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Excimer Laser Corneal Tissue Removal Calculations

For Lasik, All-Laser Lasik, PRK, LASEK, and Epi-Lasik.


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The most common used formula for calculating the depth the excimer laser will ablate during conventional Lasik, All-Laser Lasik, PRK, LASEK, or Epi-Lasik is called the Munnerlyn formula. Munnerlyn says the depth of the ablation (in microns) per diopter of refractive change is equal to the square of the optical ablation zone measured in millimeters, divided by three.

As an example, for a 6mm optical ablation zone, the depth of ablation per diopter of correction would be 12 microns (6?)?=12. Don't confuse the optical ablation zone with the transition zone. Adding the transition zone can require the optical ablation zone to be a little deeper.

The transition zone calculation can vary, but the general calculation to calculate the optical ablation zone with a transition zone is to add one-third of the transition zone to the calculation for the optical ablation zone. An example: for a 6mm optical ablation zone with a 1mm transition zone, the depth of ablation per diopter of correction would be 13.34 microns ((6+(1?))?(6+(1?)))?=13.34. This is for a standard, conventional excimer laser assisted refractive surgery.

Wavefront-guided ablations normally require significantly more tissue removal than conventional ablations. This is due to the laser attempting to limit the increase of higher order aberrations. The calculations for wavefront-guided ablations are infinitely more complex, but a general rule of thumb is to add about 30-40% of the total for a conventional ablation. Fortunately, prior to surgery the wavefront-guided systems have the ability to determine exactly how much tissue will be ablated and where.

These are only guidelines. There are many, many factors that dictate changes in this formula. Atmospheric pressure and relative humidity at the time of surgery will cause a change. Sex, age, and race of the patient can require changes to this formula. If the laser uses a gaussian profile flying spot rather than a broadbeam application, less tissue may required per diopter of refractive change. The length of time during surgery will change the hydration of the cornea and may require less laser energy for the same correction. Different lasers of the same type require slightly different formulas. Each doctor refines his or her formula based upon real practical experience with a particular set of parameters.

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, NearVision CK, RLE, or any refractive surgery procedure, we highly recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Laser Eye Surgery Doctor.

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.


Current Lasik Ablation Calculation Medical Journal News...

Real Ray Tracing Simulation Versus Clinical Outcomes of Corneal Excimer Laser Surface Ablations.

Related Articles

Real Ray Tracing Simulation Versus Clinical Outcomes of Corneal Excimer Laser Surface Ablations.

J Refract Surg. 2010 Apr 14;:1-13

Authors: Einighammer J, Oltrup T, Bende T, Jean B

PURPOSE:To investigate the recently reported discrepancy between theoretical expectations and clinical outcomes of corneal ablations after excimer laser corneal refractive surgery. METHODS:Thirty-four eyes of 25 patients who had laser epithelial keratomileusis (LASEK) for myopia (mean -6.26+/-2.52 diopters [D], full correction diameter 6.71+/-0.25 mm) without astigmatism correction were assessed. Based on preoperative topographies, corneal ablation was simulated using the Munnerlyn formula-one with homogeneous beam fluence and another with variable beam fluence (including reflection loss and non-normal laser beam incidence). Corneal shape was analyzed pre- and postoperatively. Corneal wavefront aberration was calculated with real ray tracing and reported according to the Optical Society of America standard. RESULTS:Corneal asphericity for a 6.0-mm diameter showed that preoperative measured corneas (-0.21+/-0.11) and postoperative simulated corneas (homogeneous beam fluence -0.32+/-0.19, variable beam fluence -0.41+/-0.22) were prolate, whereas postoperative measured corneas (0.40+/-0.57) were oblate. Corneal wavefront aberration (higher order aberrations 3rd to 6th/spherical aberration Z[4,0] in microns) for a 6.0-mm diameter, compared to the preoperative state (0.34+/-0.19/0.15+/-0.09), did not increase in postoperative simulation (homogeneous beam fluence 0.29+/-0.15/0.05+/-0.08, variable beam fluence 0.34+/-0.14/0.16+/-0.08), but in contrast increased for postoperative measurements (0.64+/-0.17/0.49+/-0.15). CONCLUSIONS:The increase in oblateness, higher order aberrations, and spherical aberration of real patients' postoperative corneas was not seen in simulations using a Munnerlyn ablation profile. The fluence loss of the laser was one important factor, but did not explain all increasing aberrations observed clinically. We hypothesize that corneal wound healing and biomechanics play a role.

PMID: 20415288 [PubMed - as supplied by publisher]

 

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Last updated Monday, April 12, 2010

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