Focus Co Management 2016 Edmison

Focus Co Management 2016 Edmison

• 1.
  25 Years Retrospective David R.Edmison, MD Focus Eye Centre June 2, 2016
• 2.
  FEC Once Upona Time…  Started Standard (STD) PRK in 1992  Practice restricted to Refractive (2000)  Keravision Intac corneal ring segments (2000)  LASIK 6 month “trial” 2003  Early beginnings with CustomVue Wavefront Guided Analysis (WGA) 2003  New office 1565 Carling Ave. Suit 110 (2005)
• 3.
  FEC Once Upona Time…  Majority of treatments with WGA (2005)  Everest SurgiCentre expansion (2006)  Start of SBK treatments April 2008  Shine Rejuvenation expansion (2008)  Advances to the iDesign WGA (2013)
• 4.
  Patient expectations &deliverables  We can expect to help reduce dependence on glasses and contact lenses.  1992-2003  Early technology with chances of side effects (ie. haloes, glare, starbursts).  Did not have advanced diagnostics to explain 20/20 unhappy patients experiencing side effects.  Higher chance of requiring a retreatment.  2003-2013  Era of wavefront aberrometry and custom LVC, ie. WaveScan and CustomVue.  Able to measure and treat all ocular aberrations.  Overall improvents in visual acuity results, ie. more 20/20 with less chance of side effetcs.  Less chance of requiring retreatment.  2013-2016  Upgrade to iDesign aberrometry.  Greater diagnostic and treatment resolution along with better results.
• 5.
  Integrity of FEC Credibility ISO certification is evidence that we are committed to providing the best possible patient care.  Communication across all staff is key for providing consistent patient messaging.  Low employee turnover Care & Outcomes  All patients receive the best outcomes possible with the safest procedures presented to them.  Our surgeons are conservative and stand behind not offering LASIK due to its risks. Technology  State of the art technology  Routine calibrations
• 6.
  Surface Ablation LASIK PRK SBK •Epithelium removed only • Remove 95 µ of tissue • Flap thickness 120 – 180 µ • Leaves thickest cornea • Integrity returns ~6 months • Biomechanical integrity compromised • No flap • Planar Flap • Difficult to dislodge flap no change to Rx • Meniscus flap • Easy to dislodge flap – forever large hyperopic refractive error • Minimal dry eye • Minimal dry eye • Dry eye ++ • Rare ectasia • Rare ectasia • Ectasia common • No ION • No ION ION 1/5
• 7.
  SBK vs. LASIK LASIK SBK planar95 µ Meniscus 120 – 180 µ
• 8.
  Monovision  Recommended fora majority of patients above the age of 39  Typically the non-dominant eye is corrected for reading vision  Soft contact lens trials serve as an inadequate demonstration of the true benefits of monovision  Poor fitting, dryness, uncorrected astigmatism, inconsistent lens use  Patients with acuity of 20/30 or less in the non-dominant eye are ineligible for monovision  Patients must be aware that monovision will provide a range of beneficial distance and near vision, but also an overall reduction in total UCDVA
• 9.
  Standard of Care: Setting the appropriate expectation is key for a successful monovision experience  Some DVA must be compromised to have good NVA REASSURANCE++  Adaptation period can be anywhere from a few weeks to 9 months  Reversible process  9 month wait period is necessary before considering monovision reversal  The amount of reading power typically depends on the age of the patient:  39-49: +1.25  50-59: +1.50  60+: +1.75 Monovision
• 10.
  Corneal Topography Placido DiskTechnology  Simple axial view of the anterior cornea. Problems with alignment.  Intuitive curvature map, but not the whole cornea. Pentacam Technology  Elevation-based systems utilize a direct triangulation technique to measure the corneal surfaces.  Best view of the anterior segment. Anterior corneal surface, posterior corneal surface, and corneal thickness are measured.  Able to make the best possible decision about LVC candidacy.
• 11.
  Wavefront Aberrometry  FDAapproved 2003  Measures higher order aberrations (HOA); the potential for improved visual quality beyond vision of glasses and contacts  Explains reduced vision due to higher order aberrations or irregular optics/astigmatism  3rd and 4th order aberrations: Coma, Trefoil & Spherical aberration  Software optimizes each laser spot shape, size, placement & repetition rate based on Pulse-Packing concept  Variable Spot Scanning (VSS)  Pulse size, 0.65 to 6.5mm  Variable Rate Repetition (VRR)  Laser repetition rate, 6 to 20 Hz www.abbottmedicaloptics.com www.abbott.mediaroom.com www.eyeworld.org/ewsupplementarticle.php?id=281
• 12.
