Wavefront Customized Visual Correction The Quest for Super Vision II RONALD R. KRUEGER, MD, MSE Medical Director, Department of Refractive Surgery Cleveland Clinic Foundation Cole Eye Institute Cleveland, Ohio RAYMOND A. APPLEGATE, OD, PHD Professor and Borish Chair of Optometry College of Optometry University of Houston Houston, Tex SCOTT M. MACRAE, MD Director of Refractive Surgery Professor of Ophthalmology Professor in the Center for Visual Science University of Rochester Medical Center Rochester, NY An innovative information,education,and management company 6900 Grove Road • Thorofare, NJ 08086 DEDICATION To the Glory of God through the person of Jesus Christ, To whom I owe everything, and without whom I am nothing, He is my life, hope, and joy, now and forever... ....And to my loving mother, Lucie Krueger, God Bless You on your 80th Birthday Year! Ronald R. Krueger, MD,MSE I dedicate this book to my father, K. Edwin Applegate, and mother, Elizabeth Dilts Applegate, for their unwavering love, support, and faith in my ability. Happy 60th anniversary. Raymond A. Applegate, OD, PhD I dedicate this book to my 6-year-old daughter, Morgan, whose energy, curiosity, and creativity will bless the world for many years to come. To my wife, Abby, whose loving support and thoughtful reflection lift my wings and feed my soul. To my mom, Bets, whose gentle spirit teaches me grace and appreciation. Scott M. MacRae, MD Copyright © 2004 by SLACK Incorporated Front cover: Image courtesy of Dan Topa at WaveFront Sciences, Inc, Albuquerque, NM. Back cover: The editors, hard at work on their edits. Photo courtesy of Bernadine Ursell. All rights reserved. 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Rev. ed. of: Customized corneal ablation. c2001. Includes bibliographical references and index. ISBN 1-55642-625-9 (alk. paper) 1. LASIK (Eye surgery) 2. Corneal topography. [DNLM: 1. Corneal Topography. 2. Cornea--surgery. 3. Ophthalmologic Surgical Procedures--methods. 4. Refractive Errors--therapy. WW 220 W355 2004] I. Krueger, Ronald R. II. Applegate, Raymond Alan. III. MacRae, Scott. IV. Customized corneal ablation. RE336 .W386 2006 617.7'19059--dc22 2003023442 Published by: SLACK Incorporated 6900 Grove Road Thorofare, NJ 08086 USA Telephone: 856-848-1000 Fax: 856-853-5991 www.slackbooks.com Contact SLACK Incorporated for more information about other books in this field or about the availability of our books from distributors outside the United States. For permission to reprint material in another publication, contact SLACK Incorporated. 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Prior to photo- copying items, please contact the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA01923 USA; phone: 978-750-8400; website: www.copyright.com; email: [email protected] Last digit is print number: 10 9 8 7 6 5 4 3 2 1 CONTENTS Dedication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv Section I Introduction Chapter 1 An Introduction to Wavefront-Guided Visual Correction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Scott M. MacRae, MD; Raymond A. Applegate, OD, PhD; and Ronald R. Krueger, MD, MSE Chapter 2 AReview of Basic Wavefront Optics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Austin Roorda, PhD Chapter 3 How Far Can We Extend the Limits of Human Vision?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 David R. Williams, PhD; Jason Porter, MS; Geunyoung Yoon, PhD; Antonio Guirao, PhD; Heidi Hofer, PhD; Li Chen, PhD; Ian Cox, PhD; and Scott M. MacRae, MD Chapter 4 Ophthalmic Wavefront Sensing: History and Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Howard C. Howland, MS, PhD Chapter 5 Retinal Imaging Using Adaptive Optics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Austin Roorda, PhD and David R. Williams, PhD Section II Wavefront Diagnostics and Standards Basic Science Section Chapter 6 Assessment of Optical Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Larry N. Thibos, PhD and Raymond A. Applegate, OD, PhD Chapter 7 Assessment of Visual Performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Raymond A. Applegate, OD, PhD; Gene Hilmantel, OD, MS; and Larry N. Thibos, PhD Chapter 8 Metrics to Predict the Subjective Impact of the Eye’s Wave Aberration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 