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4 Achieving premium outcomes and practice success with next-generation laser vision correction ablations by Edward Manche, MD Emergence of new laser vision correction technology Optical Express have been using it to obtain exceptional results for a number of years outside the U.S. The high-resolution iDesign (Abbott Medical Optics, Abbott Park, Ill.) allows surgeons to image highly aberrated eyes with very good precision for keratoconic eyes and eyes with previous incisional refractive surgery and irregular ablation profiles. The improved spot quality reduces spot crossover effect. The high-resolution system offers the ability to capture more patients, improved detection of higher order aberrations, and better wavefront reconstruction for treatment, both in virgin eyes and highly aberrated eyes. It provides an improved ablation profile based on whole eye optical aberra- tions, with a higher-quality aberrometer, increased dynamic range, more precise torsional alignment, and corneal curva- ture compensation (Figure 1). curvature. In contrast, wavefront-guid- ed technology is designed to reduce or eliminate the induction of higher order aberrations, based on wavefront maps. Advanced wavefront-guided ab- lation, based on wavefront maps, is designed to meet the same goals as wavefront-guided procedures—reducing or eliminating induction of higher order aberrations. However, because it has increased resolution and registration ca- pabilities, we can image highly aberrated eyes and better image virgin eyes. Topography-guided treatment is designed to produce a detailed map of the cornea shape and power and create a treatment pattern to regularize it. Advanced wavefront-guided ablations The newer high-definition wavefront- guided technology is proven. Steven Schallhorn, MD, and his colleagues at High-definition wavefront- guided ablation and topography-guided ablation offer new opportunities for customization A lthough most refractive surgeons currently use wavefront-guided or wave- front-optimized systems, emerging technology will offer patients opportunities for higher-quality vision. Tomorrow's procedures will be performed with high-definition wave- front-guided and topography-guided ablation, providing an unprecedented level of customization. The goal of wavefront-optimized technology is to avoid changes in corneal asphericity by placing increased pulses in the periphery. Treatment is based on the manifest refraction and corneal Figure 1. The advantages of advanced wavefront-guided ablation • Improved ablation profile based on whole eye optical aberrations • Higher-quality aberrometer • Increased dynamic range • More precise torsional alignment • Corneal curvature compensation Advanced wavefront-guided technology Figure 2. Topography-guided ablation used to treat corneal aberrations Topography-guided ablation and corneal aberrations • Ablation profile based on the entire corneal shape • Adjust postop corneal asphericity • Centration control • Specify refractive correction " Advanced wavefront-guided ablation and topography-guided ablation offer an unprecedented level of customization. " –Edward Manche, MD

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