Aberration-Free Refractive Surgery: New Frontiers in Vision

209 Pages·2003·13.099 MB·English

by  J. F. Bille (auth.), Prof. Dr. Josef F. Bille, Carol F. H. Harner PhD, Dr. Frieder H. Loesel (eds.)

Aberration-Free Refractive Surgery
Springer
Berlin
Heidelberg
New York
Hong Kong
London
ONLINE LIBRARY
Milan Physics and Astronomy
Paris
Tokyo http://www.springer.de/phys/
J.F. Bille C.F.H. Harner F.H. Loesel (Eds.)
Aberration-Free
Refractive Surgery
New Frontiers in Vision
With 171 Figures
Springer
Prof. Dr. Josef E Bille
Kirchhoff Institute of Physics, University of Heidelberg
1m Neuenheimer Feld 227, 69120 Heidelberg, Germany
Carol EH. Harner, PhD
VISX, Inc., 3400 Central Expressway, Santa Clara, CA 95051, USA
Dr. Frieder H. Loesel
20110 Perfect Vision, Optische Geriite GmbH
1m Taubenfeld 21-1, 69123 Heidelberg, Germany
Library of Congress Cataloging-in-Publication Data applied for.
Die Deutsche Bibliothek - CIP-Einheitsaufnahme
Bille, Josef E:
Aberration free refractive surgery: new frontiers in Vision 1 J. E Bille; C. E H. Harner; E Loese!. -
Berlin; Heidelberg; New York; Hong Kong; London; Milan; Paris; Tokyo: Springer, 2003
(Advanced texts in physics)
(Physics and astronomy online library)
ISBN-13: 978-3-642-97920-0 e-ISBN-13: 978-3-642-97918-7
DOl: 10.1007/978-3-642-97918-7
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Preface
In recent years, new surgical techniques have evolved for customized correc
tion of refractive disorders, based on groundbreaking achievements in objec
tive assessment of refractive properties of the human eye and greatly refined
excimer laser surgical vision correction systems. This book comprises a thor
ough discussion of the underlying optical and laser-technological principles
as well as the first clinical studies for wavefront guided LASIK ablations.
In the first two chapters, the development of wavefront technology and its
application to ophthalmology and the assessment of the quality of the human
eye are presented. In Chaps. 3 and 4 first clinical results with WaveScan™
in American and European clinics are summarized. The basic technologies,
three-dimensional eye tracking and wavefront driven custom ablation pro
cedures are covered in Chaps. 5 and 6. First clinical results of ,wavefront
driven custom ablation, the so-called Heidelberg Study, are summarized in
Chap. 7. In Chap. 8 the state of the art in photorefractive keratectomy and
LASEK clinical results is presented. Chapter 9 contains with first surgical
applications of ultrashort pulse femtosecond laser surgery, a glimpse into one
of the promising future technological developments in refractive surgery. In
Appendix A several contributions to the Refractive Society Symposium (New
Orleans, November 11, 2001) are briefly summarized. The book is concluded
with Appendix B: Refractive Outcomes With "One-Step" Wavefront Guided
LASIK, which was presented at the recent ASCRS Conference in Philadel
phia (June 2002), summarizing the Htatus of the clinical VISX US-FDA Htudy
on custom ablations.
On the front cover of the book an artist's view of the CUi:itom ablation
vision correction procedure is illustrated. On the back cover a painting of
the Heidelberg Castle is presented. Most of the underlying technologies in
wavefront measurements and adaptive optics were developed in the early
1980H at the University of Heidelberg. In addition, the firHt international
clinical Htudy of wavefront guided LASIK ablation was performed at the
surgical eye center ("Augenpraxisklinik") in Heidelberg.
The editors are grateful to the authors of thii:i book who have made this
multifacetted overview of baHic science and engineering as well as surgical
and clinical topics possible. It was our intention to provide the refractive
VI Preface
surgical community with the most recent results in wavefront guided LASIK
ablations.
The editors are grateful to the editorial group at Springer, Heidelberg, for
their strong support and arc especially indebted to Michael Schottner, M.S.
whose considerable editorial skills and excellent computer professionalism
were invaluable to the creation of this book. Dr. Meng Han also contributed
greatly to the final format of the book.
