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7 white circle (denoting the foveola of the macula), where the very best vision is. On the left, there are faint stray areas of blue wisps extending outside of the white circle, which causes a starburst effect in the patient's nighttime vision. After surgery, on the right, the blue is contained almost completely within the white circle, which is why the patient sees better at night than she did before surgery. At 6 and 12 months out, this map will improve even further. The maps in Figure 7 show the total eye's higher order aberrations present. Preoperatively, on the left side, the blue arrow is pointing to an area of yellow that is extending beyond the 4-mm circle. That same area on the right side (postoper- atively) shows that the blue has been drawn out beyond that 4-mm circle. Treatment with CONTOURA Vision has pulled the higher order aberrations away from the center of the pupil, and because the pupillary zone is so critical for good vision, pulling that outward improves vision as well. Look carefully again at the preoperative map. The center of best focus is the smallest, darkest blue circle "bullseye," and it is dis- placed ever so inferiorly to the cen- ter of the crosshairs, denoting the central visual axis. Examining the postoperative map, this "bullseye" is now perfectly centered on the crosshairs. This is a powerful image because it shows that CONTOURA Vision is able to align the optical correction perfectly. Some reports indicate that Fourier analysis is even more ac- curate at examining corneas than Zernike or higher order aberrations. In Figure 8 on the left is a map of the patient 3 months after surgery showing spherical equivalence. We want this image to be perfectly symmetrical and centered, and it is perfect after this CONTOURA Vision treatment. The map on the right denotes irregularities in the corneal topography with regard to shape. If irregularities were present, they would be in different colors. This is a perfect cornea with no irregular- ities. Figure 9 is a beautiful post- operative cornea. This is powerful technology. Surgeons are now able to make patients' corneas topo- graphically better than we ever have before. Additionally, we can achieve postoperative vision that is better than patients had preoperatively with glasses or contact lenses. How- ever, these optimal results require work. We must make sure that our staff understands and embraces the technology, and we must obtain good images from our technicians. These are the keys to a great result with CONTOURA Vision. Contact information Lobanoff: mlobanoff@gmail.com LenSx Laser important product information Caution United States Federal Law restricts this de- vice to sale and use by or on the order of a physician or licensed eye care practitioner. Indication Cataract Surgery Indication The LenSx Laser is indicated for use in patients undergoing cataract surgery for removal of the crystalline lens. Intended uses in cataract surgery include anterior capsulotomy, phacofragmentation, and the creation of single plane and multi-plane arc cuts/incisions in the cornea, each of which may be performed either individually or con- secutively during the same procedure. Corneal Flap Indication The LenSx Laser is indicated for use in the creation of a corneal flap in patients un- dergoing LASIK surgery or other treatment requiring initial lamellar resection of the cornea. Restrictions • Patients must be able to lie flat and mo- tionless in a supine position. • Patient must be able to understand and give an informed consent. • Patients must be able to tolerate local or topical anesthesia. • Patients with elevated IOP should use topical steroids only under close medical supervision. Contraindications Cataract Surgery Contraindications • Corneal disease that precludes applana- tion of the cornea or transmission of laser light at 1030 nm wavelength • Descemetocele with impending corneal rupture • Presence of blood or other material in the anterior chamber • Poorly dilating pupil, such that the iris is not peripheral to the intended diameter for the capsulotomy • Conditions that would cause inade- quate clearance between the intended capsulotomy depth and the endothelium (applicable to capsulotomy only) • Previous corneal incisions that might pro- vide a potential space into which the gas produced by the procedure can escape • Corneal thickness requirements that are beyond the range of the system • Corneal opacity that would interfere with the laser beam • Hypotony, glaucoma* or the presence of a corneal implant • Residual, recurrent, active ocular or eyelid disease, including any corneal abnormali- ty (for example, recurrent corneal erosion, severe basement membrane disease) • History of lens or zonular instability • Any contraindication to cataract or kerato- plasty • This device is not intended for use in pediatric surgery. *Glaucoma is not a contraindication when these procedures are performed using the LenSx Laser SoftFit Patient Interface Accessory Corneal Flap Contraindications • Corneal lesions • Corneal edema • Hypotony • Glaucoma • Existing corneal implant • Keratoconus • This device is not intended for use in pediatric surgery. Warnings The LenSx Laser System should only be op- erated by a physician trained in its use. The LenSx Laser delivery system employs one sterile disposable Patient Interface con- sisting of an applanation lens and suction ring. The Patient Interface is intended for single use only. The disposables used in con- junction with ALCON instrument products constitute a complete surgical system. Use of disposables other than those manufactured by Alcon may affect system performance and create potential hazards. The physician should base patient selection criteria on professional experience, pub- lished literature, and educational courses. Adult patients should be scheduled to undergo cataract extraction. Precautions • Do not use cell phones or pagers of any kind in the same room as the LenSx Laser. • Discard used Patient Interfaces as medical waste. Complications Cataract Surgery AEs/Complications • Capsulotomy, phacofragmentation, or cut or incision decentration • Incomplete or interrupted capsulotomy, fragmentation, or corneal incision proce- dure • Capsular tear • Corneal abrasion or defect • Pain • Infection • Bleeding • Damage to intraocular structures • Anterior chamber fluid leakage, anterior chamber collapse • Elevated pressure to the eye Corneal Flap AEs/Complications • Corneal edema • Corneal pain • Epithelial in-growth • Epithelial defect • Infection • Flap decentration • Incomplete flap creation • Flap tearing or incomplete lift-off • Free cap Attention Refer to the LenSx Laser Operator's Manual for a complete listing of indications, warn- ings and precautions. Figure 7. Total eye's higher order aberrations Figure 8. Map showing spherical equivalence on left; map showing irregularities in the corneal topography with regard to shape on the right Figure 9. Postoperative cornea Source (all): Mark Lobanoff, MD

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