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Discussion Topics
• VISX® Star S4 Excimer Laser System Features
• Bausch & Lomb Orbscan
• Lasik Procedure
• Procedure Risks and Benefits
• Surgeon Experience
• Questions
VISX Leadership
•
1983 Stephen Trokel, MD invents laser vision
correction
•
1987 VISX system used to treat 1st human eye
•
1995 VISX StarTM launched
•
1998 VISX Star S2TM launched
•
1999 VISX CAPTM Method launched &
•
2001
–Millionth VISX procedure performed in the United
States
–VISX WaveScanTM WaveFront System
–VISX STAR S3TM
VISX® New Technology
• Variable Sized Beams (VSS™)
• STAR S4 ActiveTrak™ System
• Larger ablation zones
VISX STAR S4 ActiveTrakTM
key features
• Variable Sized Beams (VSS™)
– Variable offset scanning beam sizes and shapes
• Active 3D eye tracker
– Tracks entire natural pupil
– No dilation required
– Tracks eye in X,Y, and Z planes
– No pre-imaging required
• Larger Ablation Zones
– Reduced Incidence of night vision problems
Variable Sized Beams
• Myopic treatments use variable size beam
– Treatment starts at 0.65 mm
– Treatment finishes at up to 6.5 mm
Beam diameter
increases as
treatment
progresses
Variable Sized Beams
• Variable shaped beam myopic astigmatism
– Exclusive elliptical treatment combines sphere and
cylinder shapes
Elliptical shape
corrects both myopia
and astigmatism
Variable Sized Beams
• Offset beam with scanning capabilities
• Hyperopic treatments use offset scanning
– Offset rectangular beam scans across the cornea
Beam scans in
periphery to steepen
central cornea
Variable Sized Beams
• More treatment options than any other laser
• Variable beam size
– Beam changes shape and size to address all
refractive errors
• Scanning capabilities
– SmartBeam™ scans across the cornea with
hyperopia and larger ablation zones
• Personalized treatments
– Capable of performing individualized treatments
VISX STAR S4 ActiveTrak™
Eye Tracker features and benefits
• Active eye tracker
– Moves beam to compensate for all eye movements
– 3D infrared eye tracker
– Dual side-mounted infrared cameras monitor x, y,
and z
• No dilation required
– Patient comfort and convenience
– Maintains LASIK “wow factor”
VISX STAR S4 ActiveTrak™
Eye Tracker features and benefits
• Flexible, responsive eye tracking
– Assures eye remains in optimal 3D window
• No pre-imaging required
– Direct measurement of pupil position
– Fast patient throughput
• Doctor controls eye tracker function
– Doctor engages tracker, controlling centration and
alignment
VISX STAR S4 ActiveTrak™
Eye Tracker
• Dual side-mounted,
infrared cameras monitor
x, y, and z movements
• Oblique IR lighting does
not interfere with
procedure
VISX STAR S4 ActiveTrak™
Eye Tracker
• Tracker is engaged by physician
• Laser, reticle, and pupil indicator are active and
aligned
VISX STAR S4 ActiveTrak™
Eye Tracker
• ACTIVE 3-D eye tracking video
(Click on image to start the video)
Actual eye
movements
Laser Beam
actively
follows eye
movements
VISX STAR S4 ActiveTrak™
Eye Tracker
• Eye movements during LASIK
– ActiveTrak™ tracks at 60 Hz
– 99.4% of all eye movements can be captured with a
20 Hz tracker†
– Eye position is verified and safety checked before
every laser pulse
– Continues to monitor between pulses
– Checks eye position 6 times for every pulse
delivered to the cornea
† Data on file, VISX, Inc.
VISX STAR S4 ActiveTrak™
Technical Comparison
• VISX ® ActiveTrak™ 3D eye tracker
– Developed for laser vision correction
– No dilation
– Tracks X, Y, and Z axis movements
• LadarVision®
– Developed for non-ophthalmic applications
– Requires dilation to minimum 7mm
– Limited range of motion (no z-axis)
VISX STAR S4 ActiveTrak™
Technical Comparison
• VISX ® ActiveTrak™: DIRECT measurement of
eye position in real time
– Tracks pupil in its natural position
– Direct measurement increases system accuracy
• LadarVision® tracker: Requires pre-imaging for
indirect measurement of eye position
– Pre-imaging is a source of error
– Extrapolates eye position from only 4 points, based
on where the pupil center WAS when pre-imaging,
not where it is during the actual surgery
Eye Tracker Centration
Technical Comparison
Radar Tracker-only 4
data points used
3-D Infrared Video Trackerthousands of data points
used
Larger Ablation Zones with VSS™
•
•
•
•
Enlarged ablations using blend zones
Uses scanning beams of varying sizes
Allows 2.2 mm blend zone for total treatment of 8 mm
Treatment times are reduced,
• Removes less tissue than fixed spot systems
Beam sizes are
varied from 1mm to
6mm in diameter
Larger Ablation Zones With VSS
• Enlarged ablation zone benefits
–
–
–
–
–
–
Increases treatment area to 8 mm
Minimal added depth
Minimal increase in treatment time
Accurate
Smooth
Safe
Larger Ablation Zones With VSS
• Advantages of Blend Zone
– Decreases the angle of ablation edge
– May reduce incidence of night vision
problems
– May help LASIK flap to lay smoother and fit
better in the bed
Larger Ablation Zones With VSS
• VISX® 8 mm ablation zone - actual treatment video
– Click on image to start video
Larger Ablation Zones With VSS
Conclusion
• Larger ablation zones using VSS™ offers a
new and unique approach to laser vision
correction
– Advantages of quicker procedure times and less
tissue removal
– Ability to extend ablation zone to 8 mm
– Is an accurate and safe treatment
Bausch & Lomb OrbScan™ System
• OrbScanTM
– Patient’s AcuityMap™, a unique “fingerprint” of the eye
» Anterior Float map (left)
» Posterior Float map (right)
OrbScan™ System
• OrbScanTM interface:
OrbScanTM maps show:
– Front and Rear
Corneal Surfaces
– Keratometry
– Pachymetry
(thickness)
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
LASIK for Myopia
Excimer: Ablation on Human Hair
Courtesy of IBM
Treatment Parameters
• -0.25 to -14.00 D with up to -4.00 D
cylinder
• +0.00 to +6.00 with less than -4.00 D
cylinder
• Generally 18 years of age or older
Risks
• Infection
• Haze
• Under or over-correction
• Regression
• Fluctuation in vision
Benefits
• Lifestyle enhanced
• Career opportunities
• Reduced dependence on contacts and
glasses
Consultation Appointment
• No charge- 30-45 minutes appointment
• Connie will counsel patients about lvc and treatment
options
• Basic eye measurements taken- auto refraction &
lensometry
• Educate about Freedom Laser Center and benefits
of lvc
Laurence Miller, D.O.
• Associate Professor Department of Surgery,
Kirksville College of Osteopathic Medicine
• Member of the American Academy of
Ophthalmology
• Member American Osteopathic Association
• Fellowship in the Osteopathic College of
Ophthalmology and Otochirolarynogology
• Performed over 10,000 refractive surgery
procedures
Questions?
Thank You
for your Attention