Heidelberg and Santa Clara, J.F. Bille
August 2002 C.F.H. Hamer
F.H. Loesel
Contents
1 The Development of Wavefront Technology
and its Application to Ophthalmology
J.F. Bille ...................................................... 1
1.1 Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.3 History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.4 Principle of Aberration Measurement ........................ 4
1.5 Definitions of Optical Imaging Quality . . . . . . . . . . . . . . . . . . . . . . . 7
1.5.1 Root Mean Square. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.5.2 Optical Aberration Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.5.3 Modulation Transfer Function. . . . . . . . . . . . . . . . . . . . . . . . 8
1.5.4 Point Spread Function .......................... , . . . . 9
1.5.5 Application of the Performance Indices
in a Normal Human Eye. . .. . . . . . . . . . .. . . .. . . . . . . . . . . 9
1.6 Principle of Closed Loop Adaptive Optical Control ............ 9
1.6.1 Adaptive Optics in Astronomy ....................... 10
1.6.2 History of Adaptive Optics
at the University of Heidelberg. . . . . . . . . . . . . . . . . . . . . .. 11
1.6.3 Performance of Foil Mirrors. . . . . . . . . . . . . . . . . . . . . . . . .. 12
1.6.4 Comparison of Foil Mirrors and Microchip Mirror. . . . . .. 15
1. 7 CLAO /Bille Aberrometer .................................. 15
1.8 Demonstration of CLAO/Bille Aberrometer. . . . . . . . . . . . . . . . . .. 19
1.9 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 22
References ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 22
2 Optical Quality of the Human Eye
J.F. Bille, J. Buchler Costa, F. Muller ............................ 25
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 25
2.2 The Quality of the Human Eye. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 25
2.3 Linear Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 28
2.3.1 Optical Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 29
2.4 Representation of Aberrations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 32
2.5 Simulations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 36
References ............... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 45
VIn Contents
3 First Clinical Results with WaveScan ™
A. Gleibs ...................................................... 47
3.1 First Clinical Results with WaveScan™ . . . . . . . . . . . . . . . . . . . . .. 47
3.2 The Performance of a Wavefront Measurement
and the Understanding of the WavePrint ™ Maps. . . . . . . . . . . .. 47
3.3 Application of the WaveS can™ in Refractive Surgery. . . . . . . . .. 52
3.4 Results of this Study: The Reliability of the WaveScan™
Compared to Manifest Refraction. . . . . . . . . . . . . . . . . . . . . . . . . . .. 52
3.5 Final Review ............................................. 54
4 Wavefront Analysis: Clinical Primer
J.F. Doane, S. Morris, A.D. Border, L.S. EuDaly, J.A. Denning. . . . . .. 57
4.1 Definition of Important Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 57
4.2 Current Ocular Refraction Evaluation Systems. . . . . . . . . . . . . . .. 59
4.2.1 Phoroptor and Autorefractors . . . . . . . . . . . . . . . . . . . . . . .. 59
4.2.2 Corneal Topography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 60
4.2.3 20/10 Perfect Vision Wavefront System. . . . . . . . . . . . . . .. 60
4.2.4 Other Wavefront Sensing Devices. . . . . . . . . . . . . . . . . . . .. 60
4.3 How the VISX 20/10 Wavefront System Works. . . . . . . . . . . . . . .. 62
4.4 How to Read a Wavefront Map. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 64
4.5 What are the Shortcomings of Shack-Hartmann
Wavefront Analysis? ............................... , . . . . . .. 66
4.6 Reproducibility and Effect of Pupil Size. . . . . . . . . . . . . . . . . . . . .. 69
4.7 Clinical Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 70
4.7.1 Case 1. Keratoconus ................................ 70
4.7.2 Case 2. Status Post Radial Keratotomy. . . . . . . . . . . . . . .. 72
4.7.3 Case 3. Posterior Subcapsular Cataract
and Anterior Cortical Cataract . . . . . . . . . . . . . . . . . . . . . .. 72
4.7.4 Case 4. Status Post Penetrating Keratoplasty
for Keratoconus .................................... 74
4.7.5 Case 5. Unoperated "Normal" Eyes. . . . . . . . . . . . . . . . . .. 75
4.7.6 Case 6. Irregular LASIK Ablation. . . . . . . . . . . . . . . . . . . .. 78
4.7.7 Case 7. Status Post Hyperopic LASIK ................ 79
4.7.8 Case 8. Normal Examination / No Refractive Error. . . .. 80
4.7.9 Case 9. Status Post Myopic LASIK ................... 83
4.7.10 Case 10. Normal Examination / Minimal Refractive Error 85
References ..................................................... 87
5 The VISX STAR S3™ ActiveTrak ™ Eye Tracker
J. Shimmick, K. Yee, B. Cutrer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 89
5.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 89
5.2 Design Requirements ...................................... 91
5.2.1 Measured Eye Motion is of Sufficient Amplitude
to Warrant an Eye Tracker. . . . . . . . . . . . . . . . . . . . . . . . . .. 92
Contents IX
5.2.2 The Eye Tracking System Maintains the Safety