David R. Williams, PhD; Raymond A. Applegate, OD, PhD; and Larry N. Thibos, PhD Chapter 9 Wavefront Information Sampling, Fitting, and Conversion to a Correction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Jim Schwiegerling, PhD Chapter 10 Chromatic Aberration and Its Impact on Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Larry N. Thibos, PhD and Arthur Bradley, PhD Chapter 11 Optical Quality of the Eye and Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Susana Marcos, PhD; Sergio Barbero, MSc; James S. McLellan, PhD; and Stephen A. Burns, PhD Chapter 12 Variation in Ocular Aberrations Over Seconds, Minutes, Hours, Days, Months, and Years. . . . . . . . . . . . . . . . 109 Larry N. Thibos, PhD and Arthur Bradley, PhD Chapter 13 Accommodation Dynamics and Its Implication on Customized Corrections. . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Vikentia J. Katsanevaki, MD, PhD; Sophia I. Panagopoulou, PhD; Sotiris Plainis, PhD; Harilaos Ginis, PhD; and Ioannis Pallikaris, MD, PhD Chapter 14 The Implications of Pupil Size and Accommodation Dynamics on Customized Wavefront-Guided Refractive Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Sophia I. Panagopoulou, PhD; Sotiris Plainis, PhD; Scott M. MacRae, MD; and Ioannis Pallikaris, MD, PhD iv Contents Clinical Science Section: Commercially Available Wavefront Devices Chapter 15 Shack-Hartmann Aberrometry: Historical Principles and Clinical Applications. . . . . . . . . . . . . . . . . . . . . . . . . 127 Maria Regina Chalita, MD and Ronald R. Krueger, MD, MSE Chapter 16 Optimizing the Shack-Hartmann Wavefront Sensor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Geunyoung Yoon, PhD; Seth Pantanelli, BS; and Scott M. MacRae, MD Chapter 17 Retinal Imaging Aberrometry: Principles and Application of the Tscherning Aberrometer. . . . . . . . . . . . . . . . 137 Michael Mrochen, PhD; Mirko Jankov, MD; Hans Peter Iseli, MD; Farhad Hafezi, MD; and Theo Seiler, MD, PhD Chapter 18 Retinal Imaging Aberrometry: Principles and Applications of the Tracey (Ray Tracing) Aberrometer. . . . . . . 145 Vasyl Molebny, PhD, DSc; Ioannis Pallikaris, MD, PhD; Sergiy Molebny, MSc; and Harilaos Ginis, PhD Chapter 19 Retinoscopic Double Pass Aberrometry: Principles and Application of the Nidek OPD-Scan. . . . . . . . . . . . . . 149 Philip M. Buscemi, OD Chapter 20 Spatially Resolved Refractometry: Principles and Application of the Emory Vision InterWave Aberrometer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Jonathan D. Carr, MD, MA, FRCOphth; Henia Lichter, MD; Jose Garcia, BS; R. Doyle Stulting, MD, PhD; Keith P. Thompson, MD; and P. Randall Staver, MS Chapter 21 Comparing Wavefront Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Daniel S. Durrie, MD and Erin D. Stahl Section III Wavefront Customized Corneal Ablation Basic Science Section Chapter 22 Physics of Customized Corneal Ablation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 David Huang, MD, PhD Chapter 23 Technology Requirements for Customized Corneal Ablation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Ronald R. Krueger, MD, MSE Chapter 24 Eye Tracking and Alignment in Refractive Surgery: Requirements for Customized Ablation. . . . . . . . . . . . . . 195 Natalie Taylor, PhD and Winfried Teiwes, Dr Ing Chapter 25 Wound Healing in Customized Corneal Ablation:Effect on Predictability, Fidelity, and Stability of Refractive Outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Joel A.D. Javier, MD; Puwat Charukamnoetkanok, MD; and Dimitri T. Azar, MD Clinical Science Section Chapter 26 Customized Ablation Using the Alcon CustomCornea Platform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 George H. Pettit, MD, PhD; John A. Campin, BSc; Marguerite B. MacDonald, MD; and Ronald R. Krueger, MD, MSE Chapter 27 Customized Ablation Using the VISX WaveScan System and the VISX S4 ActiveTrak Excimer Laser. . . . . . . 227 Junzhong Liang, PhD and Douglas D. Koch, MD Chapter 28 Customized Ablation Using the Bausch & Lomb Zyoptix System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Scott M. MacRae, MD; Steven Slade, MD; Daniel S. Durrie, MD; and Ian Cox, PhD Chapter 29 Customized Corneal Ablation Using the Carl Zeiss Meditec Platform: CRS-Master, WASCA, TOSCA, MEL70, and MEL80 Excimer Lasers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Dan Z. Reinstein, MD, MA(Cantab), FRCSC; Daniel R. Neal, PhD; Hartmut Vogelsang, PhD; Eckhard Schroeder, PhD; Zoltan Z. Nagy, MD, PhD; Michael Bergt, PhD; James Copland, MS; and Daniel Topa Chapter 30 The Allegretto Wave: ADifferent Approach to Wavefront-Guided Ablation. . