Lewis R Groden MD Lewis R Groden MD (1,2(1,2), Ana-Maria Oliva MD ), Ana-Maria Oliva MD (2)(2), , S Elizabeth Groden, Amy Martino MD S Elizabeth Groden, Amy Martino MD (2)(2)

11 LasikPlus Vision Center, Tampa, FL LasikPlus Vision Center, Tampa, FL

22 University of South Florida Dept of Ophthalmology, Tampa, FL University of South Florida Dept of Ophthalmology, Tampa, FL

LRG: code A, consultant, Alcon LabsLRG: code A, consultant, Alcon Labs

AMO, SEG, AM: no financial interests in the subject matter of this posterAMO, SEG, AM: no financial interests in the subject matter of this poster

Results of Hyperopic PRK: Results of Hyperopic PRK: Comparison of 3 Excimer Laser Comparison of 3 Excimer Laser PlatformsPlatforms

Purpose:To determine if the visual acuity results of hyperopic prk differ based on the excimer laser platform used, and compare the results of hyperopic prk to those of hyperopic lasik.  Methods:Retrospective chart review of 135 consecutive hyperopic prk cases performed by one surgeon using either the Alcon Wavelight Allegretto EyeQ 400 wavefront-optimized (WFO) (31 eyes), AMO VISX Star S4 IR conventional (VSX) (83 eyes), or AMO VISX Star S4 IR wavefront-guided CustomVue (CV) (21 eyes) excimer platforms. All cases had a minimum follow-up of three months. Patient demographics, preoperative vision data, and post-operative uncorrected visual acuity (UCVA) were collected and analyzed. Results were also compared to previously reported hyperopic lasik results. Results:20/20 or better UCVA was obtained in 21 of 31 WFO eyes (68%), 49 of 83 VSX eyes (59%), and 17 of 21 CV eyes (81%). These differences are not statistically significant (Fisher’s exact test): WFO vs CV, p=0.35; WFO vs VSX, p=0.52; CV vs VSX, p=0.08. 20/25 or better UCVA was obtained in 23/31 (74%) WFO, 67/83(81%) VSX, and 19/21 (90%) CV eyes. These differences are not statistically significant (Fisher’s exact test). UCVA results for mixed astigmatism prk vs hyperopic astigmatic prk , and hyperopic prk vs hyperopic lasik were also not significantly different.  Conclusion: Good UCVA results were obtained with hyperopic prk done on each of the platforms studied. There was no statistically significant difference in achieved UCVA between these three platforms. These UCVA results are not significantly different from those previously reported for hyperopic lasik.

To determine if the visual acuity results of To determine if the visual acuity results of hyperopic prk differ based on the excimer hyperopic prk differ based on the excimer laser platform used, and compare the results laser platform used, and compare the results of hyperopic prk to those of hyperopic lasikof hyperopic prk to those of hyperopic lasik

PurposePurpose

MethodsMethodsPRK standard technique: 20% alc for epi removal, PRK standard technique: 20% alc for epi removal, 0.02% mmc x 12 sec0.02% mmc x 12 sec retrospective chart review of consecutive cases retrospective chart review of consecutive cases 2008-2010, one surgeon (LRG), follow- up: minimum 2008-2010, one surgeon (LRG), follow- up: minimum 3 months 3 months 135 eyes / 74 patients135 eyes / 74 patients age: 27 – 69 yrs age: 27 – 69 yrs sex: 34 F, 40 Msex: 34 F, 40 M preop refraction: sphere +0.25 - +4.75 Dpreop refraction: sphere +0.25 - +4.75 D

cyl 0 - -3.50 D cyl 0 - -3.50 D

Alcon Wavelight Allegretto EyeQ 400, wavefront Alcon Wavelight Allegretto EyeQ 400, wavefront optimized (WFO) : 31 eyesoptimized (WFO) : 31 eyes

AMO VISX Star 4 IR conventional (VSX): 83 eyesAMO VISX Star 4 IR conventional (VSX): 83 eyes

AMO VISX Star 4 IR wavefront-guided CustomVue AMO VISX Star 4 IR wavefront-guided CustomVue (CV) : 21 eyes(CV) : 21 eyes

Excimer Laser PlatformExcimer Laser Platform

Topography pattern (pmd, I-S diff 1.4 – 1.9 D): Topography pattern (pmd, I-S diff 1.4 – 1.9 D):

101 eyes101 eyesThinnest pach < 470 microns: 17 eyesThinnest pach < 470 microns: 17 eyesGuttata: 2 eyesGuttata: 2 eyesOccupation / patient preference: 15 eyesOccupation / patient preference: 15 eyes

