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Purpose: To compare the visual outcomes following topography-guided laser in situ keratomileusis (LASIK) treatment using manifest refraction versus a new topography analysis software. Methods: A prospective, randomized, observer-masked contralateral study was conducted in the refractive services of a tertiary eye care hospital in South India. Analysis of visual outcomes, corneal higher-order aberrations, and contrast sensitivity were performed at 3 months postoperative visit following uneventful topography-guided LASIK using the Wavelight EX500. One eye was treated with the Contoura platform using manifest refraction (Contoura), while the contralateral eye was treated using an ablation profile planned by the Phorcides Analytic Engine (Phorcides). Results: Sixty eyes of 30 patients were included in the study. At 3 months postoperative visit, the uncorrected distance visual acuity (UDVA) in the Contoura and Phorcides groups was logarithm of the minimal angle of resolution (logMAR) 0.04 ± 0.07 and logMAR 0.06 ± 0.1, respectively (P = 0.483). Postoperative manifest refractive spherical error (MRSE) was 0.12 ± 0.22 and − 0.06 ± 0.20 D in the Contoura and Phorcides groups, respectively (P = 0.338). Although higher number of eyes demonstrated a gain in one or more lines of corrected distance visual acuity (CDVA) in the Contoura group (16.6% vs. 6.6%), the difference was not statistically significant (P = 0.361). Vector analysis (Alpins criteria) for postoperative cylinder, contrast sensitivity measurement, and corneal higher-order aberration profile showed no significant difference between the two groups at 3 months postoperative visit (P = 0.213, 0.514, and 0.332, respectively). Conclusion: Quantitative and qualitative visual outcomes with the Phorcides Analytic Software were similar to the Contoura treatment using manifest refraction.

To compare and analyze the differences in visual outcomes between Visx iDesign Advanced WaveScan Studio™ System, Alcon Wavelight Allegro Topolyzer and Nidek EC-5000 using Final Fit™ Custom Ablation Treatment Software from the submitted summary of safety and effectiveness of the US Food and Drug Administration (FDA) data. In this retrospective comparative study, 334 eyes from Visx iDesign, 212 eyes from Alcon Contour, and 135 eyes from Nidek CATz platforms were analyzed for primary and secondary visual outcomes. These outcomes were compared via side-by-side graphical and tabular representation of the FDA data. Statistical significance was calculated when appropriate to assess differences. A -value <0.05 was considered statistically significant. The mean postoperative uncorrected distance visual acuity (UDVA) at 12 months was 20/19.25±8.76, 20/16.59±5.94, and 20/19.17±4.46 for Visx iDesign, Alcon Contoura, and Nidek CATz, respectively. In at least 90% of treated eyes at 3 months and 12 months, all three lasers showed either no change or a gain of corrected distance visual acuity (CDVA). Mesopic contrast sensitivity at 6 months showed a clinically significant increase of 41.3%, 25.1%, and 10.6% for eyes using Visx iDesign, Alcon Contoura, and Nidek CATz, respectively. Photopic contrast sensitivity at 6 months showed a clinically significant increase of 19.2%, 31.9%, and 10.6% for eyes using Visx iDesign, Alcon Contoura, and Nidek CATz, respectively. FDA data for the three platforms shows all three were excellent with respect to efficacy, safety, accuracy, and stability. However, there are some differences between the platforms with certain outcome measurements. Overall, patients using all three lasers showed significant improvements in primary and secondary visual outcomes after LASIK surgery.

