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Monday / June 27.
HomemistoryThe New Frontier For Clear Vision

The New Frontier For Clear Vision

Astigmatism could be a thing of the past thanks to an Australian advance that is impressing eye health professionals worldwide. And it’s all due to the dedicated work over the past decade by an optometrist, together with a cataract and refractive eye surgeon. [/vc_column_text][/vc_column]

It’s called Vector Planning, a technique pioneered by optometrist George Stamatelatos and Dr. Noel Alpins and has now been shown to deliver better outcomes for astigmatism in normal eyes and those with keratoconus.

As one article reviewer noted, their research is important ‘not least because it challenges the current dogma’ in excimer laser treatment for patients with keratoconus.

Mr. Stamatelatos says of the partnership: “I had an interest in the ability to get rid of glasses and contact lenses – the idea of a whole new lifestyle for potential candidates. Noel shared this interest, and our combined experience and skills allowed us to think beyond the status quo in current techniques and treatment options.”

At the end of the day, these results need to flow on to patients with astigmatism having access to treatment using Vector Planning on a larger scale

In April 2007, Mr. Stamatelatos and Dr. Alpins published their study in the Journal of Cataract and Refractive Surgery (JCRS). In the study, Vector Planning was performed in 45 eyes with mild and forme fruste keratoconus using PARK over a 10 year period. This study demonstrated that corneal astigmatism could be reduced without compromising the refractive astigmatism. The potential to improve best corrected visual acuity (BCVA) was highlighted with no adverse effects after using Vector Planning.

The pair has now been treating patients with astigmatism using Vector Planning for more than a decade. However, with the implementation of Wavefront aberrometry, they combined this advanced technology with Vector Planning to demonstrate that it could improve visual outcomes over and above the best current treatment paradigms for healthy astigmatic corneas.

The Lastest Research

The international interest in this research has only been heightened with their latest study published last August. The study (also published in JCRS – the leading peer reviewed publication of American and European Cataract and Refractive surgeons) demonstrated that current laser eye surgery techniques for astigmatism can be improved beyond those achieved with Wavefront, the current gold standard in treatment. The research highlighted that patients can also have better postoperative results, particularly under dim light and low contrast levels.

Using Vector Planning, people wearing glasses or contact lenses who have been considered unsuitable for laser eye surgery (for example those with keratoconus), may soon be able to access the benefits of this treatment and ultimately gain better vision. In an accompanying editorial in August, the JCRS recognises that the technique, which is not yet available to patients, can improve the way astigmatism is treated along with patient outcomes.

“The study shows the excellent process of laser treatment can be made even more effective and we are extremely pleased with the results achieved”, says Dr. Alpins.

“Wavefront technology is currently the most advanced in laser technology, but when combined with Vector Planning, we have found that patients’ treatments were further enhanced”, he says.

Current planning of laser surgery treatments is based on refraction alone – this can be manifest or Wavefront, with little regard for the corneal shape when it comes to astigmatism. This refraction will be permanently sculpted onto the cornea, which in many cases is different in magnitude or axis to the corneal astigmatism, resulting in less than optimal visual outcomes due to an excess amount of astigmatism remaining on the cornea.

The gold standard in treatment using the refraction alone is Wavefront aberrometry. This measures and is able to produce a very detailed ‘refraction’ of the eye. The resultant treatment profile is based solely on this measurement, without considering the corneal shape.

Vector Planning is an innovation that combines the corneal shape together with the refraction in the treatment profile. Laser treatment based on Wavefront parameters, in combination with corneal topography using Vector Planning, has not previously been performed in healthy astigmatic eyes.

This study was conducted over 12 months and tested the results of combining Wavefront and Vector Planning. Fourteen people and 21 eyes were involved in the study, with treatments based on a combination of Wavefront and Vector Planning, compared to Wavefront alone.

In particular, compared to treatment by Wavefront parameters alone, the study involved the use of Vector Planning with LASIK in healthy normal corneas with myopic astigmatism over a six month period with six month follow-up. The results of the study demonstrated less corneal astigmatism and improvements in contrast and quality of vision under mesopic conditions.

No laser system currently available allows the user this combination of refractive Wavefront and corneal shape parameters. In this study, the research and development department of the laser manufacturer used in the study (AMO/ViSX), calculated the required treatment profiles from the treatment parameters supplied by Dr. Alpins and Mr. Stamatelatos – this complex process kept the study sample low.

Dr. Alpins and Mr. Stamatelatos’ most recent study also demonstrates that current advanced Wavefront technology can be improved. It is envisaged that it will pave the way for inclusion of the corneal shape into the treatment profile using Vector Planning by adopting the ASSORT planning and outcomes analysis software in laser systems worldwide.

For patients, this means better quality of vision under low lighting conditions and better contrast – e.g. driving at night, credits or subtitles on the TV, theatre and cinema situations. From the patients’ perspective, there is no difference in the treatment procedure. Rather, it is the laser profile that has been modified with Vector Planning. The difference is not noticeable during treatment, but certainly, the visual benefits are realized shortly after. Excitingly, this also means that Vector Planning has greater potential to improve best corrected visual acuity compared with current technology.

