Editors Ashok Garg MS PhD FIAO(Bel) FRSM FAIMS ADM FICA
International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Centre 235-Model Town, Dabra Chowk Hisar- 125005 (India)
JT Lin PhD
Technical Director Photon Data Inc.7055, University Blvd Winter Park, Florida USA
Jerome Jean Bovet MD
Consultant Ophthalmic Surgeon FMH Clinique de L'oeil 15, Avenyue Du Bois-de-law-Chapelle CH-1213, Onex, Switzerland
Bojan Pajic MD
Chief Corneal and Refractive Surgery Deptt. Department of Ophthalmology Vision Care, Klinik Pallas Louis Giroud Str. 20 4600 Olten, Switzerland
Emanuel Rosen MD
Medical Director Rosen Eye Associates Harbour City, Salford Quays M50 3BH, UK
Noel Alpins MD FRACS
Medical Director New Vision Clinics 7, Chesterville Road Chelternham, Victoria 3192 Australia
Roberto Pinelli MD
Director, Istituto Laser Microchirurgia Oculare Crystal Palace, Via Cefalonia, 70 25124, Brescia, Italy
Cyres K Mehta MS FSVH FAGE
Director and Consultant Mehta International Eye Institute Seaside, 147, Shahid Bhagar Singh Rd. Colaba, Mumbai- 400005 India
Foreword Marguerite B McDonald
5Contributors
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Mastering the Techniques of Customized LASIK (Technology and Innovations)
© 2007, Editors
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2007
9788184480757
Typeset at JPBMP typesetting unit
Printed at Ajanta
4Dedicated to
- My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings & motivation.
- My Respected Parents, teachers, my wife Dr. Aruna Garg, son Abhishek and daughter Anshul for their constant support and patience during all these days of hard work.
- My dear friend Dr. Amar Agarwal, a renowned International Ophthalmologist for his constant support, guidance and expertise.
Ashok Garg
- The memory of my step daughter Nicola Ross who enjoyed benefits from refractive surgery were cut short by a tragic fatal illness.
Emanuel Rosen
- My wife, Jeanette and my sons Alex and Tao, who have been giving me constant support and love.
J.T. Lin
- To darling Sylvia and our daughters, for all your support and encouragement.
Noel Alpins
- Yveric, Luc and Fanny Laure.
- Silvio Korol, who was not only a teacher but also an intellectual guide and a friend.
Jerome Bovet
- I dedicate this book to India's Talented ophthalmologists, in the fervent hope that they may become increasingly devoted to refractive surgery.
Roberto Pinelli
- To my son Valentin Aleksandar.
Bojan Pajic
- My parents for everything.
- To Vini my Best friend.
Cyres K Mehta
- Alexander Hatsis md
- 2, Lincoln Ave
- Suite 401, Rockville Center
- New York, USA
- Amar Agarwal ms frcs frc Ophth
- Consultant
- Dr. Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600086, India
- Amit Gupta ms
- Chaudhary Eye Centre and Laser Vision
- 4802, Bharat Ram Road,
- Ansari Road, 24, Darya Ganj
- New Delhi-110002, India
- Arturo Pérez-Arteaga md
- Medical Director
- Centro Oftalmologico Tlalnepantla
- Dr. Perez-Arteaga Vallarta no.42
- Tlalnepantla, Centro, Estado de Mexico 54000, Mexico
- Arun C Gulani md ms
- Director, Gulani Vision Institute,
- 4500 Salisbury Rd Suite 160
- Jacksonville, Florida
- USA
- Ashish Doshi md
- Consultant Dr Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600086
- India
- Ashok Garg ms phd fiao(bel) frsm faims adm fica
- International and National Gold Medalist
- Chairman and Medical Director
- Garg Eye Institute and Research Centre
- 235-Model Town, Dabra Chowk
- Hisar-125005, India
- Ashu Agarwal ms
- Centre for Sight
- B5/24, Safdarjung Enclave
- New Delhi, India
- Athiya Agarwal md do frsh
- Consultant
- Dr. Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600086
- India
- Bojan Pajic md
- Chief Corneal and Refractive
- Surgery Deptt.