To evaluate patient-reported outcomes with a validated patient questionnaire following topography-guided LASIK (TG-LASIK).PurposeTo evaluate patient-reported outcomes with a validated patient questionnaire following topography-guided LASIK (TG-LASIK).Patients undergoing TG-LASIK using Phorcides analytic software were prospectively enrolled to receive an adapted Patient-Reported Outcomes with LASIK Symptoms and Satisfaction (PROWL) questionnaire before and 26-weeks after treatment. The main study outcome was the change in the Global Vision Satisfaction Index from the PROWL questionnaire.MethodsPatients undergoing TG-LASIK using Phorcides analytic software were prospectively enrolled to receive an adapted Patient-Reported Outcomes with LASIK Symptoms and Satisfaction (PROWL) questionnaire before and 26-weeks after treatment. The main study outcome was the change in the Global Vision Satisfaction Index from the PROWL questionnaire.Forty-six patients underwent treatment and completed the modified PROWL questionnaire before and 26-weeks after TG-LASIK. The Global Vision Satisfaction Index from the modified PROWL questionnaire improved from 4.07 (3.87-4.26) to 5.00 (4.81-5.19) after the TG-LASIK treatment (p < 0.0001). The study population's binocular uncorrected distance visual acuity was 20/16, 20/12.5, and 20/10 or better in 100%, 87.0%, and 15.2% at 26 weeks post TG-LASIK, respectively.ResultsForty-six patients underwent treatment and completed the modified PROWL questionnaire before and 26-weeks after TG-LASIK. The Global Vision Satisfaction Index from the modified PROWL questionnaire improved from 4.07 (3.87-4.26) to 5.00 (4.81-5.19) after the TG-LASIK treatment (p < 0.0001). The study population's binocular uncorrected distance visual acuity was 20/16, 20/12.5, and 20/10 or better in 100%, 87.0%, and 15.2% at 26 weeks post TG-LASIK, respectively.Patient satisfaction as assessed with the modified PROWL questionnaire is very high after undergoing TG-LASIK using Phorcides analytic software. Patient-reported outcomes add another dimension when assessing treatment efficacy beyond change in visual acuity and corneal architecture, and specialists may consider incorporating such assessments into the consenting process and patient education at large.ConclusionPatient satisfaction as assessed with the modified PROWL questionnaire is very high after undergoing TG-LASIK using Phorcides analytic software. Patient-reported outcomes add another dimension when assessing treatment efficacy beyond change in visual acuity and corneal architecture, and specialists may consider incorporating such assessments into the consenting process and patient education at large.

The aim of this study was to evaluate the health-related quality of life (HRQoL) before and after the management of keratoconus (KCN) with Combined Topography-Guided Transepithelial partial photorefractive keratectomy (PRK) and corneal Cross-Linking: the Athens Protocol. Thirty-four consecutive patients treated for progressive KCN were selected for retrospective telephone interview and individual questionnaire submission. A disease-specific HRQoL questionnaire was administered before and after the Athens Protocol intervention, using the following administrative questionnaires: National Eye Institute Visual Function Questionnaire (NEI VFQ) 25/39 and IVI-28. The disease grade was ranked according to the Amsler-Krumeich classification (KCN severity). Reliability of collected data was evaluated with Cronbach's α test. Patients' age ranged from 15 to 51 years at the time of the operation. Mean time before the operation during which the questionnaires were administered was 52±6 months. General visual acuity, psychological well-being, and driving ability showed significant improvement. Younger keratoconic patients tend to have more enhanced psychological status and to cope better with difficulties in everyday activities (prior to operation) than older patients. The Athens Protocol treatment has been proven to be beneficial to patients in a large number of aspects.

To assess the safety, aberrometric and keratometric changes, and stability of trans-epithelial topography-guided phototherapeutic keratectomy (TE-TG-PTK) with mitomycin C (MMC) using the ALLEGRO Topolyzer platform for the treatment of irregular astigmatism. This is a retrospective case series including 57 eyes that underwent TE-TG-PTK + MMC using the ALLEGRO Topolyzer platform for the treatment of irregular astigmatism. CDVA, manifest refraction (MR), keratometry readings, and aberrometry readings were analyzed at 1, 3, 6, and 12 months. Causes of corneal irregularity included non-infectious leucoma (n=23), infectious leucoma (n=7), adenoviral keratitis (n=20), corneal haze (n=2), post-penetrant keratoplasty (PKP) (n=1), and others (n=4). Overall, 76% of the eyes (n=40) gained lines of vision; patients gained 1, and 2 or more lines of vision in 76%, and 38% of cases, respectively. Only 1 patient (2%) lost 5 lines of vision. Mean preoperative CDVA (LogMAR) was 0.37 ±0.31 and improved to 0.14 ±0.18 (p<0.001) at final follow-up (12 months). CDVA remained unchanged in 10 eyes (21%). No significant changes were observed in mean keratometry (Kmean) and keratometric astigmatism readings. Regarding aberrometry, only changes in coma proved to be significant 6 months after surgery (P<0.01). No intraoperative/postoperative complications were reported. At final follow-up, significant improvements were observed in CDVA and coma. TE-TG-PTK + MMC proved to be an effective and safe procedure for the treatment of corneal irregular astigmatism due to several causes.

