LaserVision Refractive Audit

Mr John Fenton FRCSI

Refractive auditRefractive audit

• 1160 consecutive procedures in 14 months1160 consecutive procedures in 14 months• 300 lasek300 lasek• 816 lasik816 lasik• 85 % choose wavefront guided treatment (of 85 % choose wavefront guided treatment (of

benefit if high refractive errors ,night glare, benefit if high refractive errors ,night glare, astigmatism, large pupils) –15% standard astigmatism, large pupils) –15% standard treatment – equal outcomes for low errorstreatment – equal outcomes for low errors

• Post-op 96% binocular distance acuityPost-op 96% binocular distance acuity <= 6/6 unaided<= 6/6 unaided

Audits: All patients

014

413393

206

111

240 0 0

0

50

100

150

200

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300

350

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450

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Age Distribution - Eyes

pre op (1161)

month(eyes)

Age Distribution

1%

36% 34%

18%

10%

2%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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Age Distribution - Percentage

pre op (1161)

month(eyes)

0%4% 4%

12%7%

82%87%

1% 1% 1%1%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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Refractive outcome - Percentage within Attempted

1 m (848) 3 m (137)

month (eyes)

Audits; All Surgery types- All patient types

Audits: All surgery types-Myopes

Achieved Correction SEQ over Time 'STABILITY'

-0.25

-0.13-0.23-0.23

-0.25-0.24

-3.35

1990 732 111 66 27 15-6.00

-5.00

-4.00

-3.00

-2.00

-1.00

0.00

1.00

pre op 1 m 3 m 6 m 9 m 1 y 2 y

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Audits: All Surgery types- Hyperopes

Achieved Correction SEQ over Time 'STABILITY'

-0.29

0.130.210.180.04

2.65

143 97 23 9 6 6-1.00

-0.50

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

pre op 1 m 3 m 6 m 9 m 1 y

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number of eyes pre OP: 1160

age@OP average 35 years (from 18 to 66)

eye left 49.9% or 579 eyes right 50.1% or 581 eyes

pre SR equiv: mean -2.53 D ± 2.58 D (from -9.50 to 6.38)pre SR sph: mean -2.11 D ± 2.66 D (from -9.25 to 7.00)pre SR cyl: mean -0.86 D ± 1.01 D (from -7.25 to 0.00)

number of eyes 1 m: 848 (follow up rate 73.1%)

post SR equiv: mean -0.21 D ± 0.44 D (from -2.50 to 1.63)post SR sph: mean -0.10 D ± 0.45 D (from -2.50 to 2.25)post SR cyl: mean -0.22 D ± 0.36 D (from -2.75 to 0.00)

0%

10%

43%

60%

29%

14%17%

10%4%2% 4%5%

1%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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UCVA - Percentage 'EFFICACY'

1 m (290)

4 m (42)

month(eyes)

All LASEK cases efficacy after 1 and 4 months

Audits Custom LASEK Myopes

46%

35%31%29%

15%18%

4%3% 4%1%

15%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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UCVA - Percentage 'EFFICACY'

1 m (237)

3 m (34)

month(eyes)

Audits: Custom LASIK Myopes

1%

31%

42%

32%36%

19%14%

8%7% 6%2% 3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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UCVA - Percentage 'EFFICACY'

1 m (376)

3 m (59)

month(eyes)

Complications Complications • Undercorrection (+/- 1D) or overcorrection of Undercorrection (+/- 1D) or overcorrection of

refractive error require enhancement – lasek refractive error require enhancement – lasek enhancement rate of 4% - high refractive errors enhancement rate of 4% - high refractive errors more likelymore likely

• Lasik flap complications (decentered, thin) 6 Lasik flap complications (decentered, thin) 6 eyes require additional enhancementeyes require additional enhancement

• Epithelial ingrowth requiring flap lift and Epithelial ingrowth requiring flap lift and debridement 4 eyesdebridement 4 eyes

• 2 eyes lost one line of best corrected acuity2 eyes lost one line of best corrected acuity• 14 eyes gained one or more lines of best acuity14 eyes gained one or more lines of best acuity