- Department of Ophthalmology
- Vision Care, Klinik Pallas
- Louis Giroud Str. 20
- 4600 Olten
- Switzerland
- C Banu Cosar md
- Sinpas Aqua City 1. Etap
- H Block D:13A. Dudullu 80260
- Istanbul, Turkey
- Carlo Francesco Lovisolo md
- Medical Director
- QuattroElle Eye Center
- via Cusani, 7-9, 20121
- Milano, Italy
- Charles Wm. Stewart md
- QuattroElle Eye Center
- via Cusani, 7-9, 20121
- Milano
- Italy
- Claes Feinbaum md
- Professor Emeritus Optometry
- OkoMedica
- Warsaw, Poland
- Cyres K Mehta ms fsvh fage
- Director and Consultant
- Mehta International Eye Institute
- Seaside 147, Shahid Bhagar Singh Rd.
- Colaba, Mumbai-400005
- India
- Dariel Mathur mbbs ms
- Cornea and Refractive Surgery Service
- Shroff Eye Centre,
- New Delhi, India
- David Piñero msc
- Instituto Oftalmologico De Alicante
- Avda. Denia 111, 03016
- Edificio Vissum
- Alicante, Spain
- David T Vroman md
- Magill Research Centre for Vision
- Correction, Storm Eye Institute-MUSC
- 167, Ashley Avenue
- Charleston, South Carolina
- 29425, USA
- Dimitrii Dementiev md
- Chief and Medical Director
- Blue Eye Centro di
- Michro Chirurgia Oculare Eye Clinic
- Arese 20020 (MI)
- Via Campo Gallo 21/10, Italy
- Dolores Ortiz phd
- Instituto Oftalmologico De Alicante
- Avda. Denia 111, 03016
- Edificio Vissum
- Alicante, Spain
- Emanuel Rosen md
- Medical Director
- Rosen Eye Associates
- Harbour City, Salford Quays
- M50 3BH, UK
- Erik L Mertens md febo
- Medical Director
- Antwerp Eye Center
- Kapelstraat 8
- B-2660 Antwerp, Belgium
- Francisco S´nchez León md
- Instituto Nova Vision
- Medical Director
- Cornea, Refractive and
- Anterior Segment Clinic
- Cd de Mexico, Acapulco
- Mexico
- Franco Bartoli md
- Centro Microchirurgia Oculare
- Via Donizetti 24, 20052
- Frank J Goes md
- Director Goes Eye Centre
- W.Klooslaan 6 B2050
- Antwerp, Belgium
- Frederic Hehn md
- Centre de La Vision
- Nations - Vision
- 23, Boulevard de l'europe
- 54500, Vandoeuvre, France
- George Stamatelatos md
- New Vision Clinics
- 7, Chesterville Road
- Chelternham
- Victoria 3192, Australia
- Gregg Feinerman md facs
- Feinerman Vision Center
- 320 Superior Avenue, Suit # 350
- Newport Beach, California 92663
- USA
- Harkaran S Bains md
- Augenklinik am Neumarkt
- Schildergasse 107-109
- D-50667 Koln, Germany
- Hermann Anhalm phd
- Senior Optometrist
- Deptt. of Ophthmology
- Klinik Pallas
- Louis Giroud-Str. 20
- 4600 Olten, Switzerland
- Jairo E Hoyos md phd
- Instituto Oftalmologico Hoyos
- Rambla de Sabadell 62 1°
- 08201 Sabadell
- Barcelona, Spain
- Jairo E Hoyos–Chacon md
- Instituto Oftalmologico Hoyos
- Rambla de Sabadell 62 1°
- 08201 Sabadell
- Barcelona, Spain
- Jerome Jean Bovet md
- Consultant Ophthalmic Surgeon FMH
- Clinique de L'oeil
- 15, Avenyue Du Bois-de-law- Chapelle
- CH-1213, Onex, Switzerland
- Johan A de Lange md
- Ocumed Building, Vaal Drive
- Vanderbijilpark, Gauteng
- South Africa
- Jorge L Alio md phd
- Professor and Chairman
- Instituto Oftalmologico De Alicante
- Avda. Denia 111, 03016
- Edificio Vissum, Alicante, Spain
- Jörg Müller ms
- Department of Ophthmology
- Klinik Pallas
- Louis Giroud-Str. 20
- 4600 Olten
- Switzerland
- JT Lin phd
- Technical Director
- Photon Data Inc.7055
- University Blvd
- Winter Park
- Florida, USA
- Keiki R Mehta ms do fios
- Chairman and Medical Director
- Mehta International Eye Institute
- 147, Shahid Bhagat Singh Road
- Colaba Road
- Mumbai-400005
- India
- Kerry D Solomon md
- Magill Research Centre for Vision
- Correction, Storm Eye Institute-MUSC
- 167, Ashley Avenue
- Charleston, South Carolina
- 29425, USA
- Kim Nguyen md
- Consultant Ophthalmologist
- USA
- Kumar J Doctor ms dnb
- Director
- Doctor Eye Institute
- Spenta Mansion, 1st Floor
- SV Road, Andheri (West)
- Mumbai-400058
- India
- Luis E Fernández de Castro md
- Magill Research Centre for Vision
- Correction, Storm Eye Institute-MUSC
