Surgical data reveals that Q-Factor is important for good surgical outcome

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1 Surgical data reveals that Q-Factor is important for good surgical outcome Michael Mrochen, PhD Michael Bueeler, PhD Tobias Koller, MD Theo Seiler, MD, PhD IROC AG Institut für Refraktive und Ophthalmo-Chirurgie Stockerstrasse Zürich PD Dr. Michael Mrochen, 3/7/07 1

2 Some history 1st Wavefront Congress, Santa Fe, 2000 Jack T. Holladay, MD PD Dr. Michael Mrochen, 3/7/07 2

3 Background Spherical based ablation profiles (hyperopia) Munnerlyn s profile Pre- and post asphericity are assumed to be equal Q 1 = Q 2 = 0 Valid one for very small optical zones Assumes paraxial optics Paraxial + small optical zone allows to neglect the pre- and postoperative operative corneal curvature: a( r) = a max 2 ΔDr 2( n 1) Reference: Munnerlyn CR, Koons SJ, Marshall J. Photorefractive keratectomy: a technique for laser refractive surgery. J Cataract Refract Surg. 1988;14: PD Dr. Michael Mrochen, 3/7/07 3

4 Background Ablation profile for sphere based on wavefront theory Change in corneal shape equals to wavefront aberrations a( r) = amax Wavefront defocus can be represented in diopter Ablation profile ΔDr 4 ( r, φ) W ( n 1) PD Dr. Michael Mrochen, 3/7/07 4 C 4 a( r) = a = max ΔDr 2( n 1)

5 Background Change in asphericity due to a defocus correction The cornea has an aspherical shape z ( x, y) R + = R 2 2 ( 1+ Q)( x + y ) 1+ Q There is a change in the corneal asphericity when using Munnerlyn s ablation profile 2 dq 8ΔDR Q 1 1 Reference: Damien Gatinel: Corneal Asphericity Change after Excimer Laser Hyperopic Surgery: Theoretical Effects on Corneal Profiles and Corresponding Zernike Expansions. Investigative Ophthalmology & Visual Science, May 2004, Vol. 45, No. 5 PD Dr. Michael Mrochen, 3/7/07 5

6 c c 5 Q-value and spherical aberration Preoperative spherical aberration of the cornea ( Q + 1) 5( Q + 1) 5( Q + 1) 5 5( Q + 1) 0 pre pre pre pre 4, pre = rpre 320rpre 448rpre 3072rpre Postoperative spherical aberration of the cornea ( Q + 1) 5( Q + 1) 5( Q + 1) 5 5( Q + 1) 0 post post post post 4, post = rpost 320rpost 448rpost 3072rpost r r pre = post = Induced spherical aberration Δc = c c 0 R... R pre r 0 post r 0 4 4, pre 4, post =... PD Dr. Michael Mrochen, 3/7/07 6

7 Postoperative corneal asphericity that does not induce spherical aberration POST-OP q-value SPHERICAL MYOPIA CORRECTION [D] PD Dr. Michael Mrochen, 3/7/07 7

8 Distribution of asphericity in a normal population Mainly negative Q-values The mean shape of the human cornea P.M. KIELY, G. SMITH and L.G. CARNEY OPTICA ACTA, 1982, Vol. 29, No. 8, PD Dr. Michael Mrochen, 3/7/07 8

9 The role of intraocular structures Corneal aberrations? Total aberrations PD Dr. Michael Mrochen, 3/7/07 9

10 C12OSA pre-op [micron] Spherical aberration vs. Q-value Fit Resultate: r = p < Significant correlation Extreme large scatter in data set Impact of intraocular structures Ideales Q für mittlere Augen Fit linear 99% Vorhersage Q Pre-OP C12OSA post-op [micron] PD Dr. Michael Mrochen, 3/7/07 10

11 Ideal Q-value for zero spherical aberration Navaro eye model (others were used too) Variation of corneal curvatures according to the amount of myopic correction Variation of the lens power and lens asphericity according to their typically published ranges PD Dr. Michael Mrochen, 3/7/07 11

12 Data set for Navaro eye model Dimension Low-power lens Standard Lens High-power lens Radii of curvature (mm) r r Axial thickness (d2) Surface powers (D) F F Equivalent power (D) Assumed depth of anterior chamber Q = -6.1 Q = -3.1 Q = -0.1 Dimension Mean value Range Corneal radius (mm) to 8.8 Corneal power (D) to 48 Depth of anterior chamber (mm) incl. corneal thickness to 4.6 Equivalent power of lens (D) to 29 Equivalent power of eye (D) to modified eye models PD Dr. Michael Mrochen, 3/7/07 12

