A. Mannsfeld

Early Outcomes of INTRACOR Femtosecond Laser Treatment for Presbyopia

PURPOSE To investigate early functional outcomes of the INTRACOR femtosecond laser-based intrastromal procedure to treat presbyopia. METHODS Twenty-five eyes of 25 presbyopic patients were enrolled in this prospective, ethics committee-approved study. Following detailed preoperative examination, the INTRACOR procedure was performed using the TECHNOLAS femtosecond laser (Technolas Perfect Vision GmbH) in the non-dominant eye. Postoperatively, follow-up examinations were performed at 1 day, 1 week, and 1 and 3 months, including near and distance visual acuity, slit-lamp microscopy, and corneal topography. RESULTS All 25 surgeries were uneventful. The mean postoperative uncorrected near visual acuity increased from 0.7+/-0.16 logMAR to 0.26+/-0.21 logMAR and the mean uncorrected distance visual acuity changed slightly from 0.11+/-0.11 logMAR to 0.05+/-0.1 logMAR at 3 months postoperative. Regarding best distance correction, mean sphere changed from +0.75+/-0.23 diopters (D) preoperatively to +0.15+/-0.31 D postoperatively and mean cylinder from -0.33+/-0.17 D to -0.42+/-0.23 D. Postoperative healing was uneventful, and in all eyes, the cornea was clear within a few hours after surgery without any remaining cavitation gas bubbles. CONCLUSIONS The INTRACOR procedure for presbyopia showed good visual acuity outcomes in the early postoperative period. The short treatment time in combination with maintained corneal integrity suggests this new technique has good potential for the treatment of presbyopia.

Intraocular lens power calculation after intrastromal femtosecond laser treatment for presbyopia: Theoretic approach

PURPOSE: To evaluate the accuracy of intraocular lens (IOL) power calculation after an intrastromal femtosecond laser procedure to treat presbyopia using a theoretic approach. SETTING: International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. DESIGN: Nonrandomized clinical trial. METHODS: Preoperatively and 12 months after intrastromal femtosecond laser treatment (IntraCor) of presbyopia, biometry was performed by partial coherence interferometry (PCI) (IOLMaster). The postoperative keratometry (K) values and IOL power calculation formulas (Holladay I, Haigis, SRK/T, Hoffer Q) were compared with results derived from the clinical history method, taking the manifest refraction change into account. RESULTS: The study enrolled 25 patients (median age 54 years). Three eyes were excluded for age‐related lens changes. The median spherical equivalent change in the other 22 eyes was −0.38 diopter (D). The median difference in K values between the clinical history method and PCI was −0.21 D, resulting in a median IOL power difference between −0.23 D (SRK/T) and −0.29 D (Haigis) (range −1.58 to +1.00 D). The IOL power was underestimated in 59.1% of cases with the Hoffer Q and 63.6% of cases with the Holladay I, Haigis, and SRK/T. There was a difference of ±0.75 D in 72.7% of eyes using the Holladay I, Haigis, and Hoffer Q and in 86.4% of eyes using the SRK/T. Neither K values nor IOL power differences were statistically significant (P > .17). CONCLUSION: Intraocular lens power calculation using modern standard formulas incorporated in a PCI biometry device after intrastromal femtosecond presbyopia treatment was reliable, with minimum underestimation on average. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Dynamic stimulation of accommodation

We describe the analysis of accommodation using wavefront measurements in phakic and pseudophakic eyes. Accommodation measurements were performed in phakic and pseudophakic eyes using a dynamic stimulation aberrometry (DSA) device (Optana) as an attachment to the WASCA aberrometer (Carl Zeiss Meditec AG). Aberrations were measured for distance fixation (3.0 m) and near fixation (0.3 to 0.11 m) presenting different accommodative stimuli (3.0 to 9.0 diopters). The device was able to detect changes in aberrations using near and distance stimulation. Eyes with phakic iris-fixated intraocular lenses (IOLs) showed normal age-correlated accommodation. In pseudophakic eyes, accommodation varied depending on the IOL. With monofocal IOLs (eg, MA60AC, Alcon), there was no accommodation; with an accommodating IOL (eg, Synchrony, Visiogen), there was a low level of accommodation. The DSA device is capable of measuring accommodation using wavefront data. It will help to further analyze changes in accommodation-related wavefront aberrations.