The safety and long-term efficacy of automated ray-tracing customized myopic and myopic astigmatic femtosecond laser-assisted LASIK. This consecutive case series retrospective analysis, of 20 subjects (40 eyes) treated with automated raytracing named Wavelight Plus, to include low and high order aberrations based on a three-dimensional custom virtual eye for each case-calculated from interferometry data-obtained from a single diagnostic device that also provides Hartman-Shack Wavefront and Scheimpflug tomography data. We evaluated before and after the customized LASIK procedure: visual acuity, refractive error, high order aberrations, contrast sensitivity, and psychometric post-operative visual function data. At 24 months, the comparison of the pre-operative to the post-operative refractive and visual function value changes in average were: subjective manifest refraction from -4.38 ± 2.54 diopters (D) (range -9.75 to -1.25 D) to +0.11 ± 0.19 D; subjective manifest refractive astigmatism from -0.76 ± 0.91 D (range -2.75 to 0 D) to -0.13 ± 0.16 D, corneal astigmatism from -1.16 ± 0.64 D (range -0.2 to -2.8) to -0.47 ± 0.11 D. 65% of the eyes studied demonstrated an increase of at least one line of vision, while from the same group 38% demonstrated 2 lines of increase. High order aberrations, contrast sensitivity as well as the subjective psychometric input based on the VFQ-25 questionnaire demonstrated actual improvement. This longer-term follow-up, single-arm retrospective consecutive case series documents LASIK treatment customization that appears to be safe and effective in the correction of myopia and myopic astigmatism. Markedly improved objective and subjective visual function post-operatively, underlying the potential importance of simultaneously attempting to correct high order aberrations and improving the spatial alignment of total, measured human eye optics.

To assess the efficacy and safety of topography-guided LASIK (TG-LASIK) in correcting myopia and astigmatism and to evaluate clinical outcomes and visual quality postoperatively. We conducted a prospective study including patients aged 18-40 years with stable refraction for over 12 months. The outcomes measured were uncorrected distance visual acuity (UDVA), contrast sensitivity, higher-order aberrations (HOAs), and patient-reported visual quality using a validated Quality of Vision (QoV) questionnaire. A total of 86 eyes of 43 patients were analyzed. At 12 months postoperatively, 97% of the eyes achieved a UDVA of 20/20 or better, and 99% maintained or improved their corrected distance visual acuity (CDVA). The mean UDVA remained stable over time ( > 0.05). The correction index for astigmatism was 0.99, with a strong correlation between target-induced astigmatism (TIA) and surgically induced astigmatism (SIA) ( = 0.9751). Contrast sensitivity improved significantly at all spatial frequencies postoperatively ( < 0.05) and remained stable after 6 months. The QoV questionnaire revealed that blurred vision and fluctuations in vision were the most frequently reported symptoms, with fluctuation being the most bothersome. HOAs and coma increased significantly after surgery ( < 0.05), whereas lower-order aberrations (LOAs) and spherical aberration remained unchanged ( > 0.05). TG-LASIK is an effective approach in personalized refractive surgery, demonstrating safety and efficacy in improving visual quality for myopia and astigmatism. The improvement in visual quality, despite an increase in HOAs, suggests the effectiveness of personalized ablation profiles.