of the Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 95
5.2.3 The ActiveTrak™ System Accurately Tracks
Eye Movement ..................................... 96
5.2.4 The VISX STAR S3™ Laser System Appropriately
Responds to Eye Motion. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 99
5.2.5 Ablations Made While Using the ActiveTrak™
Eye Tracker Closely Match the Theoretical Profiles ..... 100
5.3 Conclusion ............................................... 102
References ..................................................... 103
6 Method for Wavefront Driven Custom Ablations
J. Watson, J. Shimmick, B. Cutrer, E. Gross, J. Wong, L. Bechtel,
C.F.H. Harner .................................................. 105
6.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
6.2 Variable Spot Scanning .................................... 106
6.3 Discussion of the Computation Problem ...................... 106
6.3.1 Algorithm Input .................................... 106
6.3.2 Algorithm Output .................................. 107
6.4 VSS™ for Pure Refractive Targets . . . . . . . . . . . . . . . . . . . . . . . . .. 107
6.5 VSS for Arbitrary Shapes .................................. 109
6.6 Wavefront Corrections ..................................... 111
6.6.1 VISX WaveScan Wavefront Sensor .................... 112
6.7 Creating Corrective Ablation Targets ........................ 114
6.8 PreVue™ Lenses .......................................... 116
6.9 Conclusion ............................................... 119
6.10 Addendum: Search Algorithms .............................. 120
6.10.1 General Approach .................................. 120
References ..................................................... 121
7 Wavefront Driven Custom Ablation: First Clinical Results
R. Volz, U. von Pape ............................................ 123
7.1 Introduction .............................................. 123
7.2 History .................................................. 123
7.3 Methods ................................................. 124
7.3.1 Wavefronts ......................................... 124
7.3.2 Single Pass Wavefront Measurement ................... 126
7.3.3 Principle of the Shack-Hartmann Sensor ............... 126
7.3.4 Techniques ......................................... 128
7.3.5 Presentation of WaveScan ™ Results .................. 130
7.3.6 What a Wavefront Map Can Tell Us .................. 130
7.3.7 What is the RMSjOAI? ............................. 131
7.3.8 Treatment Tables ................................... 133
X Contents
7.4 The Study ................................................ 134
7.4.1 Scope of Study ..................................... 134
7.4.2 Study Group ....................................... 135
7.4.3 Subject Eligibility .................................. 136
7.5 Results ................................................... 137
7.5.1 Uncorrected Visual Acuity ........................... 137
7.5.2 Best Corrected Visual Acuity ........................ 137
7.5.3 Refractive Error .................................... 138
7.5.4 Higher Order Aberrations ............................ 138
7.6 Conclusion ............................................... 140
References ..................................................... 141
8 Photorefractive Keratectomy: Indications,
Surgical Techniques, Complications, and Results
W.B. Jackson .................................................. 143
8.1 Introduction .............................................. 143
8.2 Indications for PRK ....................................... 143
8.3 Preoperative Management .................................. 144
8.4 Surgical Technique ........................................ 145
8.5 Preoperative Medications ................................... 145
8.6 Epithelial Removal ........................................ 145
8.6.1 Mechanical ........................................ 146
8.6.2 Chemical .................................. : ....... 146
8.6.3 LASEK ........................................... 146
8.6.4 Laser .............................................. 147
8.6.5 Transepithelial ..................................... 147
8.6.6 Stromal Treatment .................................. 147
8.7 Nomogram and Laser Algorithm ............................ 148
8.7.1 Centration ......................................... 148
8.7.2 Stromal Cooling .................................... 148
8.8 Postoperative Management ................................. 149
8.8.1 Medications ........................................ 149
8.8.2 Epithelial Healing ................................... 149
8.9 Complications ............................................ 150
8.9.1 Haloes and Glare ................................... 150
8.9.2 Loss of Visual Performance .......................... 150
8.10 Late Complications ........................................ 150
8.10.1 Undercorrection .................................... 150
8.10.2 Overcorrection ..................................... 151
8.10.3 Haze and Regression ................................ 151
8.10.4 Treatment of Haze and Regression .................... 152
8.10.5 Decentration ....................................... 153
8.10.6 Irrecular Astigmatism ............................... 153