Evolution of Refractive Surgery 2003

Daniel S. Durrie, MDOverland Park, KansasUSA

Surgical Options

2. change the lens2. change the lens

3. add a lens

1. corneal1. corneal curvaturecurvature

Evolution of Refractive Surgery

Evolution of Refractive Surgery

Evolution of Refractive Surgery

Surface Ablation Lamellar Ablation

Evolution of Refractive Surgery: - Technique 1989

LamellarSurface

PRKBroad beam laserMechanical debridment4.5 to 5.0 mm OZNo transition zonesUnilateral surgery

Excimer Laser KeratomileusisFree cap – 240 micronsUnderside of the flap ablatedSutured in place

Evolution of Refractive Surgery: - Technique 1990

LamellarSurface

PRKBroad beam laserMechanical debridment4.5 to 5.0 mm OZNo transition zonesUnilateral surgery

Excimer Laser KeratomileusisFree cap – 240 micronsUnderside of the flap ablatedSutured in place

Evolution of Refractive Surgery: - Technique 1991

LamellarSurface

PRKBroad beam laserMechanical debridment5.0 mm OZNo transition zonesUnilateral surgery

LASIKHinged flapStromal ablationNo sutures neededNasal hingeBarraquer Keratome

Evolution of Refractive Surgery: - Technique 1992

LamellarSurface

PRKBroad beam, scanning slit and spot lasersMechanical debridmentUp to 7.0 mm OZUnilateral surgery

LASIKHinged flapStromal ablationNo sutures neededNasal hingeACS Keratome

Evolution of Refractive Surgery: - Technique 1993

LamellarSurface

PRKBroad beam, scanning slit and spot lasersMechanical debridmentUp to 7.0 mm OZMultizone/multipass

LASIKHinged flapNasal hingeACS Keratome

Evolution of Refractive Surgery: - Technique 1994

LamellarSurface

PRKBroad beam, scanning slit and spot lasersAlcohol debridmentUp to 7.0 mm OZBandage contact lenses

LASIKHinged flapNasal hingeACS Keratome

Evolution of Refractive Surgery: - Technique 1995

LamellarSurface

PRK – FDA approvedBroad beam, scanning slit and spot lasersAlcohol debridmentUp to 7.0 mm OZBandage contact lenses

LASIKHinged flapNasal hingeACS Keratome

Evolution of Refractive Surgery: - Technique 1996

LamellarSurface

PRK – FDA approvedBroad beam, scanning slit and spot lasersAlcohol debridmentUp to 7.0 mm OZBandage contact lenses

LASIKHinged flapNasal hingeACS Keratome

Evolution of Refractive Surgery: - Technique 1997

LamellarSurface

PRK – FDA approvedBroad beam, scanning slit and spot lasersLaser scrapeUp to 7.0 mm OZBandage contact lenses

LASIKHinged flapNasal hingeACS Keratome

Evolution of Refractive Surgery: - Technique 1998

LamellarSurface

PRK – FDA approvedBroad beam, scanning slit and spot lasersLaser scrapeUp to 7.0 mm OZBandage contact lenses

LASIKHinged flapSuperior hingeHansatome Keratome

Evolution of Refractive Surgery: - Technique 1999

LamellarSurface

PRK – FDA approvedBroad beam, scanning slit and spot lasersLaser scrapeUp to 7.0 mm OZEye trackers

LASIKHinged flapSuperior hingeHansatome KeratomeNomograms

Evolution of Refractive Surgery: - Technique 2000

LamellarSurface

LASEKBroad beam, scanning slit and spot lasersEpithelial flapUp to 7.0 mm OZEye trackers

LASIK – FDA approvedHinged flapSuperior hingeHansatome KeratomeNomograms

Evolution of Refractive Surgery: - Technique 2001

LamellarSurface

LASEKBroad beam, scanning slit and spot lasersEpithelial flapUp to 7.0 mm OZEye trackers

LASIK – FDA approvedHinged flapHansatome KeratomeNomogramsWavefront custom ablation

Evolution of Refractive Surgery: - Technique 2002

LamellarSurface

Advance Surface AblationFlying spot lasersAlcohol debridment, no flapWavefront custom ablation

IntraLasikPrecision laser flap

Choice of hinge position and flap thicknessCentered on visual axis

Wavefront custom ablation

Lamellar

LASIK Technique 2003

Revolutionary Ultra FastMicron Level PrecisionSafety Platform

Software Controlled Laser

Optimal PrecisionEase of UseCustomizable

Breakthrough Safety Technology Platform

Single Use DisposableSterileSimple

Patient InterfaceINTRALASE FS Laser

Evolution to IntraLASIK

Evolution to IntraLASIK

IntraLASIK Technique 2003

Lamellar

Surface AblationTechnique 2003

Surface

Evolution of Refractive Surgery: 2003

We have worked over the past 10 years to improve safetyWe have improved our techniques, hardware and softwareGoals 2003 and beyond:

Improve the quality, not just Snellen acuityChoose the technology and procedure that is best for the patient, not your pocketbookWork to help those patients that have had previous refractive surgery upgrade to new technology