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Matthias Maus, MD; Arthur Cummings, MBChB, MMed, FCS(SA) FRCSEd; and Stefan Tuess, Dip Eng Chapter 31 Clinical Results With the Nidek NAVEX Platform. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Arturo Chayet, MD and Harkaran S. Bains Contents v Section IV Wavefront Customized Lenses Chapter 32 Biomaterials for Wavefront Customization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 Liliana Werner, MD, PhD; Nick Mamalis, MD; and David J. Apple, MD Chapter 33 Feasibility of Wavefront Customized Contact Lenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 Ian Cox, PhD and Michele Lagana, OD Chapter 34 Aberration-Correcting Intraocular Lenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 Patricia Piers; N.E. Sverker Norrby, PhD; and Ulrich Mester, MD Chapter 35 The Calhoun Light Adjustable Lens: APostinsertion Method for the Correction of Refractive Errors. . . . . . . 291 Christian A. Sandstedt, PhD; Shiao Chang, PhD; and Daniel M. Schwartz, MD Section V Nonwavefront Customized Corrections Basic Science Section Chapter 36 Corneal Topography and Customized Ablation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 Charles E. Campbell, BS Chapter 37 Combining Corneal and Ocular Wave Aberrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Pablo Artal, PhD Chapter 38 Combining Vector Planning With Wavefront Analysis to Optimize Laser In-Situ Keratomileusis Outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 Noel Alpins, FRACO, FRCOphth, FACS and Leisa Schmid, PhD Clinical Science Section Chapter 39 Custom-Contoured Ablation Pattern Method for the Treatment of Irregular Astigmatism. . . . . . . . . . . . . . . . 331 Gustavo E. Tamayo, MD and Mario G. Serrano, MD Chapter 40 Surgeon-Guided Retreatment of Irregular Astigmatism and Aberrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339 Gilles Lafond, MD, FRCS(C) Chapter 41 Customized Visual Correction of Presbyopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353 Fabrice Manns, PhD; Arthur Ho, MOptom, PhD; and Ronald R. Krueger, MD, MSE Section VI The Future of Customization Chapter 42 The Future of Customization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363 Ronald R. Krueger, MD, MSE; Scott M. MacRae, MD; and Raymond A. Applegate, OD, PhD Appendix 1 Optical Society of America Wavefront Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391 ACKNOWLEDGMENTS I wish to acknowledge all those who contributed tirelessly to the completion of this book: To our authors, the experts in their respective fields, who took their time and energy to write yet another book chapter, and yet make it the best chapter they've ever written, To our editors at SLACK Incorporated—Amy McShane, Lauren Biddle Plummer, and April Billick—who believed in us and our novel ideas in compiling this book and its cover, and who kept pushing us to its completion, even when we were past our deadlines, To my coeditors, Ray and Scott, who each play such a unique role in the editorial process, and who keep challenging me and pushing me to pur- sue excellence, even when we don't always agree (see the photo on the back cover), To my Refractive Surgery Clinical Team at CCF, to Amy, Kelly, Ann, Regina, Jenny, Alan, Kim, and Sharon, and to my secretary, Bobbi, for keep- ing my clinical and professional life organized and running efficiently, so I have time to travel and pursue noble educational goals, such as the writ- ing of this book! Finally, to Stephen Trokel, MD, who 20 years ago (December 1983) wrote the first article on excimer laser photoablation of the cornea. Without that article, his mentorship, and input, I would not have entered into this field in the first place. Ronald R. Krueger, MD, MSE I wish to acknowledge scholars before my time; my mentors, coeditors, colleagues, students, and family; and the financial support of the National Eye Institute. My work, like that of others, is built upon the shoulders of scientists and