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The latest results from US clinical trials indicate that the Zyoptix (Bausch & Lomb) system for wavefront-guided Lasik provides
excellent visual results with few complications, according to Stephen Slade MD, FACS.

More than 94% of subjects maintained or improved their BCVA six months after surgery and 70.3% had unaided 20/16 vision. The results were based on a cohort of 340 eyes of 170 patients, with a combination of myopia of up to -7.0 D and astigmatism of up to -3.5 D. Follow-up was 100% at six months.

“We have both a subjective and objective improvement in quality, with contrast and sensitivity testing, a real decrease of higher order aberrations and a very favourable comparison with the only system that has so far been published,” said Dr Slade, who presented the results of the latest trials with Zyoptix for the correction of myopia with and without astigmatism at the 7th ESCRS Winter Refractive Surgery meeting.

Describing the results as very encouraging, Dr Slade said there is “a reduction in higher order aberrations, more accurate measurement and correction of lower-order aberrations, improvement of visual quality and a reduction in many cases of problems such as halos or glare”.

He explained that the system corrects both spherical aberrations and astigmatism, and that no adjustments in the software program were necessary. Overall, the results suggest the customised ablation approach may safely reduce higher order optical aberrations with resultant benefits in uncorrected visual acuity and patient satisfaction.

The Zyoptix system, which has been used to perform more than 30,000 personalised Lasik procedures worldwide, combines the Zywave wavefront aberrometer, Obrscan II corneal diagnostics and the Technolas 217 excimer laser to create customised corneal ablations.

Dr Slade said that the results were encouraging for both spherical and cylindrical aberrations. The postoperative UCVA was equal to or better than preoperative BCVA in 78% of eyes with spherical aberrations. While two eyes lost two lines of BCVA, 61% gained one line or more.

Six months after surgery, 99% of subjects reported that they were satisfied with the results; 99.7% indicated improvement in quality of vision, of which more than 40% reported improvement in night vision while driving. Contrast sensitivity at low illumination was improved or the same in 77% to 83% of eyes.

Refractive predictability was also excellent, Dr Slade reported. Almost 75% of eyes were within 0.5 D and close to 90% within 1.0 D of the expected outcome. The refractive stability for all 340 eyes, sphere and cylinder, tracked “very nicely” from day one to the six month period, he said.

He noted that the data confirmed that the Zyoptix system reduced wavefront aberrations postoperatively compared to standard treatment. At a 6.0mm pupil, 69% showed no change or a decrease in third-order aberrations postoperatively.
“Overall, looking at the higher order aberrations, the patients who had significant detectable aberration preoperatively wound up with lower amounts than they started out with,” Dr Slade said.

He added that induced spherical aberrations yielded the least impressive results from the clinical data, but said that this could be explained by the fact that the nomogram wasn't set up to specifically address induced spherical aberration.
“Of course this is the bulk of the induced aberrations, certainly with myopic treatments. That'll be changed as we go forward,” he said.
Dr Slade added that there was now a large series of custom ablation results from global studies which confirmed the effectiveness of the Zyoptix system.

Stephen G Slade MD, FACS
TLC Laser Eye Centres, Houston, Texas
Email: sgs@visiontexas.com

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