6 Month Results of a Wavefront-

Topography-Supported Custom Ablation:

MEL80 CRS-Master II

Dan Z Reinstein MD MA(Cantab) FRCSC1,2,3,4

Timothy J Archer, MA(Oxon), DipCompSci(Cantab)1
1. London Vision Clinic, London, UK
2. St. Thomas’ Hospital - Kings College, London, UK
3. Weill Medical College of Cornell University, New York, USA
4. Centre Hospitalier National d’Ophtalmologie, (Pr. Laroche) , Paris, France
MEL80: CRS-Master II

Irregular
Surface

Target Toric
Target Surface starts at “lowest”
Surface point of the irregularities

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Principles of CRS-Master II
• Combination:
• Manifest refraction
• Topography/Topographic Wavefront
• Internal ocular optics

• Result: Ideal postoperative surface

• Accurate postoperative refraction.

• First system in the world to do this.

©DZ Reinstein 2006

dzr@londonvisionclinic.com
MEL80: CRS-Master II
• Topography algorithm
measures the refraction
• Target elevation is a toric
surface with this refraction

Refraction: +0.75 -1.50 x 170°

Refraction treated

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Non-Linear Aspheric Profile

• CRS Master proprietary energy correction algorithm

• Reduce induction of spherical aberration
• Improve effective ablation for irregular profiles

VHF digital ultrasound

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Study: Patients
• 48 eyes from 32 patients
• Patient Complaints
– Severe Night Vision Disturbances
• Clinical Diagnoses – Atlas Topography
– Small optical zone
– Decentred ablation
– Irregular Surface
• Wavefront exams showing increased aberrations
• Artemis VHF digital ultrasound RST

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Procedures
Primary Procedures
• LASIK 16 eyes
• PRK 14 eyes
• CK 4 eyes
• RK 4 eyes
• Deep lamellar transplant 7 eyes
• Central corneal scar 1 eye
• Wound gape following cataract surgery 2 eyes

Repair Procedures
• LASIK 3 eyes
• LASIK flap lift 12 eyes
• PRK 33 eyes
©DZ Reinstein 2006
dzr@londonvisionclinic.com
Outcome Measures
• Efficacy
• Accuracy
• Safety
• Contrast Sensitivity
• Topography Change
• Higher Order Aberrations

• Follow-up: median 9.4 mths (at least 3 mths)

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Example: Zone Expansion
Pre Op Post Op – 6 Months Post PRK
UCVA 20/20 UCVA 20/63 Topography
Rx: +0.75 -0.50 x 11 (20/20) Rx: +1.50 -0.50 x 141 (20/20) Difference

Ablation Pattern

Coma 5.30 µm Coma 0.73 µm

Sph Ab -15.84 µm Sph Ab -8.38 µm
HO RMS 1.26 µm HO RMS 0.64 µm 8 out of 10
©DZ Reinstein 2006
dzr@londonvisionclinic.com
Example: Decentration
Pre Op Post Op – 6 Months Post PRK
UCVA 20/20 UCVA 20/16 Topography
Rx: +0.25 -0.25 x 33 (20/20) Rx: +0.50 -0.75 x 62 (20/16) Difference

Ablation Pattern

Coma 4.49 µm Coma 2.81 µm

Sph Ab -7.71 µm Sph Ab -3.15 µm
HO RMS 0.88 µm HO RMS 0.50 µm 8 out of 10
©DZ Reinstein 2006
dzr@londonvisionclinic.com
Example: Decentration
Pre Op Post Op – 4 Days Post PRK
UCVA 20/100 UCVA 20/32 Topography
Rx: -1.88 -0.75 x 28 (20/20) Rx: -0.25 -0.25 x 105 (20/32) Difference

Ablation Pattern
No WASCA post
op yet

Coma 3.61 µm Coma µm

Sph Ab -13.17 µm Sph Ab µm
HO RMS 1.00 µm HO RMS µm 8 out of 10
©DZ Reinstein 2006
dzr@londonvisionclinic.com
Example: High Myopia Deep Lamellar Transplant
Pre Op Post Op – 3 Months Post PRK
UCVA 20/4000 UCVA 20/40 Topography
Rx: -8.50 -4.00 x 73 (20/40) Rx: 0.00 -1.25 x 130 (20/32) Difference

