Role Of Visual Adaptive Optics In Optimising Visual Outcomes In Patients Undergoing Topo Guided Customised Ablation Treatments In Keratoconus

To identify if modulating spherical aberration (SA) in patients with keratoconus undergoing customised laser treatments can impact quantity and quality of vision

Narayana Nethralaya, Bengaluru

40 patients (40 eyes) with progression of keratoconus undergoing wavefront guided customised ablation treatment underwent refraction followed by vision assessment & simulation on Visual adaptive optics simulator (VAO, Voptica Inc). After measurement of wavefront aberration, patients underwent visual acuity (VA) assessment for distance with baseline SA of patient on VAO. SA of measured wavefront was modulated in steps of +0.05 μm & -0.05 μm & VA was tested for distance. Group 1 consisted of 20 patients (20 eyes) who showed improved distance vision after inducing SA. Group 2 included 20 patients (20 eyes) who did not improve after inducing SA & served as controls.All patients underwent wavefront guided ablation treatment without treating SA.

16 out of 20 eyes (80%) of in group 1 showed 2 lines of improvement in the best corrected distance visual acuity at 6 months post operatively. The remaining 4 eyes showed 1 line improvement in the BCVA. In group 2, 8 out of 20 eyes (40 %) patients showed gain in 1 line. No loss of lines was noted in the remaining 12 eyes in group 2.  The treated refraction and the ablation depth was statistically similar in both the groups. (p>0.05).

Visual adaptive optics is a novel imaging tool that can be used to customise aberration profiles of patients and optimise post operative visual outcomes