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The Pathophysiology of Regression Following LASIK Dan Z Reinstein MD MA(Cantab) FRCSC DABO 1,2,3,4 1. London Vision Clinic, London, UK 2. St. Thomas’ Hospital - Kings College, London, UK  3. Weill Medical College of Cornell University, New York, 4. Centre Hospitalier National d’Ophtalmologie, (Pr.Laroche), Paris
The author acknowledge a financial interest in the subject matter of this presentation. Many aspects of the  Artemis™  technology are patented.  Patents are administered by the  Cornell Research Foundation .  This intellectual property has been licensed by Cornell to  Ultralink, LLC ., a company in which the authors have a financial interest.
Regression following LASIK ,[object Object],[object Object],[object Object]
The Accuracy of Routine LASIK; Isolation of Biomechanical and Epithelial Factors Dan Z Reinstein, MD, MA(Cantab), FRCSC Sabong Srivannaboon, MD Ronald H Silverman, PhD D Jackson Coleman, MD Weill Medical College of Cornell University, NY, NY Lasik Vision Corporation, Vancouver Canada Service V, Centre Hopitalier National d’Ophtalmologie des XV-XV. Paris, France Mahidol University, Bangkok Thailand ARVO 2000
“ Artemis 2” by Ultralink  LLC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.ArcScan.com FDA approved  2000
VHF Digital Ultrasound ,[object Object],[object Object],[object Object],[object Object],[object Object]
VHF Digital Ultrasound
Artemis C12 Display Reinstein et al. Journal of Refractive Surgery 2000 Jul-Aug;16:414-30 Roberts C. The cornea is not a piece of plastic.
Deformation of the Cornea - Distinction ,[object Object],[object Object],[object Object],[object Object]
Deformation of the Cornea - Distinction ,[object Object],[object Object],[object Object],[object Object]
Deformation of the Cornea - Distinction ,[object Object],[object Object],[object Object],[object Object]
Method ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Calculated Total Corneal Power ,[object Object],[object Object],[object Object],[object Object],Orbscan Orbscan front +  VHF Ultrasound Thickness
Calculated Total Corneal Power ,[object Object],[object Object],[object Object],[object Object],Calculated Corneal Power
[object Object],Calculated Corneal Power Orbscan Orbscan front +  VHF Ultrasound Thickness Post-LASIK-epithelial hyperplasia Post-LASIK “bowing”
[object Object],Calculated Corneal Power Calculated Corneal Power
Calculated Corneal Power ,[object Object],[object Object],Post-LASIK-epithelial hyperplasia Post-LASIK “bowing”
Calculated Corneal Power ,[object Object],[object Object],Substitute  with pre-epithelium Post-LASIK “bowing”
Calculated Corneal Power ,[object Object],[object Object],Substitute  with pre-epithelium Post-LASIK “bowing” Calculated Corneal Power
Calculated Corneal Power ,[object Object],[object Object],Subtract “bowing” Post-LASIK  “ bowing ” Post-LASIK-epithelial hyperplasia
Calculated Corneal Power ,[object Object],[object Object],Subtract “bowing” from all three surfaces
Calculated Corneal Power ,[object Object],[object Object],Calculated Corneal Power
Calculated Corneal Power ,[object Object],[object Object],[object Object]
Calculated Corneal Power ,[object Object],[object Object],[object Object],Subtract “bowing”
Calculated Corneal Power ,[object Object],[object Object],[object Object],Subtract “bowing”
Calculated Corneal Power ,[object Object],[object Object],[object Object],Substitute pre-op epithelial layer Subtract “bowing”
Calculated Corneal Power ,[object Object],[object Object],[object Object],Substitute pre-op epithelial layer Subtract “bowing”
Calculated Corneal Power ,[object Object],[object Object],[object Object],Substitute pre-op epithelial layer Subtract “bowing” Calculated Corneal Power
Methods: Outcome Measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Magnitude of Post-Operative Epithelial and Biomechanical Changes p <0.0005
Results - Accuracy of Treatment ,[object Object]
