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Up Front | Feb 2011


Wavefront Technology Has Come a Long Way

This month’s cover focus is dedicated to the topic of wavefront technologies, specifically exploring the use of wavefront-guided, topographic wavefront-guided, and wavefront-optimized laser treatments for refractive surgery. Patients and surgeons will agree that, with the latest excimer laser technologies, quality of vision after surgery is at the very least preserved and in most cases improved.

After more than 10 years of experience with wavefront-guided technology, it has finally reached a mature stage. Alignment and registration of the ablation are of the utmost importance, and these are now reliable enough to achieve correction of higher-order aberrations (HOAs). Additionally, most laser manufacturers have been able to design software that improves the spherical aberration profile of the cornea, inducing fewer or no night vision problems for our patients.

Nowadays, retreatment rates below 1% for myopic treatments are common. It is reassuring to read that the worldwide experience by leading experts is strikingly similar. CRST Europe has asked a panel of surgeons to share their wavefront-related experience and discuss the different excimer laser platforms and their specific characteristics. Antonio Uceda-Montanes, MD, describes his familiarity with the iLASIK Suite (Abbott Medical Optics Inc., Santa Ana, California); Michael Mrochen, PhD, with the WaveLight EX500 (Alcon Laboratories, Inc., Forth Worth, Texas); Patrick Versace, MD, with the MEL 80 (Carl Zeiss Meditec, Jena, Germany); Paolo Vinciguerra, MD, and Elena Albé, MD, with the Nidek EC-5000 (Nidek, Gamagori, Japan); Massimo Camellin, MD, and Samuel Arba-Mosquera, MSc, with the Amaris (Schwind eye-tech-solutions, Kleinostheim, Germany); and Leonardo Mastropasqua, MD, and Lisa Toto, MD, with the Technolas 217 Z100 (Technolas Perfect Vision, Munich, Germany).

Guy M. Kezirian, MD, FACS, opens the cover focus with practical principles to guide patient selection for wavefront treatments. Naoyuki Maeda, MD, follows with an explanation of the popular wavefront applications in ophthalmology. Scott M. MacRae, MD, who developed the Zyoptix Advanced Nomogram (Technolas Perfect Vision GmbH), stresses the importance of unanticipated aberration interaction. His tremendous work led to the development of this nomogram, which does not compromise the correction of sphere and cylinder while effectively neutralizing HOAs. He describes this approach as the best of both worlds.

A. John Kanellopoulos, MD, provides an overview of the history and future of wavefront-guided treatments. Dr. Kanellopoulos has extensive experience using these treatments not only for primary LASIK but also for secondary procedures, including combining wavefront- guided PRK with corneal collagen crosslinking for the treatment of keratoconus. Dr. Camellin also focuses on retreatments, describing his transepithelial PRK technique combined with corneal wavefront after radial keratotomy or corneal transplantation.

Professor Mrochen is another pioneer in wavefront technologies. With the help of Theo Seiler, PhD, Professor Mrochen introduced the wavefront-optimized approach now available with the WaveLight Allegretto. The goal is to correct sphere and cylinder and to maintain the physiological condition of the eye’s optical errors.

Wavefront sensors will continue to improve so that we can measure more complex eyes. This will allow us to correct more complex aberrations, providing customized corrections for an even larger patient population.