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Results of Hyperopic PRK: Comparison of 3 Excimer Laser Platforms

Lewis R Groden MD (1,2 ), Ana-Maria Oliva MD (2) , S Elizabeth Groden, Amy Martino MD (2) 1 LasikPlus Vision Center, Tampa, FL 2 University of South Florida Dept of Ophthalmology, Tampa, FL LRG: code A, consultant, Alcon Labs

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Results of Hyperopic PRK: Comparison of 3 Excimer Laser Platforms

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  1. Lewis R Groden MD (1,2), Ana-Maria Oliva MD (2), S Elizabeth Groden, Amy Martino MD (2) 1 LasikPlus Vision Center, Tampa, FL 2 University of South Florida Dept of Ophthalmology, Tampa, FL LRG: code A, consultant, Alcon Labs AMO, SEG, AM: no financial interests in the subject matter of this poster Results of Hyperopic PRK: Comparison of 3 Excimer Laser Platforms

  2. 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.

  3. 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 Purpose

  4. Methods • PRK standard technique: 20% alc for epi removal, 0.02% mmc x 12 sec • retrospective chart review of consecutive cases 2008-2010, one surgeon (LRG), follow- up: minimum 3 months • 135 eyes / 74 patients • age: 27 – 69 yrs • sex: 34 F, 40 M • preop refraction: sphere +0.25 - +4.75 D cyl 0 - -3.50 D

  5. Alcon Wavelight Allegretto EyeQ 400, wavefront optimized (WFO) : 31 eyes • AMO VISX Star 4 IR conventional (VSX): 83 eyes • AMO VISX Star 4 IR wavefront-guided CustomVue (CV) : 21 eyes Excimer Laser Platform

  6. Topography pattern (pmd, I-S diff 1.4 – 1.9 D): 101 eyes • Thinnest pach < 470 microns: 17 eyes • Guttata: 2 eyes • Occupation / patient preference: 15 eyes Reason for PRK

  7. HPRK 20/20+ 20/25+ 20/40+ Total 135 eyes 87 eyes (64%) 109 (81%) 133 (99%) VSX 83 eyes 49 (59%) 67 (81%) 82 (99%) CV 21 eyes 17 (81%) 19 (90%) 21 (100%) WFO 31 eyes 21 (68%) 23 (74%) 30 (97%) Results : uncorrected visual acuity (UCVA)

  8. Fisher’s exact test 20/20+ 20/25+ 20/40+ VSX vs CV p= 0.08 p= 0.5 p= 1.0 CV vs WFO p= 0.35 p= 0.17 p= 1.0 VSX vs WFO p= 0.52 p= 0.44 p= 0.47 Differences between laser platforms are not statistically significant

  9. mixed astig prk (52 eyes) hprk (83 eyes) Fisher’s exact Chi Sq 20/20+ 35 eyes (67%) 48 (58%) p=0.28 p=0.36 20/25+ 45 (87%) 59 (71%) p=0.06 p=0.06 20/40+ 52 (100%) 81 (98%) p=0.5 p=0.69 Results: UCVA mixed astig prk = hprk

  10. < 3 D >3 D 67 eyes 16 eyes Fisher’s exact 20/20+ 42 (63%) 6 (38%) p= 0.09 20/25+ 48 (72%) 11 (69%) p= 1.0 20/40+ 65 (97%) 16 (100%) p= 1.0 Results: UCVA spherical equivalent < 3D = > 3D

  11. hprk hlasik (*) 135 eyes 135 eyes Chi Sq 20/20+ 87 (64%) 94 (70%) NS 20/25+ 109 (81%) 114 (84%) NS * Groden LR, Saunders T Comparison of Hyperopic Lasik with Wavefront-Optimized, Conventional, and Wavefront-Guided Platforms ASCRS 2010 Results: UCVA hprk = hlasik

  12. Good UCVA results were obtained with hyperopic prk done on each of the excimer platforms studied • No statistically significant differences in achieved UCVA between the three platforms (WFO, VSX, CV) • UCVA results for prk in eyes with mixed astigmatism did not differ from the results for prk in eyes with hyperopic astigmatism • UCVA results for hyperopic prk are not significantly different from the results previously reported for hyperopic lasik Conclusions

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