- 167, Ashley Avenue
- Charleston, South Carolina
- 29425, USA
- Mahendra D Dive ms dnb
- Doctor Eye Institute
- Spenta Mansion, 1st Floor
- SV Road, Andheri (West)
- Mumbai-400058, India
- Mahipal S Sachdev md
- Chairman and Medical Director
- Centre for Sight
- B5/24, Safdarjung Enclave
- New Delhi, India
- Manoj S Venkiteshwar phd
- Scientific and Clinical Affairs-Ocular
- Research, Bausch and Lomb
- 1400N, Goodman Street
- Rochester, New York 14609, USA
- Marcus Solorzano md
- Consultant Ophthalmologist
- USA
- Masanao Fujieda md
- Japan
- Melania Cigales md
- Instituto Oftalmologico Hoyos
- Sabadell (Barcelona)
- Spain
- Mikhail Pojaritsky md
- Blue Eye Centro di
- Michro Chirurgia Oculare Eye Clinic
- Arese 20020 (MI)
- Via Campo Gallo 21/10, Italy
- Ming Wang md phd
- Clinical Associate Professor of
- Ophthalmology, University of
- Tennessee, Staff Physician
- Thomas Hospital, Director
- Mohinder M Merchea od phd
- Scientific and Medical Affairs-Ocular
- Research, Bausch and Lomb
- 1400N, Goodman Street
- Rochester, New York 14609
- USA
- Mukesh Jain ms
- CustomVis
- Ground Floor, 110 Erindale Road
- Balcatta-Western Australia-6021
- Australia
- N Timothy Peters md facs
- Clear Advantage Vision Correction Center
- 30 Borthwick Ave Suite 306
- Portsmouth, New Hampshire 03801, USA
- Neil Vice md
- CustomVis
- Ground Floor, 110 Erindale Road
- Balcatta-Western Australia-6021
- Australia
- Nilesh Kanjani ms
- Consultant
- Dr. Agarwal's Eye Hospital Pvt. Ltd.
- 19, Cathedral Road
- Chennai-86, India
- Noel Alpins md fracs
- Medical Director
- New Vision Clinics
- 7, Chesterville Road
- Chelternham, Victoria 3192
- Australia
- Noshir M Shroff mbbs ms
- Cornea and Refractive Surgery Service
- Shroff Eye Centre
- New Delhi, India
- Omid Kermani md
- Augenklinik am Neumarkt
- Schildergasse 107-109
- D-50667 Koln, Germany
- Paul Karpecki md
- Director of Research
- Moyes Eye Center
- Kansas City, USA
- Peter Keller phd
- Department of Optometry and
- Vision Sciences
- University of Melbourne, Australia
- Ranjan Dutta mbbs md
- Cornea & Refractive Surgery Service
- Shroff Eye Centre,
- New Delhi,
- India
- Robert Montés-Micó md
- Instituto Oftalmologico De Alicante
- Avda. Denia 111, 03015
- Alicante
- Spain
- Roberto Pinelli md
- Director, Istituto Laser Microchirurgia
- Oculare Crystal Palace, Via Cefalonia, 70
- 25124, Brescia,
- Italy
- Ronald Singal md
- Blue Eye Centro di
- Michro Chirurgia Oculare Eye Clinic
- Arese 20020 (MI)
- Via Campo Gallo 21/10,
- Italy
- S Bharti ms
- Medical Director
- Bharti Eye Foundation
- 1/3, East Patel Nagar
- New Delhi-110008, India
- Samuel Arba Mosquera msc
- Optical/Visual Researcher
- R&D Department
- SCHWIND eye-tech solutions
- Germany
- Sanjay Chaudhary ms
- Chaudhary Eye Centre and
- Laser Vision
- 4802, Bharat Ram Road
- Ansari Road, 24, Darya Ganj
- New Delhi-110002, India
- Sara Turella ma
- Istituto Laser Microchirurgia Oculare
- Crystal Palace,
- Via Cefalonia, 70, 25124 Brescia
- Shiela Scott md
- Consultant Ophthalmologist
- USA
- Sonika Doshi md
- Consultant
- Dr. Agarwal's Eye Hospital
- 19, Cathedral Road
- Chennai-600086, India
- Sunita Agarwal ms do psvh
- Dr. Agarwal's Eye Hospital,
- 19, Cathedral Road,
- Chennai-600086, India
- 15, Eagle Street, Langford Town
- Bangalore, India
- Tarak Pujara ms
- CustomVis
- Ground Floor, 110 Erindale Road
- Balcatta—Western Australia-6021
- Australia
- Tracy Schroeder Swartz md
- Gulani Vision Institute,
- 4500 Salisbury Rd Suite 160
- Jacksonville, Florida, USA
- Vidyasagar Paul ms
- Chaudhary Eye Centre and Laser Vision
- 4802, Bharat Ram Road
- Ansari Road, 24, Darya Ganj
- New Delhi-110002,
- India