Reason for PRKReason for PRK

HPRK 20/20+ 20/25+ 20/40+HPRK 20/20+ 20/25+ 20/40+

Total 135 eyes 87 eyes (64%) 109 (81%) 133 (99%)Total 135 eyes 87 eyes (64%) 109 (81%) 133 (99%)

VSX 83 eyes 49 (59%) 67 (81%) 82 (99%)VSX 83 eyes 49 (59%) 67 (81%) 82 (99%)

CV 21 eyes 17 (81%) 19 (90%) 21 (100%)CV 21 eyes 17 (81%) 19 (90%) 21 (100%)

WFO 31 eyes 21 (68%) 23 (74%) 30 (97%) WFO 31 eyes 21 (68%) 23 (74%) 30 (97%)

Results : uncorrected visual acuity Results : uncorrected visual acuity (UCVA)(UCVA)

Fisher’s exact test 20/20+ 20/25+ 20/40+Fisher’s exact test 20/20+ 20/25+ 20/40+

VSX vs CV p= 0.08 p= 0.5 p= 1.0VSX vs CV p= 0.08 p= 0.5 p= 1.0

CV vs WFO p= 0.35 p= 0.17 p= 1.0CV vs WFO p= 0.35 p= 0.17 p= 1.0

VSX vs WFO p= 0.52 p= 0.44 p= 0.47 VSX vs WFO p= 0.52 p= 0.44 p= 0.47

Differences between laser platforms Differences between laser platforms are not statistically significantare not statistically significant

mixed astig prk (52 eyes) hprk (83 eyes) Fisher’s exact Chi Sqmixed astig prk (52 eyes) hprk (83 eyes) Fisher’s exact Chi Sq

20/20+ 35 eyes (67%) 48 (58%) p=0.28 p=0.3620/20+ 35 eyes (67%) 48 (58%) p=0.28 p=0.36

20/25+ 45 (87%) 59 (71%) p=0.06 p=0.0620/25+ 45 (87%) 59 (71%) p=0.06 p=0.06

20/40+ 52 (100%) 81 (98%) p=0.5 p=0.69 20/40+ 52 (100%) 81 (98%) p=0.5 p=0.69

Results: UCVA mixed astig prk = hprkResults: UCVA mixed astig prk = hprk

< 3 D >3 D< 3 D >3 D

67 eyes 16 eyes Fisher’s exact67 eyes 16 eyes Fisher’s exact

20/20+ 42 (63%) 6 (38%) p= 0.0920/20+ 42 (63%) 6 (38%) p= 0.09

20/25+ 48 (72%) 11 (69%) p= 1.020/25+ 48 (72%) 11 (69%) p= 1.0

20/40+ 65 (97%) 16 (100%) p= 1.0 20/40+ 65 (97%) 16 (100%) p= 1.0

Results: UCVA Results: UCVA spherical equivalent < 3D = > 3Dspherical equivalent < 3D = > 3D

hprk hlasik (*) hprk hlasik (*)

135 eyes 135 eyes Chi Sq135 eyes 135 eyes Chi Sq

20/20+ 87 (64%) 94 (70%) NS20/20+ 87 (64%) 94 (70%) NS

20/25+ 109 (81%) 114 (84%) NS 20/25+ 109 (81%) 114 (84%) NS

* Groden LR, Saunders T Comparison of Hyperopic Lasik with Wavefront-* Groden LR, Saunders T Comparison of Hyperopic Lasik with Wavefront-Optimized, Conventional, and Wavefront-Guided Platforms ASCRS 2010 Optimized, Conventional, and Wavefront-Guided Platforms ASCRS 2010

Results: UCVA hprk = hlasikResults: UCVA hprk = hlasik

Good UCVA results were obtained with hyperopic prk done on each Good UCVA results were obtained with hyperopic prk done on each of the excimer platforms studiedof the excimer platforms studied

No statistically significant differences in achieved UCVA between the No statistically significant differences in achieved UCVA between the three platforms (WFO, VSX, CV)three platforms (WFO, VSX, CV)

UCVA results for prk in eyes with mixed astigmatism did not differ UCVA results for prk in eyes with mixed astigmatism did not differ from the results for prk in eyes with hyperopic astigmatismfrom the results for prk in eyes with hyperopic astigmatism

UCVA results for hyperopic prk are not significantly different from UCVA results for hyperopic prk are not significantly different from the results previously reported for hyperopic lasikthe results previously reported for hyperopic lasik

ConclusionsConclusions