Wavefront analysis in ophthalmologic diagnostics

ZusammenfassungDie moderne Aberrometrie erfasst neben den Standardrefraktionsfehlern des Auges auch die sog. Aberrationen höherer Ordnung. In der Ophthalmologie und Optometrie werden Zernike-Polynome verwendet, um Aberrationen der Hornhaut sowie der Linse, die durch Refraktionsfehler entstehen, zu beschreiben. Aberrationen höherer Ordnung können nach erfolgreicher Laserchirurgie die Ursache von Visusminderung und Patientenunzufriedenheit sein. Auf den Wellenfrontdaten basierende „enhancements“ können hier Abhilfe bringen. In der Akkommodationsforschung werden Aberrometer auch zur objektiven Messung einer Refraktionsänderung verwendet. Die Wellenfronttechnologie und ihre individualisierte klinische Anwendung haben dem Ophthalmologen eine Vielzahl von Alternativen beschert, die delikate Balance der Optik des Auges zu verstehen. Die Zukunft der refraktiven Chirurgie besteht in vermehrten individualisierten Behandlungen zur Unterdrückung induzierter höherer Aberrationen und damit verbesserten klinischen Ergebnissen. Im Intraokularlinsenbereich werden die Patienten weitere Forderungen nach individualisierten IOL stellen, welche Aberrationen höherer Ordnung korrigieren.AbstractModern aberrometry measures standard and so-called higher-order refractory aberrations. Ophthalmology and optometry use Zernike polynomials to describe aberrations of the retina and lens causing refractory errors. Aberrations of a higher order sometimes follow successful laser surgery, causing reduced vision and inducing patient dissatisfaction; enhanced wavefront data can help to avoid this. Aberrometry is used also for objective measurement of refractory changes. Wavefront techniques and their clinical application enable many options for understanding the delicate balance of eye optics. The future of refractive surgery lies in increasingly individualized treatment to suppress higher degrees of aberration and thus improve clinical results. Patients will continue placing greater demand on individualized intraocular lenses that correct higher-order aberrations.Modern aberrometry measures standard and so-called higher-order refractory aberrations. Ophthalmology and optometry use Zernike polynomials to describe aberrations of the retina and lens causing refractory errors. Aberrations of a higher order sometimes follow successful laser surgery, causing reduced vision and inducing patient dissatisfaction; enhanced wavefront data can help to avoid this. Aberrometry is used also for objective measurement of refractory changes. Wavefront techniques and their clinical application enable many options for understanding the delicate balance of eye optics. The future of refractive surgery lies in increasingly individualized treatment to suppress higher degrees of aberration and thus improve clinical results. Patients will continue placing greater demand on individualized intraocular lenses that correct higher-order aberrations.

