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Treatment of Adult Amblyopes With Advanced Surface Ablation

Sze H. Wong Emil W. Chynn, MD, MBA Maximiliano Plana, MD Emily Ceisler, MD. Treatment of Adult Amblyopes With Advanced Surface Ablation . ASCRS, May 2013 San Francisco, CA. LASEK / Epi -LASIK to treat amblyopes is not FDA-approved. PURPOSE.

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Treatment of Adult Amblyopes With Advanced Surface Ablation

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  1. Sze H. Wong Emil W. Chynn, MD, MBA MaximilianoPlana, MD Emily Ceisler, MD Treatment of Adult Amblyopes With Advanced Surface Ablation ASCRS, May 2013 San Francisco, CA LASEK /Epi-LASIK to treat amblyopes is not FDA-approved.

  2. PURPOSE • Can adult strabismic and/or refractive amblyopes be safely and effectively treated with Advanced Surface Ablation (ASA)? • Can UCVA, BCVA, functional vision be improved? • Can strabismus be decreased?

  3. METHOD • Retrospective review of adult amblyopes who underwent LASEK or Epi-LASEK with a VISX S4 IR excimer laser between 2006-2013 • Adjunctive treatment to prevent scarring: • Mitomycin C (MMC) 0.01% intraoperatively • Oral + Topical steroids: 1-6 mo postop • Vitamin C + UV protection: 6-12 mo postop

  4. STUDY POPULATION CHARACTERISTICS

  5. RESULTS: UCVA (safety) UCVA Log MAR 20/2000 error bar = sd 20/200 20/20 PreOp PostOp (months) • Postop UCVA vs Preop UCVA: • 100% had improvement in UCVA • Corneal haze: trace 29%, 1+ 4%, 2+ 4% • There was no loss of UCVA (haze = clin. insig.)

  6. RESULTS: BCVA (efficacy) • Postop vsPreop BCVA: • Mean gain of BCVA of 1.43 lines (± 1.11) • 87.5% had improved BCVA

  7. RESULTS: SE vs BCVA change in Hyperopes Spherical Equivalent Postop BCVA Minus Preop BCVA (logMAR) Correlation coefficient = 0.62 • Hyperopic amblyopes with lower Rx have more BCVA improvement

  8. RESULTS • Unilateral (anisometropic) amblyopes had a greater improvement in BCVA (2.5 lines) than Bilateral (isometropic) amblyopes (1.0 line) (1-tailed p value 0.04)

  9. RESULTS • FUNCTIONAL VISION • better peripheral vision: 63% • improved driving: 58% • increased sports ability: 29% • STRABISMUS • ET preop: 20Δ postop: 8Δ • UCVA preop: 20/200 postop: 20/30 • BCVA preop: 20/30-1 postop: 20/25 • Would do it again? YES!  • PATIENT SATISFACTION • 76% would undergo the operation again if given the choice

  10. DISCUSSION • Adult strabismic/refractive amblyopes may be safely & effectively treated with ASA • No loss of UCVA (all scarring was clinically insignificant due to adjunctive measures) • Significant gains in BCVA & functional visual improvement, with excellent patient satisfaction • Better results for unilateral refractive amblyopes and low hyperopes • Further investigation is necessary, especially in strabismic amblyopes (low n)

  11. REFERENCES • Tychsen L. Refractive surgery for children: excimer laser, phakic intraocular lens, and clear lens extraction. Curr Opin Ophthalmol. 2008 Jul;19(4):342-8.

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