clinicians who took the time to write down their findings and observa- tions in archival journals for future students to study, learn, and use as a foundation in their own work. I am routinely amazed and embarrassed to find that my "unique contributions" have already been published. Gerald Westheimer first brought this obvious and often overlooked truth to my attention. He kindly reminded me that I could save weeks and months of work in the laboratory with an hour or so in the library. I am fortunate to have had many mentors, a fraction of whom I list here. I thank and acknowledge Lee Guth for taking this green undergraduate into his lab; Jim Huff for letting me build equipment and participate in his experiments as an undergraduate; Gordon Heath for taking the time to encourage; and my graduate advisor Tony Adams for providing me academic and scientific freedom uncommon for a graduate student—his contri- bution to my career is unsurpassed. Thanks also to Russ DeValois for his evening seminars and for expertly modeling critical thinking; Gerald Westheimer for the one-on-one interactions that gave final root to my love of ocular optics; Jay Enoch for modeling scientific integrity by retracting a paper; and Bob Massof for offering scientific opportunity and friendship at Wilmer during my early days as an assistant professor when I was starv- ing for scientific opportunity. I am honored to be able to work with two exceptionally talented coeditors. I thank and acknowledge Ron Krueger for his creative energy, his abil- ity to quickly absorb, and his faith in God—it rubs off—and Scott MacRae for balance, insight, and the shared desire to create an academic balance between clinical and basic science that communicates to both. As editors, we have built the rare trust that withstands disagreements, confrontations, and the shared joy of accomplishment. It is a treasure I value deeply. My colleagues, students, and postdoctoral fellows make every day a day of discovery and a scientific challenge. I am compelled to acknowledge a few individuals and apologize to those I should have listed. I wish to thank and acknowledge Larry Thibos, Arthur Bradley, Howard Howland, Ed Sarver, Joe Harrison, Wick van Heuven, Gene Hilmantel, Austin Roorda, David Williams, Bill Donnelly, Jason Marsack, and Konrad Pesudovs for helping to make my scientific life fun and challenging. I wish to acknowledge my children—Aaron, Ryan, Camille, and Olivia—for their love, support, and faith in my abilities. Most of all I wish to acknowledge Rachel—my best friend, companion, and the love of my life. Finally, I acknowledge my grant reviewers and the dedicated people at the National Eye Institute for funding my research efforts through most of my career, beginning with a postdoctoral fellowship (F32 EY05201), an AREAgrant (R15 EY008005), R01 grant funding (RO1 EY10097 and R01 EY08520), and a CORE grant (P30EYO7551-15) to the College of Optometry. Without this support, it would have been difficult—if not impossible— to establish the scientific position allowing me to serve as a coeditor. Raymond A. Applegate, OD, PhD I am fortunate to work with many generous and talented individuals who have mentored, supported, and inspired me over the years. I am grate- ful for the mentorship of Mathew Davis, MD; Hank Edelhauser, PhD; and Fritz Fraundfelder, MD, who nurtured me in my early quest as a clinician and scientist. Each gave me room to grow in their own unique ways. I'm deeply grateful to Larry Rich, MD, my former partner who I worked with for 17 years in Oregon at the Casey Eye Institute. Larry introduced me to the field of refractive surgery as well as the works of the great Jose Barrequer, MD, and taught me the fine art of lamellar surgery. I have worked with and enjoyed the professional inspiration of many exceptionally talented individuals, including George Waring, MD; Doug Koch, MD; Dan Durrie, MD; Steve Slade, MD; Marguerite McDonald, MD; Paolo Vinciguerra, MD; Roberto Zaldivar, MD; Arturo Chayet, MD; Howard Gimbel, MD; Jay Pepose, MD; Cindy Roberts, PhD; and Jim Schwiegerling, PhD. There are many more gifted friends too numerous to mention who also have enriched my journey in ophthalmology and on a personal level. I am extremely fortunate to work with the very talented University of Rochester