EW Chicago 2012
Advances in cataract and refractive surgery: A clinical update
5
Figure 1
Figure 2. The average amount of astigmatism relative to the spherical
equivalent myopia by orientation pre-op
Figure 3. Orientation of astigmatism relative to the degree of spherical
equivalent myopia in patients with more than 1.00 D of cylinder pre-op
Figure 4. The orientation of astigmatism relative to the size of the
astigmatism pre-op
The setting provides an 8.6 mm
horizontal measurement that fits the
average cornea well. I prefer to use
this configuration for all patients to
maintain consistency in my surgical
parameters, rather than customizing
the
size of every flap according to
their individual size. In eyes with
>1.00 D of ATR astigmatism or in
hyperopic eyes (<5% overall), I
revert back to my 8.5 mm round
flap. I prefer placing the pocket in
the superior location as this puts
both pocket and hinge in the
visually insignificant area of cornea
covered by the upper lid. While my
prospective study on the outcomes
of
the oval/elliptical flaps is still in
progress, surgically I immediately
appreciated the easy and perfect
alignment of the flap after each
ablation.
Oval/elliptical flaps may not be
revolutionary, but they are another
step forward in the evolution of
LASIK. My experience has shown me
that within the next few years, oval
flaps will be the industry standard.
References
1. Assil KK. Femtosecond laser-customized
LASIK flaps. ASCRS•ASOA Symposium &
Congress presentation, 2008.
2. Mandel Y, Stone RA, Zadok D. Parameters
associated with the different astigmatism axis
orientations. Invest Ophthalmol Vis Sci
2010;51(2):723-30.
Dr. Probst is the medical director of TLC Laser
Eye Centers. Contact him at 608-249-6000.
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