Validation ,[object Object],[object Object]
Removing Epithelial Effect ,[object Object],[object Object],[object Object],[object Object]
Removing Bowing Effect ,[object Object],[object Object],[object Object],[object Object]
Removing Epithelial + Bowing Effects ,[object Object],[object Object],[object Object],[object Object]
Impact of Epithelial and Bowing Effects on Accuracy of LASIK
The Epithelium in LASIK
Effect of Epithelial Changes on Refractive Outcome in LASIK Sabong Srivannaboon, MD Dan Z Reinstein, MD, FRCSC Hugo FS Sutton, MD, FRCSC Ronald H Silverman,  Simon P Holland, MD, FRCSC D. J. Coleman, MD, FACS University of British Columbia, Vancouver, BC Canada Weill Medical College of Cornell University, New York, NY ARVO 1999
Epithelium: Results ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Methods
Epithelial Power Changes and Postop SE Error
Epithelial Profile Changes
Results Low Moderate High
Central and Epithelial Profile Changes Figure 5
Hypothesis: Epithelial Thickening End
Epithelial Power Change vs. Myopia Treated
Epithelial Power Change vs. Myopia Treated
What do we do about regression nowadays? ,[object Object],[object Object],[object Object]
Undercorrected LASIK ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Undercorrected LASIK : To enhance OD? ,[object Object],[object Object],[object Object],277 μ m
Undercorrected LASIK : To enhance OS? ,[object Object],[object Object],[object Object],[object Object],218 μ m 191–µm
Summary: Pathophysiology of Regression ,[object Object],[object Object],[object Object],[object Object]
Summary:  caution ,[object Object]

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The Pathophysiology of Regression Following LASIK

  • 1. The Pathophysiology of Regression Following LASIK Dan Z Reinstein MD MA(Cantab) FRCSC DABO 1,2,3,4 1. London Vision Clinic, London, UK 2. St. Thomas’ Hospital - Kings College, London, UK 3. Weill Medical College of Cornell University, New York, 4. Centre Hospitalier National d’Ophtalmologie, (Pr.Laroche), Paris
  • 2. The author acknowledge a financial interest in the subject matter of this presentation. Many aspects of the Artemis™ technology are patented. Patents are administered by the Cornell Research Foundation . This intellectual property has been licensed by Cornell to Ultralink, LLC ., a company in which the authors have a financial interest.
  • 3.
  • 4. The Accuracy of Routine LASIK; Isolation of Biomechanical and Epithelial Factors Dan Z Reinstein, MD, MA(Cantab), FRCSC Sabong Srivannaboon, MD Ronald H Silverman, PhD D Jackson Coleman, MD Weill Medical College of Cornell University, NY, NY Lasik Vision Corporation, Vancouver Canada Service V, Centre Hopitalier National d’Ophtalmologie des XV-XV. Paris, France Mahidol University, Bangkok Thailand ARVO 2000
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  • 8. Artemis C12 Display Reinstein et al. Journal of Refractive Surgery 2000 Jul-Aug;16:414-30 Roberts C. The cornea is not a piece of plastic.
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  • 30. Magnitude of Post-Operative Epithelial and Biomechanical Changes p <0.0005
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  • 36. Impact of Epithelial and Bowing Effects on Accuracy of LASIK
  • 38. Effect of Epithelial Changes on Refractive Outcome in LASIK Sabong Srivannaboon, MD Dan Z Reinstein, MD, FRCSC Hugo FS Sutton, MD, FRCSC Ronald H Silverman, Simon P Holland, MD, FRCSC D. J. Coleman, MD, FACS University of British Columbia, Vancouver, BC Canada Weill Medical College of Cornell University, New York, NY ARVO 1999
  • 39.
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  • 41. Epithelial Power Changes and Postop SE Error
  • 44. Central and Epithelial Profile Changes Figure 5
  • 46. Epithelial Power Change vs. Myopia Treated
  • 47. Epithelial Power Change vs. Myopia Treated
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