TREATMENT OF ADULT AMBLYOPES WITH ADVANCED

SURFACE ABLATION Sze H. Wong

Emil W. Chynn, MD, MBA

Maximiliano Plana, MD

Emily Ceisler, MD

ASCRS, May 2013San Francisco, CA

LASEK /Epi-LASIK to treat amblyopes is not FDA-approved.

PURPOSE

• Can adult strabismic and/or refractive amblyopes be safely and effectively treated with Advanced Surface Ablation (ASA)?

• Can UCVA, BCVA, functional vision be improved?

• Can strabismus be decreased?

• Retrospective review of adult amblyopes who underwent LASEK or Epi-LASEK with a VISX S4 IR excimer laser between 2006-2013

• Adjunctive treatment to prevent scarring:• Mitomycin C (MMC) 0.01% intraoperatively• Oral + Topical steroids: 1-6 mo postop• Vitamin C + UV protection: 6-12 mo postop

METHOD

STUDY POPULATION CHARACTERISTICS

n = 24 eyes

Female 54 %

Male 46 %

Age (mean ± SD; range) 31 ± 9; 22 - 52

Strabismic 4 %

Anisometropic Refractive 29 %

Isometropic Refractive 67 %

LASEK 79 %

Epi-LASEK 21 %

WaveFront 42 %

Rx Range (SE) -14 to +7.50

Preop BCVA logMAR 0.27 ± 0.23

Preop Corneal Thickness 588 ± 41 µm

Ablation Depth 99 ± 41 µm

Postop Corneal Thickness 489 ± 69 µm

RESULTS: UCVA (safety)

20/200

Postop UCVA vs Preop UCVA:• 100% had improvement in UCVA• Corneal haze: trace 29%, 1+ 4%, 2+ 4%• There was no loss of UCVA (haze = clin. insig.)

UCVALog MAR

error bar = sd

20/20

PreOp PostOp (months)

-1 0 1 2 3 4 5 6 70

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

20/2000

BCVA Preop BCVA Postop0

100

200

300

400

500

600

700

800

900

1000

RESULTS: BCVA (efficacy)

Postop vs Preop BCVA:• Mean gain of BCVA of 1.43 lines (±

1.11)• 87.5% had improved BCVA

RESULTS: SE vs BCVA change in Hyperopes

Correlation coefficient = 0.62

Postop BCVAMinusPreop BCVA(logMAR)

Spherical Equivalent

0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00

-0.5

-0.45

-0.4

-0.35

-0.3

-0.25

-0.2

-0.15

-0.1

-0.05

0

Hyperopic amblyopes with lower Rx have more BCVA improvement

RESULTS

Unilateral (anisometropic) amblyopes had a greater improvement in BCVA (2.5 lines) than Bilateral (isometropic) amblyopes (1.0 line) (1-tailed p value 0.04)

RESULTS

FUNCTIONAL VISION better peripheral vision: 63%improved driving: 58%increased sports ability: 29%

STRABISMUSET preop: 20Δ postop: 8ΔUCVA preop: 20/200 postop: 20/30BCVA preop: 20/30-1 postop: 20/25Would do it again? YES!

PATIENT SATISFACTION76% would undergo the operation again if given the choice

DISCUSSIONAdult strabismic/refractive amblyopes may be safely & effectively treated with ASA

No loss of UCVA (all scarring was clinically insignificant due to adjunctive measures)

Significant gains in BCVA & functional visual improvement, with excellent patient satisfaction

Better results for unilateral refractive amblyopes and low hyperopes

Further investigation is necessary, especially in strabismic amblyopes (low n)

REFERENCES

Tychsen L. Refractive surgery for children: excimer laser, phakic intraocular lens, and clear lens extraction. Curr Opin Ophthalmol. 2008 Jul;19(4):342-8.