13 Ideal Q-value for zero spherical aberration Medium Power Cornea Ideal corneal asphericity Q Ideal corneal asphericity Q Medium Power Cornea Highly negative Q of Lens High Power Lens -0.1 Medium Power Cornea Medium Power Mean Lens Q of Lens Low Power Lens -0.2 Medium Power Cornea -0.1 High Power Lens Q of lens close to zero Medium Power Lens Low Power Lens High Power Lens -0.4 Medium Power Lens -0.3 Low Power Lens -0.5 Ideal corneal asphericity Q Pre-op refraction [D] Pre-op refraction [D] Pre-op refraction [D] PD Dr. Michael Mrochen, 3/7/07 13

14 Lens with highly negative Q Ideal Q-value for zero spherical aberration High Power Cornea Ideal corneal asphericity Q High Power Cornea Highly negative Q of Lens High Power Lens Medium Power Lens Low Power Lens High Power Cornea Mean Q of Lens Ideal corneal asphericity Q Pre-op refraction [D] Lens with mean negative Q Ideal corneal asphericity Q High Power Lens Medium Power Lens High Power Cornea Low Power Lens Q of lens close to zero Pre-op refraction [D] Lens with Q close to zero High Power Lens Medium Power Lens Low Power Lens Pre-op refraction [D] PD Dr. Michael Mrochen, 3/7/07 14

15 Low Power Cornea Ideal corneal asphericity Q Ideal corneal asphericity Q Pre-op refraction [D] Ideal Q-value for zero spherical aberration Low Power Cornea Highly negative Q of Lens Ideal corneal asphericity Q Low Power Cornea High Power Mean Lens Q of Lens Medium Power Lens Low Power Lens Low Power Cornea Q of lens close to zero 0.2 High Power Lens Medium Power Lens Low Power Lens High Power Lens 0.0 Medium Power Lens Low Power Lens The ideal Q-value depends mainly on the optical 0.0 characteristics of the intraocular structures -> Theoretically individual wavefront corrections of -0.2 higher orders with Q-value based profiles are not possible Pre-op refraction [D] Pre-op refraction [D] PD Dr. Michael Mrochen, 3/7/07 15

16 Ideal Q-value for zero spherical aberration Ray tracing PD Dr. Michael Mrochen, 3/7/07 16

17 Ideal Q-value for zero spherical aberration Ray tracing algorithm Calculated ideal corneal asphericity for zero spherical aberration Data set generated Pupil size 6.0 mm PD Dr. Michael Mrochen, 3/7/07 17

18 Idealer Q-Wert der Cornea Theoretical Results individual eye models Linearer Fit an Daten der realen Augen 99% Vorhersage Kennlinie aus Variante des Navarro- Modells mit stark negativem Q der Linse (und mittlerer Kornea-Power) Fit Resultate: r = p = Theoretical Kennlinie eye aus models mittlerem based on 0.0 Liou-Brennan-Modell mean values do not help to determine the ideal Q-value after -0.2 corneal laser surgery -> customized eye model Pre-OP sphärisches Equivalent [Dpt] PD Dr. Michael Mrochen, 3/7/07 18

19 Q-value based maintain sperical aberration spherical Q-Value aberration [microns] Theoretical Results Ray tracing profiles zero spherical aberration Q-value J.F. OD J.F. OS S.W. OD S.W. OS F.E. OD D.A. OD D.A. OS E.M. OD B.B. OD B.B. OS W.M. OD B.M. OS Refractive range: +8 D to -12 D PD Dr. Michael Mrochen, 3/7/07 19

20 Clinical outcomes study group N = 35 eye (15 right & 20 left eyes) RMS < 0.4 µm; 6.0 mm pupil Tobias Koller et al: Q-factor customized ablation profile for the correction of myopic astigmatism J CATARACT RE FRACT SURG - VOL 32, APRIL 2006 PD Dr. Michael Mrochen, 3/7/07 20

21 Clinical outcomes study group Tobias Koller et al: Q-factor customized ablation profile for the correction of myopic astigmatism J CATARACT RE FRACT SURG - VOL 32, APRIL 2006 PD Dr. Michael Mrochen, 3/7/07 21

22 Summary A prolate shape does not essentially mean a good optical quality; some eyes require an oblate shape Q-value based ablation profiles are able to maintain the preoperative spherical aberration, if patients are preselected. Q-value based ablation profiles are not able to correct for preoperative spherical aberration. However, there were no clinical difference in Q-value versus wavefront-guided treatments (small study group) Ideal correction is only given by combining topography, wavefront and biometry. PD Dr. Michael Mrochen, 3/7/07 22

23 Conclusions Q-value based ablation profiles are a good solution for customized corrections, if wavefront measurements are not available or if there are no significant preoperative optical aberration present (rms < 0.3 µm; 6 mm pupil) PD Dr. Michael Mrochen, 3/7/07 23

24 Thank you PD Dr. Michael Mrochen, 3/7/07 24

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