Surface ablation over LASIK flaps.
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Cornea↗
Biomedical subjects
James J Salz
Publications and source records attributed to James J Salz.
Pupil size and corneal laser surgery.
PURPOSE OF REVIEW: The role of scotopic pupil size as a factor in predicting night vision complaints is controversial. This review summarizes reports in the literature, some that have found and some that have failed to find a correlation with scotopic pupil size and night vision complaints. RECENT FINDINGS: Pupil-measuring devices are discussed along with informed consent issues and reports showing that wavefront aberrations increase with increasing pupil size. A new objective measuring device (Larson) showed a correlation with postoperative starbursts and pupil size and a decrease in starbursts with wavefront-guided treatments compared with conventional excimer laser treatments. Cortical adaptation allows many patients to adapt to their new night vision. Treatment options for those who remain symptomatic include drops to reduce pupil size and wavefront-guided retreatments. SUMMARY: Reports in the literature are conflicting, and refractive surgeons would be wise to inform their patients that large scotopic pupil size is a potential risk factor for night vision complaints. By doing this they will follow the recommendations in recent patient information brochures of both VISX (Santa Clara, California) and Alcon (Orlando, Florida) and on the United States Food and Drug Administration web site.
Cornea↗
Night vision complaints after LASIK.
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Astigmatism↗
Analysis of intraocular lens power calculation in post-radial keratotomy eyes.
PURPOSE: To determine whether refractive complications can be prevented by applying the currently most accurate method of intraocular lens (IOL) power calculation in the post-radial keratotomy (RK) patient. SETTING: Department of Ophthalmology, University of California, Davis, Sacramento, and American Eye Institute, Cedars Sinai Medical Center, Los Angeles, California, USA. METHODS: Twenty-four eyes having cataract surgery after RK were studied retrospectively for the final postcataract refraction and for the target refraction used in selecting the IOL. Nine of the eyes were further studied for the keratometry (K) values obtained with different methods and for the theoretical postoperative refraction with an IOL aiming for plano or -1.50 diopters (D) based on the known flatter calculated K, axial length, power of the implanted IOL, and refraction after cataract surgery. RESULTS: Implantation of an IOL aiming for plano in the 24 post-RK eyes would have resulted in a hyperopic refraction in 83.4% cases. The choice of an IOL targeted at myopia reduced the frequency of hyperopia to 42.0% (24 cases). Selection of an IOL calculated with a flatter calculated K and aiming for plano decreased the frequency of hyperopia to 44.4%; however, aiming for -1.50 D still resulted in hyperopia in 44.4% of eyes (9 cases). CONCLUSIONS: Unintentional hyperopia can be significantly decreased but not eliminated as a complication of post-RK cataract surgery. The accuracy of the IOL power determination can be improved if myopia is targeted as the postcataract surgery refractive error and the flatter calculated K is used in the IOL determination.
Humans↗
LASIK correction of spherical hyperopia, hyperopic astigmatism, and mixed astigmatism with the LADARVision excimer laser system.
OBJECTIVE: To assess the safety and effectiveness of the LADARVision active tracking narrow beam excimer laser system (Alcon Surgical, Orlando, FL) using laser in situ keratomileusis (LASIK) for correction of spherical hyperopia, hyperopic astigmatism, and mixed astigmatism. DESIGN: A multicenter, prospective non-randomized (self-controlled) comparative trial. PARTICIPANTS: A total of 360 eyes, including 152 spherical hyperopic, 143 hyperopic astigmatic, and 65 mixed astigmatic, were treated for up to +6.00-diopter (D) sphere with up to -6.00-D cylinder. INTERVENTION: Treatments were performed at six sites in the United States using a 6-mm optic zone with a 1.5-mm peripheral blend zone for a maximum ablation zone diameter of 9 mm. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), manifest refraction, vector analysis, best spectacle-corrected visual acuity (BSCVA), complications and adverse reactions, subjective symptoms, and patient satisfaction. RESULTS: Six and 12 months of follow-up, respectively, were available on 143 and 117 spherical hyperopic eyes, 124 and 74 hyperopic astigmatic eyes, and 57 and 38 mixed astigmatic eyes, respectively. For spherical hyperopes at 6 and 12 months, UCVA was 20/40 or better in 93.4% and 93.9% of eyes, respectively. The manifest refraction spherical equivalent (MRSE) was within 0.50 D of intended in 65.0% and 74.1% of eyes, respectively, and within 1.00 D in 87.4% and 91.4%, respectively. Refractive stability was demonstrated in 94.2% or more of eyes between the intervals of 1 to 3 months and 3 to 6 months and in 95.3% or more of eyes to 12 months. A loss of two lines of BSCVA occurred in 3.5% and 3.4%, respectively, and no eyes lost more than two lines. For hyperopic astigmats at 6 and 12 months, UCVA was 20/40 or better in 90.9% and 93.8% of eyes, respectively. The MRSE was within 0.50 D of intended in 60.5% and 73.0% of eyes, respectively, and within 1.00 D in 88.7% and 89.2% of eyes, respectively. Refractive stability was demonstrated in 96.5% or more of eyes, respectively, between the intervals of 1 to 3 months and 3 to 6 months and 95.5% or more to 12 months. A loss of two lines of BSCVA occurred in 5.8% and 1.4% of eyes, respectively, and no eyes lost more than two lines. For mixed astigmats at 6 and 12 months, UCVA was 20/40 or better in 92.6% and 94.4% of eyes, respectively. The MRSE was within 0.50 D of intended in 64.9% and 73.7% of eyes, respectively, and within 1.00 D in 87.7% and 94.7% of eyes, respectively. Refractive stability was demonstrated in 100% of eyes between the intervals of 1 to 3 months and 3 to 6 months and in 97.0% or more to 12 months. A loss of two lines of BSCVA occurred in 1.9% and 0.0% of eyes, respectively, and no eyes lost more than two lines. CONCLUSIONS: The data support safety and effectiveness of the LASIK correction of spherical hyperopia, hyperopic astigmatism, and mixed astigmatism with the LADARVision system.
Adult↗
Wavefront-guided treatment for previous laser in situ keratomileusis and photorefractive keratectomy: case reports.
PURPOSE: To describe the off-label use of the Alcon LADARVision System for CustomCornea (LADARWave and LADARVision4000) in two patients, one for retreatment after laser in situ keratomileusis (LASIK) and one for retreatment after photorefractive keratectomy (PRK). METHODS AND RESULTS: Both patients were unhappy with the quality of their vision after initial refractive surgery. The first patient initially had LASIK to correct -4.75 D of myopia in each eye, and then had retreatment with CustomCornea. Before retreatment, manifest refraction was OD 0.50 -0.50 x 180 degrees (20/25 uncorrected) and OS -0.50 -0.75 x 180 degrees (20/40 uncorrected). Two months after retreatment with CustomCornea, his uncorrected visual acuity OD was 20/15, and 1 month after retreatment in his left eye, uncorrected visual acuity was 20/15. The second patient had PRK OD, with a postoperative uncorrected visual acuity of 20/25 and cycloplegic refraction of +1.00 -0.75 x 84 degrees. After CustomCornea retreatment, his 3.5-month postoperative uncorrected visual acuity was 20/15 and manifest refraction was +0.50 -0.50 x 180 degrees. CONCLUSION: The Alcon LADARVision System for CustomCornea was used effectively to retreat both a myopic LASIK and myopic PRK patient, primarily for subjective quality of night vision complaints.
Adult↗