Consistent comparison of angle Kappa adjustment between Oculyzer and Topolyzer Vario topography guided LASIK for myopia by EX500 excimer laser

AIM： To evaluate and compare the uniformity of angle Kappa adjustment between Oculyzer and Topolyzer Vario topography guided ablation of laser in situ keratomileusis（LASIK） by EX500 excimer laser for myopia.METHODS： Totally 145 cases（290 consecutive eyes）with myopia received LASIK with a target of emmetropia. The ablation for 86 cases（172 eyes） was guided manually based on Oculyzer topography（study group）, while the ablation for 59 cases（118 eyes） was guided automatically by Topolyzer Vario topography（control group）. Measurement of adjustment values included data respectively in horizontal and vertical direction of cornea. RESULTS： Horizontally, synclastic adjustment between manually actual values（dx_（manu）） and Oculyzer topography guided data（dx_（ocu）） accounts 35.5% in study group, with mean dx_（manu）/dx_（ocu） of 0.78±0.48; while in control group, synclastic adjustment between automatically actual values（dx_（auto）） and Oculyzer topography data（dx_（ocu）） accounts 54.2%, with mean dx_（auto）/dx_（ocu） of 0.79±0.66. Vertically, synclastic adjustment between dy_（manu） and dy_（ocu） accounts 55.2% in study group, with mean dy_（manu）/dy_（ocu） of 0.61±0.42; while in control group, synclastic adjustment between dy_（auto） and dy_（ocu） accounts 66.1%, with mean dy_（auto）/dy_（ocu） of 0.66±0.65. There was no statistically significant difference in ratio of actual values/Oculyzer topography guided data in horizontal and vertical direction between two groups（P=0.951, 0.621）.CONCLUSION： There is high consistency in angle Kappa adjustment guided manually by Oculyzer and guided automatically by Topolyzer Vario topography during corneal refractive surgery by Wave Light EX500 excimer laser.

Kappa angles in different positions in patients with myopia during LASIK

AIM： To investigate the difference in kappa angle between sitting and supine positions during laser-assisted in situ keratomileusis（LASIK）.·METHODS： A retrospective study was performed on395 eyes from 215 patients with myopia that received LASIK. Low, moderate, and high myopia groups were assigned according to diopters. The horizontal and vertical components of kappa angle in sitting position were measured before the operation, and in supine position during the operation. The data from the two positions were compared and the relationship between kappa angle and diopters were analyzed.· RESULTS： Two hundred and twenty-three eyes（56.5%） in sitting position and 343 eyes（86.8%） in supine position had positive kappa angles. There were no significant differences in horizontal and vertical components of kappa angle in the sitting position or horizontal components of kappa angle in the supine position between the three groups（P 〉0.05）. A significant difference in the vertical components of kappa angle in the supine position was seen in the three groups（P 〈0.01）. Differences in both horizontal and vertical components of kappa angles were significant between the sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angles（P 〈0.05） were found and vertical components of kappa angle in sitting and supine positions were negatively correlated with the degree of myopia（sitting position： r =-0.109; supine position： r =-0.172; P 〈0.05）.·CONCLUSION： There is a correlation in horizontal and vertical components of kappa angle in sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angle in sitting and supine positions till the end of the results. This result still needs further observation. Clinicians should take into account different postures when excimer laser surgery needs to be performed.

Predictive factors for photic phenomena after refractive,rotationally asymmetric,multifocal intraocular lens implantation

AIM： To investigate the independent factors associated with photic phenomena in patients implanted with refractive,rotationally asymmetric,multifocal intraocular lenses（MIOLs）.METHODS： Thirty-four eyes of 34 patients who underwent unilateral cataract surgery,followed by implantation of rotationally asymmetric MIOLs were included.Distance and near visual acuity outcomes,intraocular aberrations,preferred reading distances,preoperative and postoperative refractive errors,mesopic and photopic pupil diameters,and the mesopic and photopic kappa angles were assessed.Patients were also administered a satisfaction survey.Photic phenomena were graded by questionnaire.Independent-related factors were identified by correlation and bivariate logistic regression analyses.RESULTS： The distance from the photopic to the mesopic pupil center（pupil center shift） was significantly associated with glare/halo symptoms [odds ratio（OR）=2.065,95% confidence interval（CI）=0.916-4.679,P=0.006] and night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007）.The preoperative photopic angle kappa was significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041）.The photopic angle kappa was also significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041） and with night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007） in patients implanted with rotationally asymmetric MIOLs.CONCLUSION： A large pupil center shift and misalignment between the visual and pupillary axis（angle kappa）may play a role in the occurrence of photic phenomena after implantation of rotationally asymmetric MIOLs.

Centration axis in refractive surgery

The human eye is an asymmetric optical system and the real cornea is not a rotationally symmetrical volume.Each optical element in the eye has its own optical and neural axes.Defining the optimum center for laser ablation is difficult with many available approaches.We explain the various centration approaches(based on these reference axes)in refractive surgery and review their clinical outcomes.The line-of-sight(LOS)(the line joining the entrance pupil center with the fixation point)is often the recommended reference axis for representing wavefront aberrations of the whole eye(derived from the definition of chief ray in geometrical optics);however pupil centration can be unstable and change with the pupil size.The corneal vertex(CV)represents a stable preferable morphologic reference which is the best approximate for alignment to the visual axis.However,the corneal light reflex can be considered as non-constant,but dependent on the direction of gaze of the eye with respect to the light source.A compromise between the pupil and CV centered ablations is seen in the form of an asymmetric offset where the manifest refraction is referenced to the CV while the higher order aberrations are referenced to the pupil center.There is a need for a flexible choice of centration in excimer laser systems to design customized and non-customized treatments optimally.