The Alcon TropSat dinner symposium, an AUSCRS fixture, featured the launch of the innovative wavelight plus, over a fabulous dinner at the Hamilton Island Yacht Club.
Introducing the event, Penny Stewart, Alcon ANZ, described wavelight plus as a “revolutionary new corneal refractive treatment” while chair, Dr Tanya Trinh (Sydney), noted the exciting evolution of ray tracing laser-assisted in situ keratomileusis (LASIK).
Associate Professor Chandra Bala (Australia) opened with ‘Results of new ray trace-based LASIK’. He detailed the history of laser ablation pattern evolution, and explained how wavelight plus redefines refractive surgery – using one diagnostic device to measure biometry, tomography, and wavefront. Optical ray tracing helps calculate optimised ablation profiles.1 The technology provides a treatment based on an individual’s eye.2
Two thousand beams of light3 are directed at the eye. The reflected light is measured and analysed with microscopic precision. From this, an Eyevatar – a personalised, multidimensional model of the eye – is created.2 It’s a unique ‘digital double’ of the eye. Surgeons can now virtually treat the Eyevatar – before actual LASIK surgery – to determine impact and iteratively improve the treatment pattern to correct higher order aberrations,4 beyond the limitations of paraxial optics. Speed of treatment and detection compensates for any eye movements. Detailed clinical data illustrated impressive results and improvements in visual acuity. Real world visual outcomes showed that at three months post-op, 8% of patients achieved 20/10 (6/3) uncorrected distance visual acuity.5 Over 50% were 20/12.5 (6/3.8),5 with similar results across multiple sites. ‘Touch-up rates’ decreased from 2–3% to 0.8%6 and spherical aberration reductions were reported.5
Assoc Prof Bala said, “Ray tracing-based LASIK is the ‘haute couture’ personalised treatment that our patients deserve”.
Professor John Kanellopoulos (USA/ Greece) noted that the goals of refractive surgery outcomes are increasing, citing a desire to enable “lines of visual acuity to be gained”, as well as low contrast improvements in vision. He detailed specific uses of topographically guided LASIK as a tool for managing irregular corneas and for tweaks in existing symptomatic LASIK patients to improve visual outcomes. He gave a succinct explanation of tomography modified refraction, illustrated by a case where the subjective refractive cylinder of -0.50 at 45º disagreed with the topography suggested cylinder of -1.11 at 180°. Angle kappa reveals the regular cylinder, which acts as a prism, resulting in vertical coma. He explained how wavelight plus technology reshapes and normalises the corneal coma – with respect to the corneal vertex – by applying the treatment on the optical axis, not the geometric centre of the cornea, thus allowing for greater precision. Prof Kanellopoulos also showed significant improvements in gains of two or more lines of visual acuity with wavelight plus.
Dr David Gunn (Australia) reinforced the comments of the previous speakers surrounding the limitations of traditional Munnerlyn ablation, highlighting ray tracing technology and benefits. “If results are already good, why invest in this next evolution?” he asked. He said ophthalmologists can elevate practice and results with personalised treatment, noting that it’s professionally stimulating to be at the leading edge. There’s a learning curve for all involved, and staff realise they’re working in a leading clinic, believe in the technology, and are better at converting patients, he said.
Although his preliminary results were “fantastic”, there are still only a limited number of robust studies and no head-tohead comparisons. He summed up saying, “Ray tracing technology is an exciting new advancement in laser vision correction”.
In an interesting panel discussion, Dr Rick Wolfe (Australia), another of the few surgeons in the world to have early access to this technology, said Alcon had “introduced us to exciting technology through its excellent TropSat meetings for a quarter of a century”.
“The advanced customisation through wavelight plus provides excellent UCVA (uncorrected visual acuity). Such outcomes, I believe, are not achievable with noncustomised methods such as lenticule extraction. This unique technology is the way forward,” Dr Wolfe said.
Alan Saks is a retired optometrist. He is the Chief Executive Officer of the Cornea and Contact Lens Society of Australia, and a regular contributor to mivision.
References
- InnovEyes Sightmap Diagnostic Device User Manual 1089.
- Mrochen M, Bueler M, Donitzky C, Seiler T. Optical ray tracing for the calculation of optimized corneal ablation profiles in refractive treatment planning. J Refract Surg. 2008;24:S446-S451.
- Kanellopoulos AJ. Initial outcomes with customized myopic LASIK, guided by automated ray tracing optimization: a novel technique. Clin Ophthalmol. 2020 Nov 17;14:3955-3963.
- Schumacher S, Seiler T, Mrochen M, et al. Optical ray racing-guided laser in situ keratomileusis for moderate to high myopic astigmatism. J Cat Ref Surg. 2011;38(1):28-34. doi: 101016/j.jcrs.2011.06.032
- He G, Bala C. Ray-tracing-guided myopic LASIK: realworld clinical outcomes. J Cataract Refract Surg. 2023 Nov 1;49(11):1140-1146.
- Unpublished data owned by Dr Bala. Please contact Dr Bala for more details.