Irregular Astigmatism: Diagnosis and Treatment

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SLACK Incorporated, 2008 - Medical - 295 pages
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Since the advent of keratorefractive surgery and its rising popularity, irregular astigmatism has become an increasingly important issue for ophthalmologists and optometrists. Despite the success of LASIK and PRK, there are more and more patients experiencing visual quality problems due to the non-physiological modification of the corneal structure. Among these complications, irregular astigmatism is perhaps the most difficult to treat.

The first of its kind, Irregular Astigmatism: Diagnosis and Treatment synthesizes our knowledge and understanding of irregular astigmatism and addresses state-of-the-art technology in management and treatment. Dr. Ming Wang, assisted by Dr. Tracy Swartz, has led a team of internationally known experts in the field to produce this innovative, comprehensive, and logically presented text, which includes more than 300 illustrations to supplement the information provided.

Inside you will find:
• History and optics of regular and irregular astigmatisms
• Useful criteria for diagnosis and classification
• Current state-of-the-art technologies for treatment
• Suggestions for future direction in treatment technology

Every physician who performs keratorefractive surgery understands that in reducing a patient’s refractive error, there is a possibility of creating irreversible effects on visual quality. Irregular Astigmatism: Diagnosis and Treatment is intended to help prevent and reduce the iatrogenic creation of irregular astigmatism, as well as provide effective treatment when postoperative complications do arise.

Complications discussed include:
• Decentered treatment
• Small optical zone
• Central island
• Oblate cornea
• Destablized cornea

In addition, this text systematically separates two distinctly different etiological groups of irregular astigmatism—that of a structurally stable cornea and that of a structurally unstable weak cornea—and comprehensively presents all treatment modalities for each.

Treatment technologies addressed include:
• UV corneal cross-linking
• Intacs intracorneal rings
• Penetrating and lamellar keratoplasties
• C-CAP
• Custom wavefront- and topography-driven treatments
• Lens surgery and toric IOL
• Conductive keratoplasty

With the maturation of keratorefractive technology in recent years, effective treatment for iatrogenic irregular astigmatism is quickly developing. Irregular Astigmatism: Diagnosis and Treatment provides everything refractive surgeons, ophthalmologists, and optometrists need to know about this important topic.
 

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Contents

Introduction A Brief History Astigmatism
3
Ocular Components of Regular and Irregular Astigmatism
9
Corneal Biomechanics
23
Evaluation of Irregular Astigmatism With Artemis VHF Digital Ultrasound Scanning
29
Clinical Evaluation of Regular and Irregular Astigmatism
43
Keratoconus and Pellucid Marginal Degeneration Etiology and Clinical Presentations of Irregular Astigmatism
53
Nonectatic Corneal Problems Causing Irregular Astigmatism
61
Etiology and Clinical Presentations of Irregular Astigmatism After Keratorefractive Surgery
73
Phototherapeutic Keratectomy for Irregular Astigmatism With and Without Modulators
167
Treating Stable Corneas Combined Consideration of Wavefront and TopographyGuided Treatment
177
Irregular Astigmatism WaveLight Allegretto Wave TopographyGuided Customized Ablation Treatment
185
Irregular Astigmatism LaserSight Ellipsoid Model and Topography Driven Aspheric Treatment
195
Treatment of Irregular Astigmatism Developing an Ideal Corneal Surface With the iVIS Suite
211
TopographyGuided Ablation With the Carl Zeiss Meditec MEL80 and CRS Master
219
Irregular Astigmatism CustomContoured Ablation Pattern Treatment
227
Correcting Irregular Astigmatism After LASIK
233

Etiology and Clinical Presentation of Irregular Astigmatism in Other Surgical Settings
85
Nonsurgical Treatment for Irregular Astigmatism Contact Lens Options
101
Principles of Surgical Treatment for Irregular Astigmatism An Overview
111
Indications for Penetrating Keratoplasty for Irregular Astigmatism
117
INTACS Implantation
129
Lamellar Keratoplasty
137
Corneal CrossLinking With Riboflavin and Ultraviolet Irradiation in Unstable Corneas With Progressive Irregular Astigmatism
145
Treating Stable Corneas WavefrontGuided Treatments for Irregular Astigmatism
149
Photorefractive Keratectomy for the Correction of Corneal Irregular Astigmatism
163
Management of Astigmatism During LensBased Surgery
239
Conductive Keratoplasty Treatment for Astigmatism
245
Principles of Surgical Treatment of Irregular Astigmatism in Unstable Corneas
251
Asymmetrical Surgical Treatment Using Vector Planning
263
Optimal Trea Normal Cornea TopographicallyGuided LASIK for Myopia Using the NIDEK Customized Aspheric Treatment Zone
269
Future Direction Technological Development and Treating the Problem at Its Source
279
Index
285
Copyright

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About the author (2008)