To assess the subjective satisfaction, visual disturbances, and dry eye symptoms following Phorcides planned Contoura topography-guided LASIK. This was a single site, single arm, prospective study of patient reported outcomes after bilateral Phorcides planned Contoura topography-guided LASIK. Preoperative and postoperative data were collected for responses on the Patient-Reported Outcomes with LASIK Symptoms and Satisfaction (PROWL-SS) questionnaire (a lower score represented a worse outcome), Ocular Surface Disease Index (OSDI) questionnaire (a higher score represented a worse outcome), refraction, and visual acuity. Linear mixed effect models were used to compare preoperative and postoperative scores on the PROWL-SS for satisfaction, and the frequency, bothersomeness, and visual impact of glare, halo, starbursts, and double images. A total of 50 subjects completed the study. Mean age was 29.3 ± 5.0 years (range 20 to 39 years). The mean 3-month postoperative satisfaction score was 53.2 higher than the mean preoperative score (p <0.0001). Mean 3-month postoperative scores were 7.4, 13.7, 18.0, and 29.2 higher postoperatively compared to preoperatively for double image, glare, halo, and starburst, respectively. All differences were significant (p <0.0001) with the exception of double image. Mean score on the OSDI questionnaire was 27.0 ± 22.4 preoperatively, compared to 7.5 ± 6.7 at 3 months postoperatively (p <0.0001). Postoperatively, 97% of eyes (90/100) had MRSE within ± 0.5 D and postoperative residual astigmatism was ≤ 0.5 D in 96% of eyes (96/100). Postoperative UDVA was 20/20 or better in 98% (98/100) of eyes, 20/16 or better in 81% (81/100) of eyes, and 20/12.5 or better in 31% (31/100) of eyes. The results of this study suggest improved patient reported satisfaction, reduced dry eye symptoms, and overall decrease in visual disturbances at 3 months following Phorcides planned Contoura LASIK.

A retrospective study to determine the incidence of posterior ocular astigmatism (POA) after removal of topography guided excimer laser ablation utilizing topography measured astigmatism and axis to remove anterior corneal astigmatism and measure residual astigmatism in 1500 eyes. WaveLight Contoura was performed with topography measured astigmatism and axis, and all inaccurate outcomes were analyzed for the presence of low topographic astigmatism and significant residual manifest astigmatism. A secondary enhancement procedure was then performed, and measurements taken to measure the presence of topography measured astigmatism and the lack of manifest astigmatism to confirm that POA had been present. Out of the 1500 eyes, 44 were confirmed to have POA, resulting in an incidence of 2.93%. The average amount of manifest astigmatism in these eyes post-primary procedure was 1.13D, and the average topography measured astigmatism was 0.39D. After secondary enhancement with wavefront optimized ablation, the average amount of post-operative astigmatism was 0.01D, and the average amount of topography measured astigmatism was 1.11D. Post-secondary enhancement procedure, average higher-order aberration was reduced 9%. The incidence of 2.93% is lower than prior estimated amounts of posterior ocular astigmatism.

To compare visual outcomes of eyes that had laser refractive surgery with the Contoura Phorcides treatment plan and eyes that had laser refractive surgery with the wavefront-optimized treatment plan using the same laser. Retrospective chart review of clinical outcomes of eyes that had either Contoura with Phorcides (CP) or wavefront-optimized (WFO) corneal refractive procedures using the Wavelight EX500 (Alcon Vision, LLC). Data were collected and compared for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, change in postoperative UDVA compared to preoperative CDVA, and change in postoperative CDVA compared to preoperative CDVA. Total eyes included were 348, with 227 in the CP Group and 121 in the WFO Group. Post-operatively, there was a significantly higher percentage of eyes in the CP Group that were 20/16 or better compared to the WFO Group (57%, 129 eyes, and 17%, 21 eyes, respectively; p < 0.001). The percentage of eyes that gained 1 or more Snellen lines of UDVA compared to preoperative CDVA was higher in the CP Group (47%; 107 eyes) compared to the WFO Group (12%; 14 eyes), which was statistically significant (p < 0.001). Differences in refraction were statistically significant. Topography-guided and wavefront-optimized treatment profiles both provided excellent refractive results. A higher percentage of eyes that were treated using Contoura with Phorcides achieved 20/16 or better unaided distance vision compared to eyes receiving a wavefront-optimized treatment plan.