"TransPRK outcomes in virgin eyes

treated with the Aberration-Free

profile and AMARIS 500Hz laser

technology"

Ants Haavel MD

KSA Eye Center

Tallinn, Estonia

TransPRK - message to patients

• New Generation Laser Procedure

• No Touch

• No Cut

• First choice laser treatment for young myopes

• Precise

• Excellent vision quality

• Safe

• Convenient

• Real 100% laser treatment

Pre operative exam

• Refraction: objective, subjective, cycloplegic

• Scheimpflug, topography, pachymetry

• Pupillometry: scotopic, mesoptic and photopic

• IOP

• Biomicroscopy

• Funduscopy

• Health and lifestyle questionnaire

• Patient education, expectations and post op time line of visual recovery

Decision for TransPRK vs. LASIK

TransPRK

• myope under 38 y.o

• active lifestyle

• interested more in long than

short term benefits

• healthy

LASIK

• myope over 38 y.o

• interested in rapid recovery

• healthy

Medication protocol

• Pre op: starting 2 days before C vitamin 400 mg 2xd and

Levofloxacin 0,5 % eye drops 4xd

• Intra op: Alcaine 0,5 % , Chilled PVC sponge ( 20 sec. post ablation ),

Mitomycin 0,02% ( 90 sec. post ablation ), Acular 0,5%,

Levofloxacin 0,5% , Dexamethasone 0,5 %, Oasys Hydraclear CL

• Post op up to 5 days Chloramphenicol-Dexamethasone 0,5 % 3xd ,

Acular 3xd , non preservative artificial tears every 30 minutes

during wake up hours. Remove contact lenses 5-7 days post op not

earlier.

• Post op up to 2 months Dexamethasone 0,5% next 2 months post

op. 1 week 4xd; 2-3 week 3xd , 4-8 week 2xd. C vitamin 400 mg

b.i.d. 2 weeks post op. Artificial tears if requested.

Op video

05/12/11

Optional follow-up schedule

• 5-7 days post op remove contact lenses

• 1 M objective refraction, visual acuity

• 3 M objective & subjective refraction

• 6 M objective & subjective refraction

• 12 M months objective & subjective refraction

• 1 year in next years

Average values and ranges pre operative

in 49 patients (98 eyes)

Optical Zone

Mean ± StDev Range

Ast [D]

UCVA [logMAR]

UCVA [20/n]

Age

BCVA [logMAR]

BCVA [20/n]

28,08 ± 5,74

6,85 ± 0,32

-0,58 ± 0,63

0,95 ± 0,39

20/200++

-3,41 ± 1,48SEq [D]

20/20

19 to 40

6,30 to 7,50

-6,75 to -0,50

-2,90 to 0,00

0,10 to 1,60

20/25 to 20/800

-0,20 to 0,10

20/10 to 20/25

0,00 ± 0,04

4%6%

62%

24%

4%

0%

20%

40%

60%

loss 2 loss 1 unchanged gain 1 gain 2

monocular 3M (98 eyes)

Safety: PreOp BCVA vs. PostOp BCVA

2% 3%4%

26%

96%

92%

100%98%

100% 100%

0%

20%

40%

60%

80%

100%

20/12,5 or

better

20/16 or

better

20/20 or

better

20/25 or

better

20/32 or

better

preOP BCVA postOP UCVA 3M

Cumulative PreOp BCVA vs. PostOp UCVA

Scattergram: Defocus

y = 1,05x + 0,12

R2 = 0,93

0

1

2

3

4

5

6

7

8

9

0 1 2 3 4 5 6 7 8 9Attempted SEQ [D]

Achieved [D]

overcorrected

undercorrected

Scattergram: Astigmatism

y = 0,92x + 0,06

R2 = 0,86

0

1

2

3

4

0 1 2 3 4

Attempted Cyl [D]

Achieved [D]

overcorrected

undercorrected

Accuracy: Defocus

52%

60%

73%

83%

94%

100%

0%

20%

40%

60%

80%

100%

±0.1

3 D

±0.2

5 D

±0.5

0 D

±0.7

5 D

±1.0

0 D

±1.2

5 D

Accuracy in Defocus 3M (98 eyes)

Accuracy: Astigmatism

71%

82%

96%100%

0%

20%

40%

60%

80%

100%

±0.1

3 D

±0.2

5 D

±0.5

0 D

±0.7

5 D

Accuracy in Cylinder 3M (98 eyes)

Refractive Summary

3-month post operative in 49 patients

Mean±StDev Range

Seq [D]

Ast [D]

UCVA [logMAR]

UCVA [20/n]

BCVA [logMAR]

BCVA [20/n]

-0,20 to 0,20

20/10 to 20/32

-0,13 ± 0,22

-0,02 ± 0,07

20/20+

-0,02 ± 0,07

-0,38 to 1,25

-0,75 to 0,00

-0,20 to 0,20

20/10 to 20/32

20/20+

0,31 ± 0,42

TransPRK gives cornea more energy load than conventional surface ablations.

Extend your conventional surface ablation MMC, NSAID and dexamethasone treatment times.

Educate patients to relax and look into laser during extended ablation times.

Adjustment of clinical protocol

Marketing of Trans PRK

• You can change name of TransPRK for more customer friendly and attractive trade name which is suitable for your market and practice.

• New generation non touch laser procedure for new generation people.

• Premium product positioned and priced higher as Femto LASIK.

• Position it as treatment for intelligent, educated and open minded people.

• Young active people really prefer gradual visual recovery to avoid having life time cut in the cornea.

• Due plasticity of young tissues and accommodation abilities patients have high satisfaction rate, relatively quick visual recovery and real life is usually better than numbers in “Datagraph”.

Conclusion

• Highly patient driven No Touch No Cut laser procedure for treating myopia which rises practice’s revenue and profitability.

• Lower overhead gives practice more resources for investments andmarketing budget.

• Surface ablations need more time for educating patients and pro active communication from laser center personnel.

• TransPRK success = patient education, exact pre-op refraction and exams, precise laser technology, pro active communication, customized nomogram and adjusted clinical-medication protocol.

Welcome to TransPRK World!