Astigmatism Management and Refractive Cataract Surgery

C,I,R
Acufocus, Inc.
, Abbott Medical Optics, Inc. C,I, Adoptics C, Advanced
C
C
Refractive Technologies Alcon Laboratories,
Inc. , AqueSys C,I Bausch +
C,I,R
,
Lomb, Inc.
C,I
C,I
C,I
Bio Syntrx
Calhoun Vision Inc,
Clarity Ophthalmics ,
C,I
C,I
I,
Clear Sight , CoDa Therapeutics Confluence Acquisition Partners
I, Inc.
C,I
LLC I, EBV Partners
, EGG Basket
Curveright, LLC I, CXL Ophthalmics,
C,I,
C,I
Ventures
ELENZA, C, Encore
C,I
Evision Photography, C,I, Evision Medical Laser , I, Eyemaginations, Inc. ,
ForSight, C,
C,I
I,
Foresight Venture Fund #3, , Fziomed Glaukos
C,I
I
I,
Corporation , HEAVEN Fund , Healthcare Transaction
Services High
C,I,
Performance Optics
C,I
C,I
C
,
Hoya Surgical Optics
Improve Your Vision , ISTA, C, Lensar
C,I,
LenSx
, Lifeguard Health, C,I , Lumineyes,
Inc. C , Minnesota Eye Consultants,
C,I
P.A. ,
C,I
c
Nisco, I, NuLens
Ocular Surgery News/Slack, , Ocular Optics C,I
C
Ocular Therapeutix, C,I, Omega Eye Health,C,I, Omeros Corp.,
C, I
C,I.R
OnPoint, I, One Focus Ventures, 1, Pixel
Optics,
Quest
, Rainwater
C,I
I,
Healthcare I, Refractec , MD, Revision Optics,
Revital Vision C, I,, SarboxNP, I, SARcode Corporation 1, Schroder Life Science
Venture Fund C,1,
I
Seros Medical, LLC C, Sight Path, C,I, MD, Solbeam, I , SRxA, C, Surgijet/Visijet, C,
C,I
C,I, MD
C,I
3D Vision Systems , TLC Vision
, Tearlabs, Inc. C,I, Tracey Technologies ,
Transcend
C,I
C
I
C,I
Medical, Inc, , True Vision,
, Versant Viradax , Vision Solutions
Technologies C,I,
TriPrima, I, Wavefront Systems, I
*C=Consultant
*I= Investor * MD= Medical Director
*R= Royalty
THIS PRESENTATION MAY CONTAIN DISCUSSION OF OFF LABEL USE OF FDA APPROVED DRUGS AND/OR DEVICES
“This presentation represents the speaker’s professional experience.”
“Products/procedures not approved by the FDA and off label use of FDA approved products/procedures may
be discussed.”
• Astigmatic Keratotomy flattens the
corneal meridian where placed.
• Coupling is the phenomenon that
steepens the meridian 90 degrees away
from the AK.
• My approach combines ‘On-Axis’ Phaco
with 8 mm optical-zone arcuate
keratotomies.
• Preoperative marking of horizontal meridian.
• Gimbel-Mendez ring and Sinskey hook
surgical demarcation of primary (steep-axis)
meridian.
• 8mm optical-zone marker is placed aligned to
the primary meridian.
• HPMC is used after marking to lubricate the
epithelium and enhance visualization.
• 600 micron depth Lindstrom-Thornton
diamond fashions arcuate(s) with forceps
fixation.
• Phaco incisions are then placed.
Femtosecond Laser
•
2008: 1st Femtosecond Laser used
clinically in EU for Laser Refractive
Cataract Surgery (Nagy, Budapest)
• 1st Femtosecond Laser to receive
FDA clearance for cataract surgery
(2009)
•
Currently three 510(k) clearances:
- Anterior Capsulotomy
- Corneal Incisions
- Laser Phacofragmentation
•
1st Laser Refractive Cataract Surgery
procedure performed in US on
Feb 29, 2010 (Slade, Houston)
•
Image shown for educational purposes only
First case MEC: Aug. 22, 2011
1. Mark steeper and flatter meridian with
Mastel or Zeiss Surgical Keratoscope
2. WaveTec Intraoperative
Aberrometer(Orange/ORA) used to
select IOL power and measure
intraoperative astigmatism
3. Corneal relaxing incisions titrated open
using Mastel Surgical Keratoscope and
WaveTec aphakic refraction
ISK
•Alignment
•Diagnostic
•Centration
•Verification
Patent Pending
Illuminating Surgical Keratoscope
Corneal Mires:
Enhanced rendered image
representing corneal mires
created by the illuminated
surgical keratoscope.
Clinically Proven to Increase
Accuracy & Improve Outcomes
• Provides intra-operative refractive
information
• Enables on-demand course
correction
• “Get it right – right on the table”
• Compatible with & attaches to
existing surgical microscopes
Image shown for educational purposes only
Mean effect of an on-axis incision
1.82.2mm(n=6)
2.83.2mm(n=7)
Range
0.25-0.50 D
Mean
0.39 D
0.25-1.00 D
0.58 D
Mean effect of corneal relaxing incision
plus on axis incision (8mm optical
zone, 80% depth): (n=12)
Range
30° (n=4) 0.50-1.00
45° (n=3) 0.75-1.50
60° (n=5) 1.25-2.00
Mean
0.75D
1.19D
1.55D
A.Range: 0.25 – 0.75D (25)
B.Mean: 0.39D
C.0.50 or less : 96%(24 of 25)
* 92% of cases with 0.50D or less
defocus and 0.50D or less of
astigmatism post operative.
On Axis incision: 1-8-2.2mm
0.25 D
On Axis incision: 2.8 mm-3.2 mm
0.50 D
On Axis incision Plus: 1 X 30 CRI
0.75 D
On Axis incision Plus: 1 X 45 CRI
1.00-1.50 D
On Axis incision Plus: 1 X 60 CRI
1.50-2.00 D
On Axis Incision Plus: 2 X 45 CRI
2.00-2.50 D
On Axis Incision Plus: 2 X 60 CRI
2.50-3.00 D
1. Refractive outcomes are the critical
component in successful Refractive
Cataract Surgery.
2. New surgical tools including a
Surgical Keratoscope,
Intraoperative Aberrometer, and
Femtosecond Laser may enhance
refractive outcomes and reduce
enhancement rates.