Abstract

Customized wavefront laser vision correction, whether customized wavefront LASIK or customized wavefront PRK, is able to measure and treat aberrations in the cornea that previously could not be adequately measured by conventional methods. Previous corneal surgery can produce complex irregularities in the cornea that, in the past, have been difficult to treat. This paper examines the use of advanced customized wavefront technology, using the Advanced CustomVue approach, to successfully treat an irregular cornea which had previously undergone incisional corneal surgery (radial keratotomy).

Word Document

Custom LASIK Used To Treat Irregular Cornea After Radial Keratotomy

Publication

Shapiro DR: Case Study: Custom LASIK Used To Treat Irregular Cornea After Radial Keratotomy. Ocular Surgery News, March 15, 2006, 24 (6), p. 58.

Download PDF

Abstract

This paper is a thought proposal put forward to the medical community by Dr. Shapiro during the initial development of Customized Wavefront LASIK. It introduced techniques which could improve the accuracy of wavefront surgery by accommodating the biomechanical effect of a LASIK flap. First, lower order aberrations would be addressed and then, subsequently, higher order aberrations – aberrations beyond nearsightedness, farsightedness, and astigmatism — would also be addressed. Three years after this article was published, Customized Wavefront LASIK was approved by the FDA.

Word Document

Proposal for Increased Accuracy in Wavefront-Guided LASIK

Publication

Shapiro DR: Proposal for Increased Accuracy in Wavefront-Guided LASIK (letter) J
Cataract Refractive Surgery, November 2000, 26, p 1570.

Abstract

Highly irregular corneas pose a particular challenge to even the most experienced LASIK and PRK surgeon. This irregularity is typically encountered when treating eyes with previous corneal refractive and laser surgery and visually problematic outcomes. This paper discusses techniques for optimizing surgical outcomes in this challenging setting. The role of high resolution Fourier Wavefront analysis is discussed. The critical role of iris registration and alignment technology for these types of cases is also reviewed. A surgical strategy for approaching these types of corneas is outlined. This paper is intended for experienced LASIK and PRK surgeons who wish to optimize their technique.

Publication

Shapiro DR: Can CustomVue Cope with Highly Aberrated Eyes? Review of Ophthalmology, March 2005, p. 12-13.

Abstract

Photorefractive keratectomy (PRK) was the first laser vision correction technique approved by the FDA. It differs from LASIK in that the excimer laser is applied directly to the corneal surface, instead of beneath a corneal flap. Earlier generations of PRK were performed using conventional laser technology (non-wavefront). This paper discusses the technique for refining older generation, previously performed PRK with modern customized wavefront LASIK.

Word Document

Custom LASIK Used to Enhance Older PRK

Publication

Shapiro DR: Custom LASIK Used to Enhance Older PRK. Ocular Surgery News, July 15, 2004, 22 (14), p. 16 – 17.

The Use of Customized Wavefront LASIK to Refine Conventional PRK

Abstract

Achieving optimal surgical outcomes with CustomVue Customized Wavefront laser vision correction is not the point and shoot exercise that many patients – and even some physicians — sometimes think it is. This paper gives expert tips to surgeons regarding techniques of wavefront imaging, clinical decision making, and wavefront surgical techniques. Issues including the role of pupil size, accommodation, dry eye during wavefront measurements, eye tracking, alignment, and nomogram adjustments are all discussed. This paper is intended for eye surgeons who are already familiar with advanced LASIK and PRK surgery.

Publication

Shapiro DR: Expert Insight: Maximizing Outcomes with CustomVue, Review of Refractive Surgery, April 2004, 5 (2), p. 33-36.

Abstract

The ideal architecture of a LASIK flap includes several critical characteristics. The flap should be ultra-thin, preferably between 90 and 120 microns thick. This flap thickness positions the lamellar separation just below Bowman’s membrane. This results in the most minimal biomechanical impact on the cornea and provides the most possible tissue depth for laser ablation following flap creation, yet still allows the patient to benefit from the quick recovery traditionally associated with LASIK. The ideal flap should also be planar in architecture. These characteristics contribute to Sub-Bowman’s, or SBK, flaps. SBK LASIK flaps can be accurately achieved with either advanced mechanical microkeratomes, such as the Bausch and Lomb Zyoptix XP, or with femtosecond lasers such as the Intralase, Ziemmer LDV, Zeiss VisuMax, or Technolas Femtec lasers. This paper examines different techniques for safely and accurately achieving SBK flaps in LASIK surgery.

