. June 2004; Taormina, Sicily.