As a treatment option, laser vision correction has shown a high level of patient satisfaction resulting in independence from glasses and contact lenses. The ability to play sport without glasses getting in the way, no longer having to insert, remove and maintain contact lenses, being able to see your towel at the beach from a distance, even basic tasks such as seeing the clock radio in focus on first waking up in the morning or going to the bathroom at night reflect some of the delighted patient comments.

Of significance to the industry, Vector Planning would improve this ability to an even higher level, particularly in patients having difficulty under low light conditions and general quality of vision postoperatively. In fact, the study demonstrated that patients were delighted with visual outcomes, and two out of the 14 patients who had both eyes treated, changed their preferred eye (pre-operatively) to the one treated using Wavefront and Vector Planning (post-operatively).

Crucial to any refractive surgery outcome, is the ability to measure an accurate refraction, in addition to other clinical and diagnostic parameters. Calculating these measurements is where the optometry and ophthalmology professions complement each other. Placing these measurements in the experienced hands of a surgeon results in optimal visual outcomes and very happy patients.

Background on the development of Vector Planning and the advances made by Dr. Noel Alpins and George Stamatelatos

  • 1985: Dr. Alpins began performing refractive surgery using the technique of radial Keratotomy.
  • 1991: Dr. Alpins was one of the first surgeons in Australia to use the Laser Vision correction techniques.
  • 1992: Development commenced using the ASSORT planning and outcome analysis computer program for cataract and refractive surgery. This enabled planning of laser and cataract surgery using the technique of Vector Planning and calculation of the targeted outcomes of the intended astigmatic treatment.
  • 1992: Invented the Alpins method of astigmatism analysis to document the accuracy of surgical treatment of astigmatism and hence refine and improve future outcomes.
  • 1993: Developed a new multizone, multipass algorithm for excimer laser myopia treatment – this divided the treatment equally between zones for a smoother ablation profile.
  • 1996: Partnership of optometry with ophthalmology began at NewVision clinics.
  • 1997: Published advanced methods of astigmatism analysis and treatment – demonstrated the calculation of the ocular residual astigmatism (ORA) and the advantages of leaving less astigmatism on the cornea using Vector Planning.
  • 1998: Published treatment of irregular astigmatism – using Vector Planning to separately treat the two hemidivisions of the cornea.
  • 2001: First in Australia to use the advanced Amadeus microkerotome for laser vision correction.
  • 2007 to present: Published results of treatment of myopic astigmatism over a 10 year period in patients with forme fruste and mild keratoconus – the study is on-going, and using Vector Planning, demonstrated less corneal astigmatism without compromising the refractive astigmatism.

International attention

The results have received much attention internationally. Following publication by JCRS, the data has also been presented at several major international meetings including the American Society of Cataract and Refractive Surgery (ASCRS) and European Society of Cataract and Refractive Surgeons (ESCRS). Several other international ophthalmic publications are currently in the process of reporting the research results.

Discussions are also underway with several laser manufacturers to adopt this technology in their laser systems. The research and development departments in these companies recognise that using the corneal shape in treatment is a significant advance to improving laser vision correction. Vector Planning does this using a systematic, optimised process. It is hoped that the publication of Mr. Stamatelatos’ and Dr. Alpins’ research will give other researchers and practitioners the confidence to pursue similar studies. At the end of the day, these results need to flow on to patients with astigmatism by having access to treatment using Vector Planning on a larger scale.

Case Study: Loretta McNaulty

Loretta McNaulty, a bookkeeper from Cardigan, Victoria, underwent laser eye surgery at a NewVision Clinic in March 2006 and is now experiencing more self-confidence and enjoying life much more. Prior to the surgery, Loretta lived with very poor eyesight. She had to wear glasses or contact lenses all the time and her irritating contact lenses pushed her to make the decision to investigate laser eye surgery. After attending one of the NewVision Clinics’ seminars in Ballarat, Loretta booked herself in for the procedure.

Since having the surgery, Loretta has found her eyesight has improved immensely and says she now has amazing, clear eyesight, for which she is grateful everyday. Her new eyesight allows her to do and see things which others may take for granted, such as reading the time on her alarm clock in the middle of the night and being able to play sport again. Loretta believes the Wavefront and Vector Planning combination of treatment optimised the quality of her vision outcome.

Case Study: Gerribeth Ocampo

As a Senior Buyer for an Engineering Design Company, Gerribeth Ocampo heavily relied on her eyesight. Before undergoing laser eye surgery in 2006, Gerribeth was dependent on eye glasses constantly and suffered from terrible headaches if she did not wear them. Having been referred to the surgery by a work colleague who had undergone the procedure and had fantastic results, Gerribeth investigated NewVision Clinics and decided it was right for her.

Since having the surgery, Gerribeth can see clearly without glasses or contact lenses and no longer experiences headaches. She is now able to live without the hassle of buying glasses yearly or the daily changing and maintaining of her contact lenses. Gerribeth also feels she is more confident interacting with people without the hindrance of glasses. Gerribeth believes Wavefront and Vector Planning were more beneficial than other techniques as it addressed her astigmatism comprehensively and gave her the quality of vision she is delighted with.

Ken Griffin is a professional journalist who has worked as a healthcare consultant in Australia, New Zealand and the U.K. and writes regularly for numerous health publications.

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