It is a great honor and pleasure to write the foreword for Mastering the Techniques of Customized LASIK (Technology and Innovations), edited by Dr. Ashok Garg and seven of his esteemed colleagues: Drs Emanuel Rosen, Dr JT Lin, Dr Noel Alpins, Dr Jerome Jean Bovet, Dr Roberto Pinelli, Dr Bojan Pajic, and Dr Cyres K Mehta. This book was an ambitious project, with 58 chapters divided into four sections covering the basic biophysics and preliminary considerations in customized LASIK, various customized LASIK techniques and platforms, customized LASIK complications and management, and recent advances in customized LASIK techniques.
Speaking of experts: in this book, some of the very best international minds have come together to produce what I believe is, to date, the most extensive review of customized laser vision correction in existence.
Congratulations are in order for Dr Garg, his co-editors, and the many authors who took the time to share their knowledge so eloquently with us. Their work is both educational and inspirational, serving as a guiding light for those who wish to improve the way that medicine is practiced. I would like to end with a quote from Eleanor Roosevelt, which epitomizes their spirit: “The future belongs to those who believe in the beauty of their dreams.”
Dr. Marguerite McDonald, md, facs
Clinical Professor of Ophthalmology
Tulane University Health Sciences Center
Ophthalmic Consultants of Long Island
Lynbrook, New York, USA
Tel.: (504) 896-1240
E-mail: margueritemcdmd@aol.com
9Preface
Laser Refractive Surgery is in its second decade and improvements realized in this time is remarkable. Wavefront guided customized Lasik is a recent advancement in Corneal Refractive Surgery that is designed to correct refractive error and higher order aberrations as measured on each patient preoperatively individually. Reducing these aberrations leads to significantly improve visual performance and patient satisfaction. In customized Lasik refractive outcomes have become increasingly accurate due to nomogram, Laser algorithm adjustments and the use of larger treatment zones, the focus has shifted to maintain or possibly increasing the quality of vision. Latest generation of wavefront based platforms shall allow the refractive surgeons to visualize this goal. Excellent visual acuity results that are achieved with customized lasik have led to high patient satisfaction rates & surgeon comforts. As compare to conventiional Lasik surgery which causes a rise in higher order corneal aberrations, the Customized Lasik ablation intends to maintain the prolate shape of the cornea & reduce corneal surface irregularities which leads to Excellent UCVA, better night vision quality & lenses induced wavefront aberrations postoperatively.
Present International book has been written with the aim of providing complete uptodate information on customized lasik in a single comprehensive book which is otherwise not available at an international level. This international book contains 63 excellent chapters written by International Customized Lasik experts covering all aspects from Biophysics to varrious customized Lasik Techniques and platforms, complications management and Recent Advances in a Lucid manner. Various new technique like customized Presbyopic Lasik, Aspheric Lasik, Pentacam technology, New Algorithm to control corneal asphericity, Femtosecond Laser, Bladeless Lasik Surgery, Disposable Custom Configured Microkeratome, Visiodynamics & Customized bifocal lasik are star features of this book. A video DVD ROM is an added attraction of the book showing Latest Customized Lasik Techniques by International Masers of this field.
Our special thanks to Sh. Jitender Vij (CEO) M/s Jaypee Brothers Medical Publisher, Mr. Tarun Duneja (General Manager Publishing) & all staff members who took keen interest in the publication of this book in a short span of time.
We are confident that present book shall be able to meet all expectations of customized lasik surgeons worldwide to provide complete information on this subject in a comprehensive manner.
Editors