Die Wellenfrontanalyse in der ophthalmologischen Diagnostik

ZusammenfassungDie moderne Aberrometrie erfasst neben den Standardrefraktionsfehlern des Auges auch die sog. Aberrationen höherer Ordnung. In der Ophthalmologie und Optometrie werden Zernike-Polynome verwendet, um Aberrationen der Hornhaut sowie der Linse, die durch Refraktionsfehler entstehen, zu beschreiben. Aberrationen höherer Ordnung können nach erfolgreicher Laserchirurgie die Ursache von Visusminderung und Patientenunzufriedenheit sein. Auf den Wellenfrontdaten basierende „enhancements“ können hier Abhilfe bringen. In der Akkommodationsforschung werden Aberrometer auch zur objektiven Messung einer Refraktionsänderung verwendet. Die Wellenfronttechnologie und ihre individualisierte klinische Anwendung haben dem Ophthalmologen eine Vielzahl von Alternativen beschert, die delikate Balance der Optik des Auges zu verstehen. Die Zukunft der refraktiven Chirurgie besteht in vermehrten individualisierten Behandlungen zur Unterdrückung induzierter höherer Aberrationen und damit verbesserten klinischen Ergebnissen. Im Intraokularlinsenbereich werden die Patienten weitere Forderungen nach individualisierten IOL stellen, welche Aberrationen höherer Ordnung korrigieren.AbstractModern aberrometry measures standard and so-called higher-order refractory aberrations. Ophthalmology and optometry use Zernike polynomials to describe aberrations of the retina and lens causing refractory errors. Aberrations of a higher order sometimes follow successful laser surgery, causing reduced vision and inducing patient dissatisfaction; enhanced wavefront data can help to avoid this. Aberrometry is used also for objective measurement of refractory changes. Wavefront techniques and their clinical application enable many options for understanding the delicate balance of eye optics. The future of refractive surgery lies in increasingly individualized treatment to suppress higher degrees of aberration and thus improve clinical results. Patients will continue placing greater demand on individualized intraocular lenses that correct higher-order aberrations.Modern aberrometry measures standard and so-called higher-order refractory aberrations. Ophthalmology and optometry use Zernike polynomials to describe aberrations of the retina and lens causing refractory errors. Aberrations of a higher order sometimes follow successful laser surgery, causing reduced vision and inducing patient dissatisfaction; enhanced wavefront data can help to avoid this. Aberrometry is used also for objective measurement of refractory changes. Wavefront techniques and their clinical application enable many options for understanding the delicate balance of eye optics. The future of refractive surgery lies in increasingly individualized treatment to suppress higher degrees of aberration and thus improve clinical results. Patients will continue placing greater demand on individualized intraocular lenses that correct higher-order aberrations.

Die Wellenfrontanalyse in der ophthalmologischen Diagnostik@@@Wavefront analysis in ophthalmologic diagnostics

ZusammenfassungDie moderne Aberrometrie erfasst neben den Standardrefraktionsfehlern des Auges auch die sog. Aberrationen höherer Ordnung. In der Ophthalmologie und Optometrie werden Zernike-Polynome verwendet, um Aberrationen der Hornhaut sowie der Linse, die durch Refraktionsfehler entstehen, zu beschreiben. Aberrationen höherer Ordnung können nach erfolgreicher Laserchirurgie die Ursache von Visusminderung und Patientenunzufriedenheit sein. Auf den Wellenfrontdaten basierende „enhancements“ können hier Abhilfe bringen. In der Akkommodationsforschung werden Aberrometer auch zur objektiven Messung einer Refraktionsänderung verwendet. Die Wellenfronttechnologie und ihre individualisierte klinische Anwendung haben dem Ophthalmologen eine Vielzahl von Alternativen beschert, die delikate Balance der Optik des Auges zu verstehen. Die Zukunft der refraktiven Chirurgie besteht in vermehrten individualisierten Behandlungen zur Unterdrückung induzierter höherer Aberrationen und damit verbesserten klinischen Ergebnissen. Im Intraokularlinsenbereich werden die Patienten weitere Forderungen nach individualisierten IOL stellen, welche Aberrationen höherer Ordnung korrigieren.AbstractModern aberrometry measures standard and so-called higher-order refractory aberrations. Ophthalmology and optometry use Zernike polynomials to describe aberrations of the retina and lens causing refractory errors. Aberrations of a higher order sometimes follow successful laser surgery, causing reduced vision and inducing patient dissatisfaction; enhanced wavefront data can help to avoid this. Aberrometry is used also for objective measurement of refractory changes. Wavefront techniques and their clinical application enable many options for understanding the delicate balance of eye optics. The future of refractive surgery lies in increasingly individualized treatment to suppress higher degrees of aberration and thus improve clinical results. Patients will continue placing greater demand on individualized intraocular lenses that correct higher-order aberrations.Modern aberrometry measures standard and so-called higher-order refractory aberrations. Ophthalmology and optometry use Zernike polynomials to describe aberrations of the retina and lens causing refractory errors. Aberrations of a higher order sometimes follow successful laser surgery, causing reduced vision and inducing patient dissatisfaction; enhanced wavefront data can help to avoid this. Aberrometry is used also for objective measurement of refractory changes. Wavefront techniques and their clinical application enable many options for understanding the delicate balance of eye optics. The future of refractive surgery lies in increasingly individualized treatment to suppress higher degrees of aberration and thus improve clinical results. Patients will continue placing greater demand on individualized intraocular lenses that correct higher-order aberrations.