staff of Joseph Stamm, OD; Gary Gagarinas; Gina Crowley; Brenda Houtenbrink; and Jennifer Anstey, whose careful, diligent hours of hard work and careful observation helped generate important data that thrust the field forward, while keeping it fun for patients and staff alike. I am also very grateful to be able to work with an exceptionally talented team of basic scientists, including Jason Porter, MS; Guenyoung Yoon, PhD; Krystal Huxlin, PhD; Ian Cox, PhD; and David Williams, PhD. They are a great scien- tific team to work with and just a great group of people as well. I am indebted to Peter Slack for taking a chance and encouraging us to pursue writing the first volume of this book. Who would have guessed that the field would have exploded so quickly to warrant a second volume of this series? We are lucky to have the thoughtful editing and wonderful support of Amy McShane, April Billick, and Lauren Biddle Plummer, who have persevered to make this second volume a reality. I also want to thank my coauthors, Ron Krueger and Ray Applegate, who share their tremendous passion and insight into the field of wavefront correction of refractive errors that inspires and excites me. I am grateful to all the authors who have taken time from their busy schedules to share their important observations, the glue that holds this field together. We are indebted to those refractive surgeons who have gone before us and those who follow in our footsteps. May their path be blessed by the joy I have experienced encountering the many wonderful people mentioned as well as countless others. Scott M. MacRae, MD ABOUT THE EDITORS Ronald R. Krueger, MD, MSE, is the first of two children born to Arthur and Lucie Krueger, German immigrants and Godly, Christian parents. He was born in Elizabeth, NJ in 1960, and at a young age committed his life to a relationship with Jesus Christ. Professionally, Dr. Krueger received his MD degree from the University of Medicine and Dentistry of New Jersey (1987). Prior to that, he received a BS in Electrical Engineering from Rutgers University and an MSE in Biomedical Engineering from the University of Washington, Seattle. He completed his ophthalmology residency at the Columbia-Presbyterian Medical Center, New York, NY. He also completed two fellowships in cornea and refractive surgery from the University of Oklahoma, Oklahoma City, Okla and the University of Southern California, Los Angeles, Calif. In 1993, he joined the department of ophthalmology at the University of Missouri—St. Louis, St. Louis, Mo where he was an associate professor of ophthalmology. He then joined the Cleveland Clinic Foundation in 1998 and serves as the medical director of the department of refractive surgery, overseeing a large department of six surgeons and support staff as well as maintaining his own full schedule of patients. He is on the program planning committee of the American Academy of Ophthalmology and the International Society of Refractive Surgery and is an associate editor for the Journal of Refractive Surgery. He is cofounder and organizer of the International Congress on Wavefront Sensing and Aberration-Free Refractive Correction. He has 20 years of experience in excimer laser research, and currently is investigating the causes of presbyopia and restoration of accommodation, as well as wavefront imaging of the eye for customized laser vision correction. He is an interna- tional lecturer and is widely published. Raymond A. Applegate, OD, PhD, is the second of four children born to K. Edwin Applegate and Elizabeth Dilts Applegate. He was born in Bloomington, Ind in 1949 and attended Indiana University from Kindergarten through his Bachelor of Arts (1971), Doctor of Optometry (1975), and his Master of Science in Physiological Optics (1976). He practiced optometry in Galesburg, Ill before continu- ing his graduate education in Physiological Optics at the University of California, Berkeley where he received his PhD (1983). Dr. Applegate joined the University of Texas Health Science Center faculty in 1988 from the School of Optometry, University of Missouri—St. Louis where he served as an assistant professor of optometry. He rose through the faculty ranks quickly to become a tenured professor of ophthalmology in 1993. In January 2002, Dr. Applegate joined