  Iris Registration  WaveScanvs Laser image comparisons verify that selected WaveScan image is correct  Patient ID/Eye verification  Iris pattern unique to each patient  Automatically aligns preoperative diagnostic and laser iris images (seated vs. supine patient position)
• 13.
  Femtosecond Intralase 150 KHz(0.5 μJ) 60 KHz (0.9 μJ) 30 KHz (1.2 μJ) 15 KHz (1.5 μJ) 10 KHz (2.0 μJ)
• 14.
  Femtosecond Intralase Surgical advantagesof the iFS vs FS60  Less chance of suction break  Less chance of flap dislocation  Significantly reduced incidence of TLS  Reduced dry eye complications
• 15.
  iDesign Wavefront iDesign WaveScan High definition Hartmann-Schack wavefront sensor  Improves spot quality  1257 vs 256  Better detection of highly aberrated eyes iDesign WaveScan
• 16.
  iDesign Wavefront Guided Five measurements within single capture sequence  Wavefront Guided Aberrometry  Auto-refraction  Topography  Pupillometry  Keratometry
• 17.
  LVC Outcomes 2000– STD PRK/LASIK Low Myopes (0 – 6 D) # % Cum. % 20/10 1 0.2% 0.2% 20/15 98 15.9% 16.1% 20/20 349 56.6% 72.7% 20/25 77 12.5% 85.2% 20/30 53 8.6% 93.8% 20/40 28 4.5% 98.3% >20/40 11 1.8% 100.0% TOTAL 617 100.0% # of Retx 13 2.1% Moderate Myopes (6 – 9 D) # % Cum. % 20/10 1 0.5% 0.5% 20/15 3 1.4% 1.9% 20/20 93 44.5% 46.4% 20/25 46 22.0% 68.4% 20/30 37 17.7% 86.1% 20/40 17 8.1% 94.2% >20/40 12 5.7% 100.0% TOTAL 209 100.0% # of Retx 12 5.7% High Myopes (> 9 D) # % Cum. % 20/10 0 0.0% 0.0% 20/15 1 1.6% 1.6% 20/20 26 41.3% 42.9% 20/25 18 28.6% 71.5% 20/30 12 19.0% 90.5% 20/40 4 6.3% 96.8% >20/40 2 5.7% 100.0% TOTAL 63 100.0% # of Retx 4 6.3% * 86% ** 90% * Wavefront guided PRK 2006 data ** iDSN SBK 2016 data ** 79% ** 79% ** 1.6%** 0% ** 2.9%
• 18.
  Hyperopes # % Cum.% 20/10 0 0.0% 0.0% 20/15 2 2.3% 2.3% 20/20 19 22.1% 24.4% 20/25 28 32.6% 57.0% 20/30 19 22.1% 79.1% 20/40 12 14.0% 93.1% >20/40 6 7.0% 100.0% TOTAL 86 100.0% # of Retx 4 6.3% LVC Outcomes 2000 – STD PRK/LASIK ** 86% ** 0% ** iDSN SBK 2016 data
• 19.
  Keravision Intacs  Restorationof corneal integrity in ectactic disorders  Keratoconus, pellucid marginal degeneration, LASIK induced ectasia  Polymethylmethacrylate (PMMA) implantation in the deep stroma  FDA approved 1999  Two semi-circular canals created either mechanically by a diamond blade and semi-automated suction ring, or with a femtosecond laser
• 20.
  ReLEx® SMILE  SmallIncisional Lenticular Extraction  Flapless minimally invasive surgery combing advantages of PRK and LASIK  ZEISS ReLEx® SMILE utilizes the high-precision femtosecond laser VisuMax®from ZEISS to create a lenticule inside the cornea and access incision in a single treatment step  Up to 80 % smaller side-cut  Up to 30 % smaller cap incision area  Greater integrity of the upper corneal layers  Less incidence of dry eye
• 21.
  ReLEx® SMILE A refractive lenticuleand small incision are created inside the intact cornea – all in one step. The lenticule is removed through the incision with only minimal disruption to the corneal biomechanics. Removing the lenticule changes the shape of the cornea, thereby achieving the desired refractive correction. http://www.zeiss.com/meditec/en_de/products---solutions/ophthalmology-optometry/cornea-refractive/laser-treatment/femtosecond-laser-solutions/relex.html
• 22.
  Statistics  Tedious tocollect  Boring to present  Prone to manipulation to give desired results.  Important to ask the proper questions.
• 23.
  THANK YOU