Ming Wang, MD, PhD, is a Clinical Associate Professor of Ophthalmology at the University of Tennessee, Attending Surgeon at Saint Thomas Hospital, and Director of Wang Vision Institute in Nashville, Tennessee, USA. He is also the Director of Refractive Surgery at the Aier Eye Hospitals, the largest private eye hospital system in China. Dr. Wang received his doctorate degree in laser spectroscopy and his post-doctorate fellowship from the University of Maryland in College Park, Maryland, and the Massachusetts Institute of Technology in Boston, Massachusetts, respectively. In 1991, he received his medical degree (graduating magna cum laude and receiving the award for the best thesis) from Harvard Medical School and Massachusetts Institute of Technology in Boston, Massachusetts, and the Harold Lamport Biomedical Research Prize from Harvard and MIT. After completing both a residency in ophthalmology and a fellowship in ocular genetics at the Wills Eye Hospital in Philadelphia, Pennsylvania, he completed a clinical fellowship in cornea and external disease and refractive surgery at the Bascom Palmer Eye Institute, University of Miami School of Medicine in Miami, Florida. In 1997, he became the founding director of the Vanderbilt Laser Sight Center and a full-time faculty member of the Department of Ophthalmology at the Vanderbilt University School of Medicine. He remained at Vanderbilt for 5 years before he went into private practice in 2002. www.wangvisioninstitute.com Dr. Wang''s research career encompasses three distinctively different fields. From 1982 to 1987, he published as the first author of a dozen original papers in the leading physics journal, Physical Review A, describing the development of a novel experimental atomic physics technique that he developed with Professor John Weiner, a Doppler velocity-selected associative ionization process between sodium atoms. In 1987, Dr. Wang turned his inquisitive mind to the study of molecular biology at Harvard and MIT, and published as the first author of a major paper in the world-renowned journal, Nature, regarding a novel molecular biology technique that he invented with Professor George Church, a whole-genome approach to in vivo DNA-protein interaction and gene expression regulation. After research careers in experimental atomic physics and molecular biology, Dr. Wang then began yet another research career in 1992, this time in ophthalmology, ocular genetics, novel anterior segment reconstructive surgeries, and corneal topography. Working with Professor Larry Donoso, he cloned the first ocular melanoma-associated antigen. Dr. Wang made an original contribution to the field of corneal wound healing by publishing with Professor Scheffer Tseng the first paper in the literature regarding laboratory success in the reduction of corneal scarring and apoptosis with amniotic membrane transplantation. Dr. Wang holds a US patent for his invention of the amniotic membrane contact lens, and he successfully made the first prototype. He was a former consultant to the United States Food and Drug Administration Ophthalmic Device Panel and a primary reviewer for the panel for the first US LASIK approval by the FDA in 1999. Dr. Wang conducted the first large-scale clinical study and was the principal clinical investigator of the first 3-D stereo corneal topographer, AstraMax. He was the first surgeon from the US to study a new, high frequency excimer laser and treatment-planning platform designed to treat post-LASIK complex eyes. Dr. Wang performed the first femtosecond laser-assisted artificial cornea implantation. He was a LASIK surgeon for ABC''s national network reality show program, Extreme Makeover. Dr. Wang is on the editorial board of Cataract and Refractive Surgery Today, and is a reviewer for Ophthalmology, American Journal of Ophthalmology, Cornea, Journal of Cataract and Refractive Surgery, Journal of Refractive Surgery, Genome, and Investigative Ophthalmology and Visual Sciences. Dr. Wang was the editor of Corneal Dystrophies and Degenerations, published by the American Academy of Ophthalmology. He offers the only fellowship in cornea and external disease and refractive surgery in the state of Tennessee. He has been invited to lecture around the world and is an honorary professor of ophthalmology at Xiamen and Zhongshan Medical Universities in China and Shanghai Aier Eye Hospital, where in 2005 he performed China''s first Intralase LASIK procedure. Dr. Wang is the founding chairman of the Wang Foundation for Sight Restoration, a nonprofit organization that assists terminally corneal blind patients to undergo novel eye reconstructive surgeries performed free of charge by Dr. Wang. The foundation holds an annual fundraiser, the Eye Ball, each year in the fall. Dr. Wang is the recipient of numerous awards, including being listed continuously each year by Castle Connelly as one of the Best Doctors in America (an honor bestowed on less than 1% of US physicians), a Fight for Sight Research Grant of the Research Division to Prevent Blindness, faculty research award of Vanderbilt University, and was a co-principal investigator of a RO1 grant from the National Institutes of Health. Dr. Wang has a diverse interest in hobbies. He has a band with classical guitarist Mr. Carlos Gonzalez called Music for Sight, in which Dr. Wang plays the Er-hu, a Chinese violin. In Dolly Parton''s CD, Those Were the Days, he played his Er-hu to Ms. Parton''s song "The Cruel War." In addition, Dr. Wang is an accomplished ballroom dancer and member of the U.S. collegiate champion Harvard University team. He is the president of the Music City Chapter of the United States Amateur Ballroom Dancers Association, and is ranked fourth in the United States in pro-am international ballroom 10-dance.

Tracy Schroeder Swartz, OD, MS, FAAO graduated with a Doctorate from the Indiana University School of Optometry in 1994, and completed a Master''s degree in Physiological Optics while serving as faculty at the IU School of Optometry from 1994 to 1998. During this time, she did research, published, and lectured in the areas of glaucoma, cornea and contact lenses, pediatrics, binocular vision, and strabismus. Dr. Swartz was awarded the Glen Fry Award for research in 1998. She became a Fellow of the American Academy of Optometry in 2001, and serves as adjunct faculty at the IU School of Optometry, Bloomington, Indiana. She currently serves as the Clinical Operations Manager of the Wang Vision Institute in Nashville, Tennessee, and is skilled in the treatment of ocular disease and complications from refractive surgery. She has published over 15 book chapters on topography and refractive surgery, lectures nationwide as well as locally, and edits a monthly column for Cataract and Refractive Surgery Today. She lives in Brentwood, Tennessee with her husband, son, and twin girls.

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