the College of Optometry at the University of Houston as Professor and Borish Chair in Optometry to direct the Visual Optics Institute. Dr. Applegate has served on the editorial board of Optometry and Visual Scienceand currently serves on the editorial boards for the Journal of Refractive Surgeryand the Journal of Cataract and Refractive Surgery. He has been a feature editor on several occasions for the Journal of the Optical Society of America-A, Applied Optics, Optometry and Vision Science, and the Journal of Refractive Surgery. He is a cofounder of the International Congress on Wavefront Sensing and Aberration-Free Refraction Correction, is widely published in leading journals, and is a sought-after consult- ant and international lecturer whose National Institutes of Health-supported research interests center on the optics of the normal and clinical eye and early ocular disease detection and prevention. Scott M. MacRae, MD, did his undergraduate, medical school, and residency program at the University of Wisconsin, Madison. He did three corneal fellowships including a cornea and external disease fellowship and a NEI-sponsored corneal physiology research training fellowship both at the Eye Institute, Medical College of Wisconsin, Milwaukee. He then did a brief contact lens and light tox- icity fellowship at Emory University in Atlanta (1983). In 1983, Dr. MacRae joined the faculty of Oregon Health Sciences University, Casey Eye Institute, in 1983 through 2000. He served as a panel member and consultant to the FDAOphthalmic Devices Panel from 1986 to 2000, chaired the American Academy of Ophthalmology Public Health Committee from 1991 to 1994, and ran the American Academy of Ophthalmology Clinical Alert Program. He was an advisor to the White House in 1993 on two separate panels on health care delivery and served as a congressional advisor as well. He has received an Honor Award in 1991 and the Senior Honor Award in 2000 from the American Academy of Ophthalmology. He has won numerous awards, including the Illinois Society to Prevent Blindness Young Researcher Award, The Kambara Award, The Amini Award (2003), and The Oregonian Citizen Winners Award. In 2003, he received the Lans Lectureship Award, which is an international award given to an outstanding young clinician researcher in the field of refractive surgery by the International Society of Refractive Surgery and the American Academy of Ophthalmology. Author of over 100 published articles and book chapters, Dr. MacRae has turned his attention increasingly to refractive surgery and the development of new technology. He has spoken at over 300 meetings both in the United States and internationally. He has a special interest in customized ablation, the biomechanics of laser in-situ keratomileusis, laser subepithelial keratomileusis, astigma- tism design, and interface keratitis. He has trained hundreds of clinicians, residents, and fellows and has participated and helped lead several Food and Drug Administration clinical trials in the United States, including the Nidek Oregon Kansas Study and the University of Rochester Zyoptix Customized Ablation Study. He holds a patent on the excimer laser treatment of astigmatism and has two other patents pending in the field of laser refractive surgery. On the editorial board of three ophthalmic journals, he is currently senior associate editor for the Journal of Refractive Surgery, has coedited three special editions of the Journal of Refractive Surgery, and has chaired numerous international refractive symposiums. He is senior editor of a best-selling book in ophthalmology, Customized Corneal Ablation: The Quest for SuperVision, which is the first vol- ume of this series. In 2000, Dr. MacRae accepted an appointment as Professor of Ophthalmology and Professor of Visual Science at the University of Rochester, NY, where with the Center for Vision Science at the university and private industry he promotes research and develop- ment of new refractive surgery techniques and technology. CONTRIBUTORS Noel Alpins, FRACO, FRCOphth, FACS Jonathan D. Carr, MD, MA, FRCOphth Medical Director Emory Vision New Vision Clinics Atlanta, Ga Melbourne, Australia Maria Regina Chalita, MD David J. Apple, MD Study Coordinator/Research Fellow John A. Moran Eye Center Cole Eye