Word Document

SBK With The XP Microkeratome

Publication

Shapiro DR: SBK With The XP Microkeratome: An Evolutionary Step for Laser Refractive Surgery? Ophthalmology Management, December 2007, 11(12), p. 33-38.

Advanced Techniques: Created Sub-Bowman’s (SBK) Flaps Using the Bausch and Lomb Zyoptix XP

Abstract

Customized Wavefront LASIK was first approved by the FDA in 2002 (Autonomous LADAR-Vision Custom Cornea Sytem) and in 2003 (VISX CustomVue System). While both of these technologies represented a significant improvement upon conventional laser vision correction technologies, further evolution to even more accurate surgery was still possible. The first generation wavefront platforms used Zernike polynomials to reconstruct the wavefront shape. Second generation systems employed Fourier analysis to generate a far more detailed, higher resolution analysis of the wavefront shape. Third gerenation technology employed complex alignment systems based on iris registration technology to more perfectly align the intricate laser correction onto the cornea. This paper discusses how to optimize wavefront results using the latest wavefront technologies.

Publication

Shapiro DR: Wavefront Surgery’s Full Potential Unleashed with Latest Technology. Ocular Surgery News, August 1, 2007, 25 (15), p. 42 – 44.

Abstract

This paper introduces a new field in laser vision surgery: therapeutic wavefront surgery. Therapeutic wavefront surgery, rather than correcting a specific prescription, is used to correct visual quality problems – and particularly night vision and contrast problems — induced by older generation LASIK and PRK. This paper examines how night vision problems after LASIK are typically caused by the induction of spherical aberration close to the optical axis. Wavefront technology can be harnessed to map – and ultimately treat – these aberrations induced by older generation lasers. In this way, visual quality problems such as night vision complaints can be directly treated, even in patients who otherwise no longer have nearsightedness, farsightedness, or astigmatism after their previous surgery.

Publication

Shapiro DR: CustomVue Used to Enhance Results of LASIK Performed with Early-Generation Laser, Ocular Surgery News, March 15, 2004, 22 (6), p 30-32.

Abstract

“Supervision” is the term that has been used to describe surgically produced vision better than that achieved with glasses or contact lenses. Because wavefront guided laser vision correction is able to measure – and treat – aspects of vision beyond what glasses and contacts do, there had been initial hope that wavefront guided surgery would provide supervision. While earlier forms of wavefront surgery did produce higher levels of 20/20 outcomes than previous technologies, the goal of supervision remained elusive. Advanced wavefront techniques and technologies now make supervision more obtainable. In this study of 100 patients undergoing wavefront LASIK at the Shapiro Laser Eye Center (surgery by David Shapiro, M.D.), 96% of patients reported uncorrected vision after surgery better than with glasses or contacts and 4% of patients reported uncorrected vision equal to their glasses or contacts. No patients ended up with vision worse than their glasses or contacts. These results change the way advanced formats of wavefront surgery are viewed in comparison to other alternatives.

Publication

Shapiro DR: Achieving Patient-Assessed “Super-Vision” With Wavefront-Guided LASIK. Presented at Association for Research and Vision in Ophthalmology (ARVO) Annual Meeting, Fort Lauderdale, Florida, May 2, 2010.

Abstract

“Supervision” is the term that has been used to describe surgically produced vision better than that achieved with glasses or contact lenses. Previous studies by David Shapiro, M.D. have shown that advanced forms of wavefront LASIK can be used to achieve supervision in a high percentage of cases. This study assesses whether advanced formats of wavefront PRK also can be used to achieve the supervision results seen in the wavefront LASIK study. In this study, 50 patients underwent wavefront PRK surgery at the Shapiro Laser Eye Center (surgery by David Shapiro, M.D.) using the most advanced technologies and techniques. 96% of patients reported uncorrected vision after surgery better than glasses or contacts and 4% of patients reported uncorrected vision equal to their glasses or contacts. No patients ended up with vision worse than with their glasses or contacts. These results were identical to those seen in Dr. Shapiro’s previous study of advanced wavefront LASIK, suggesting the two techniques are equivalent in their outcomes in respect to supervision. These results change the way advanced wavefront laser vision correction – both wavefront LASIK and wavefront PRK — are viewed in comparison to other alternatives.

Publication

Shapiro DR: Achieving Patient-Assessed “Super-Vision” With Wavefront-Guided PRK. Paper presented at American Society for Cataract and Refractive Surgery (ASCRS) Annual Meeting, San Diego, CA, March 28, 2011.