Ablation Pattern

Coma 1.24 µm Coma 2.81 µm

Sph Ab -5.61 µm Sph Ab -5.96 µm
HO RMS 0.92 µm HO RMS 0.70 µm 10 out of 10
©DZ Reinstein 2006
dzr@londonvisionclinic.com
Example: High Myopia Deep Lamellar Transplant
Pre Op Post Op – 2 Weeks Post LASIK
UCVA 20/400 UCVA 20/63 Topography
Rx: +3.50 -7.75 x 70 (20/50) Rx: -0.50 -2.25 x 20 (20/32) Difference

9 out of 10
Ablation Pattern
5mm

Coma 2.15 µm Coma 1.56 µm

Sph Ab -0.18 µm Sph Ab 3.65 µm
HO RMS 0.59 µm HO RMS 0.68 µm
©DZ Reinstein 2006
dzr@londonvisionclinic.com
Example: High Myopia Deep Lamellar Transplant
Pre Op Post Op – 6 Months Post LASIK
UCVA 20/400 UCVA 20/32 Topography
Rx: -2.25 -4.75 x 19 (20/32) Rx: -1.00 sph (20/32) Difference

Ablation Pattern
5mm

Coma 2.86 µm Coma 5.43 µm

Sph Ab -2.20 µm Sph Ab -3.23 µm
HO RMS 0.63 µm HO RMS 0.72 µm 9 out of 10
©DZ Reinstein 2006
dzr@londonvisionclinic.com
Example: Decentration Following RK
Pre Op Post Op – 4 months Post PRK
UCVA 20/40 UCVA 20/16 Topography
Rx: +1.50 -1.50 x 111 (20/20) Rx: +0.25 -1.25 x 120 (20/16) Difference

Ablation Pattern

Coma 2.02 µm Coma 2.97 µm

Sph Ab -11.81 µm Sph Ab -3.69 µm
HO RMS 0.92 µm HO RMS 0.48 µm 7 out of 10
©DZ Reinstein 2006
dzr@londonvisionclinic.com
Example: Decentration Following RK
Pre Op Post Op – 6 months Post PRK
UCVA 20/50 UCVA 20/50 Topography
Rx: +3.50 -2.25 x 165 (20/50) Rx: +3.00 -2.75 x 45 (20/40) Difference

Ablation Pattern

Coma 2.82 µm Coma 3.88 µm

Sph Ab -12.04 µm Sph Ab -1.40 µm
HO RMS 1.16 µm HO RMS 0.57 µm
©DZ Reinstein 2006
dzr@londonvisionclinic.com
Safety: Best Corrected Visual Acuity

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Safety: Best Corrected Visual Acuity

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Efficacy: Uncorrected Visual Acuity

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Attempted vs Achieved Spherical Equivalent

Transplant -2.25 -4.75 x 19

Transplant +3.50 -7.75 x 70

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Accuracy: Within Range of Intended

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Higher Order RMS – All Eyes

Average HO RMS
0.80 0.73 n = 37
0.70

0.60 0.56
0.50

0.40

0.30 23% Decrease

0.20

0.10

0.00
HO RMS
Average Pre 0.73
Average Post 0.56
t-test p-value 0.0012 significant

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Spherical Aberration (Seidel) – All Eyes

Average Spherical Abberration

-7.00 -6.38
n = 37
-6.00

-5.00

-4.00 -3.62
-3.00

-2.00
43% Decrease
-1.00

0.00
Spherical Abberration
Average Pre -6.38
Average Post -3.62
t-test p-value 0.00001 significant

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Contrast Sensitivity
All Eyes Eyes with below
normal contrast

©DZ Reinstein 2006

dzr@londonvisionclinic.com
Conclusions
• Combined Topography/Wavefront
– Regularised the cornea
• Decentration
• Zone expansion
• Irregular cornea
– Accurate: 80% within ±1.00 D
– Safe: no eyes lost 2 lines, 31% gain 1 line BSCVA
– Reduced Spherical Aberration
– Reduced HO RMS
– Improved contrast sensitivity, particularly for eyes
with below contrast pre-op

©DZ Reinstein 2006

dzr@londonvisionclinic.com
6 Month Results of a Wavefront-
Topography-Supported Custom Ablation:
MEL80 CRS-Master II

Dan Z Reinstein MD MA(Cantab) FRCSC1,2,3,4

Timothy J Archer, MA(Oxon), DipCompSci(Cantab)1
1. London Vision Clinic, London, UK
2. St. Thomas’ Hospital - Kings College, London, UK
3. Weill Medical College of Cornell University, New York, USA
4. Centre Hospitalier National d’Ophtalmologie, (Pr. Laroche) , Paris, France

Thank You