Institute University of Utah The Cleveland Clinic Salt Lake City, Utah Cleveland, Ohio Pablo Artal, PhD Shiao Chang, PhD Laboratorio de Optica Calhoun Vision, Inc Departamento de Física Pasadena, Calif Universidad de Murcia Campus de Espinardo (Edificio C) Puwat Charukamnoetkanok, MD Murcia, Spain Cornea and Refractive Surgery Service Department of Ophthalmology Dimitri T. Azar, MD Massachusetts Eye and Ear Infirmary Cornea and Refractive Surgery Service Boston, Mass Department of Ophthalmology Massachusetts Eye and Ear Infirmary Arturo Chayet, MD Boston, Mass Codet Eye Institute Tijuana, Mexico Harkaran S. Bains Nidek Clinical Director Li Chen, PhD Freemont, Calif Center for Visual Science University of Rochester Sergio Barbero, MSc Rochester, NY Instituto de Optica Consejo Superior de Investigaciones Científicas James Copland, MS Madrid, Spain Wavefront Sciences Albuquerque, NM Michael Bergt, PhD Carl Zeiss Meditec AG Ian Cox, PhD Jena, Germany Research Clinic Bausch & Lomb Arthur Bradley, PhD Rochester, NY School of Optometry Indiana University Arthur Cummings, MBChB, MMed, FCS(SA) FRCSEd Bloomington, Ind Wellington Ophthalmic Laser Clinic Dublin, Ireland Stephen A. Burns, PhD Schepens Eye Research Institute Daniel S. Durrie, MD Boston, Mass Clinical Associate Professor University of Kansas Medical Center Philip M. Buscemi, OD Durrie Vision President Kansas City, Kan Battleground Eye Care Greensboro, NC Jose Garcia, BS Vice President/General Manager Emory Vision Nidek Technologies America Atlanta, Ga Greensboro, NC Harilaos Ginis, PhD Charles E. Campbell, BS University Hospital of Crete Consultant, Ophthalmic Optics and Instrumentation Department of Ophthalmology Berkeley, Calif Heraklion, Greece John A. Campin, BSc Alcon Orlando Technology Center Orlando, Fla Contributors ix Antonio Guirao, PhD Gilles Lafond, MD, FRCS(C) Laboratorio de Optica Centre Hospitalier de l’Université Laval Departamento de Física Québec City, Canada Universidad de Murcia Campus de Espinardo (Edificio C) Michele Lagana, OD Murcia, Spain Research Clinic Bausch &Lomb Farhad Hafezi, MD Rochester, NY IROC AG, Institut für Refractive und Ophthalmo Chirurgie Zürich, Switzerland Junzhong Liang, PhD VISXIncorporated Gene Hilmantel, OD, MS Santa Clara, Calif Food and Drug Administration Center for Devices and Radiological Health Henia Lichter, MD Office of Device Evaluation Emory Vision Division of Ophthalmic and Ear, Nose, and Throat Devices Atlanta, Ga Rockville, Md Nick Mamalis, MD Arthur Ho, MOptom, PhD John A. Moran Eye Center Vision Cooperative Research Center University of Utah Sydney, Australia Salt Lake City, Utah Heidi Hofer, PhD Fabrice Manns, PhD Center for Visual Science Department of Biomedical Engineering University of Rochester University of Miami College of Engineering Rochester, NY Coral Gables, Fla Howard C. Howland, MS, PhD Susana Marcos, PhD Department of Neurobiology and Behavior Instituto de Optica Cornell University Consejo Superior de Investigaciones Científicas Ithaca, NY Madrid, Spain David Huang, MD, PhD Matthias Maus, MD Cole Eye Institute VisuMed AG The Cleveland Clinic Cologne, Germany Cleveland, Ohio Marguerite B. MacDonald, MD Hans Peter Iseli, MD Southern Vision Institute IROCAG, Institut für Refractive und Ophthalmo Chirurgie New Orleans, La Zurich, Switzerland James S. McLellan, PhD Mirko Jankov, MD Schepens Eye Research Institute Departamento de Oftalmologia, Santa Casa de São Paulo, Brasil Boston, Mass Setor de Bioengenharia, Departamento de Oftalmologia, Universidade Federal de São Paulo/EPM, Brasil Ulrich Mester, MD Department of Ophthalmology Joel A.D. Javier, MD Bundesknappschaft’s Hospital Cornea and Refractive Surgery Service Sulzbach, Germany Department of Ophthalmology Massachusetts Eye and Ear Infirmary Sergiy Molebny, MSc Boston, Mass National Technical University of Ukraine Kiev, Ukraine Vikentia J. Katsanevaki, MD, PhD Tracey Technologies, LLC University of Crete Medical School Houston, Tex Vardinoyannion Eye Institute of Crete Heraklion, Crete, Greece Vasyl Molebny, PhD, DSc University Hospital of Crete Institute of Biomedical Engineering of the Academy of Techno- Department of Ophthalmology logical Sciences of Ukraine Heraklion, Greece Kiev, Ukraine Douglas D. Koch, MD Cullen Eye Institute Baylor College of Medicine Houston, Tex