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Wavefront adaptive optics refers to the technology used to evaluate the refractive properties of the eye in an area-wide orientation. A wavefront measuring device works by first reflecting a dim laser beam off the patient's retina. This reflected light is then separated into small portions, much like a checkerboard. We are able to determine the prescription at each position of the cornea instead of the average prescription of the eye, as had only been possible in the past. This allows us to determine the prescription in traditional sphere and cylinder terms, as well as determine the higher order aberrations of the individual eye system.
The LADARVision (Alcon/Summit/Autonomous) excimer system was developed to exploit the potential benefits of this technology. Its unique Gaussian beam profile, and superfast precision tracking make it the system most able to actually reduce optical aberrations in the human eye. CustomCornea is the trademarked name of the combination of wavefront measuring and guided ablation used by LADARVision. In October 2002, the FDA granted approval of CustomCornea making it the only wavefront guided excimer laser treatment available in the United States. With this approval, Dr. Soloway, Director of Vision Correction at the New York Eye and Ear infirmary and Medical Advisor to Alcon became the first and only surgeon to offer this exciting new technology in the Northeastern United States.
In the past, many patients were advised that it would be worth waiting for this new technology. Now that it has received FDA approval, the wait is over. This technology is a major breakthrough for patients with irregular astigmatism, higher order aberrations, or problems from prior surgery. With conventional laser treatment algorythms, most patients with few higher order aberrations and regular corneal topography with good vision will probably do well. However the newest laser treatment algorythm approved with CustomCornea will also reduce the level of higher order aberrations such as spherical aberration that older treatment designs produced. At this time these wavefront guided treatments are only available for 6.5 mm optical and 9.0 mm treatment areas, smaller than the 8.0 mm optical and 10.0 treatment areas available with LADARVision conventional surgery. Dr. Soloway is currently conducting research to determine the best treatment if a patient's dark adapted pupil size is greater than 6.5 mm, especially with significant higher order aberrations if standard treatment with a larger optical zone or CustomCornea surgery would result in better night vision.
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