LASIK Surgery With a New Laser for the Treatment of Myopia Without Astigmatism

A Combined First In Man And Pilot Study Investigating Visual And Refractive Outcomes In Lasik Surgery Using The Aquariuz Ablation Laser In Patients With Myopia, With Or Without Astigmatism

The AQUARIUZ ablation laser is a solid-state laser and has been CE approved for corneal surgery since March 2020 for the treatment of short- and longsightedness with and without astigmatism. The aim of this study is to collect the first clinical data. Safety and performance are examined here. The treatment with AQUARIUZ is comparable to treatments with an excimer laser, with the difference that these are operated with gas. Solid-state lasers and excimer lasers use the same process for tissue ablation, with a small difference in wavelength. This difference manifests itself in the lower involvement of water in the ablation process with the result of a gentler and safer treatment. Similar to excimer lasers for corneal surgery, the AQAURIUZ system (Ziemer Ophthalmic Systems AG) is equipped with a fast eye tracker (eye tracking system) to correct eye movements during the treatment. The shape of the removed portion of the cornea has an aspherical profile corresponding to the state of the art.

The primary objective is to assess the safety of use of the AQUARIUZ corneal ablation laser for LASIK procedures in myopia and myopia with astigmatism.

The secondary objective is to compare the predicted visual and refractive outcomes of LASIK procedures using the AQUARIUZ Ablation with clinical data.

The study is planned in 3 phases to mitigate the inherent risk of a first in man study and to allow for verification and confirmation of the system correction factor at an early stage.

Inclusion Criteria:

• Inclusion criteria number 3 to 6, 10, 11 and 12 only apply to eyes planned for investigational treatment. Inclusion criterion number 9 applies to both eyes whether planned for investigational treatment or not and inclusion criterion number 8 applies to each eye as specified in the criteria.

  1. Informed Consent as documented by signature

  2. Medically suitable for corneal refractive surgery

  3. Stable refraction over a minimum of 12 months prior to surgery Stable refraction is defined as MRSE change per year in the eye to be treated ≤ 0.50 D and should be confirmed by at least one measurement between 1 and 10 years previous to the study.

  4. Myopia sphere from -0.5 D to -4.0 D

  5. Phases I & II: Maximum cylinder diopter -1.5 D

  6. Phase II & III: Maximum cylinder diopter -1.0 D

  7. Accurate baseline biometric measurements Accurate baseline biometric measurements are defined as

     • Assessed Manifest Refraction within ± 0.5 D of Objective Refraction

     • Less than 0.75 D spherical equivalent (SE) difference between cycloplegic and manifest refractions

     • Objective refraction should be assessed by

       • Autorefractometer And either/or
       • Hartmann-Shack Aberrometer
       • Ray tracing Aberrometer

  8. Age ≥ 18 years

  9. Calculated residual stroma thickness ≥ 300 microns

  10. IOP, as measured by non-contact tonometry < 21mmHg

  11. Phase I: One of the following

      • Amblyopic eye An amblyopic eye is defined as an eye that has decreased functional visual acuity due to an insufficient development in the visual system according to the judgement of the investigator, and the following criteria
      • Pre-operative CDVA up to 20/32 ( 0.63 in decimal convention)
      • Pre operative CDVA in the fellow, dominant eye ≥ 20/40 (0.5 in decimal convention)
      • Post-cataract patient, and the following criteria
      • Pre-operative CDVA in each eye ≥ 20/40 (0.5 in decimal convention)

  12. Phase II & III: Pre-operative CDVA in each eye ≥ 20/40 (0.5 in decimal convention)

  13. Patient willing and able to return to the study site for the follow-up visits, in the judgement of the investigator

Exclusion Criteria:

• The following exclusion criteria apply for both eyes, whether planned for treatment or not.

  1. Severe local infective or allergic conditions (e.g. blepharitis, past herpes simplex or zoster, allergic eye disease severe enough to require regular treatment).

  2. Corneal disease or pathology, such as but not limited to corneal scarring or opacity, history of viral keratitis, dry eye, recurrent epithelial erosion and Fuchs' endothelial dystrophy

  3. Manifest or subclinical keratoconus or keratectasia, as diagnosed by corneal topography and/or anterior optical coherence tomography

  4. Patients with degeneration of structures of the cornea, diagnosed keratoconus or any clinical pictures suggestive to keratoconus (form-fruste keratoconus)

  5. Corneal thickness < 480 microns

  6. Previous corneal surgery of any kind, including surgery for either refractive or therapeutic purposes in either eye that, in the judgement of the investigator confounds the outcome of the study or increases risk for the patient

  7. Glaucoma and/or ocular hypertension, whether untreated and under medical control

  8. Nystagmus or hemifacial spasm

  9. Known allergy to medications used in surgery, pre- and post-operative treatment at the investigational site

  10. Immunocompromised or diagnosis of ophthalmic disease (any of the following):

      • ocular herpes zoster or simplex
      • lupus
      • collagenases
      • other acute or chronic illnesses that increases the risk to the participant or confounds the outcomes of this study in the opinion of the investigator

  11. Patients with a diagnosed collagen vascular, atopic syndrome, autoimmune or immunodeficiency disease

  12. Known psychotic disorders associated with delusions (e.g. schizophrenia)

  13. Drug or alcohol abuse

  14. Neurological diagnosis with a GCS > 13

  15. Women who are pregnant or nursing or who plan to become pregnant over the course of this investigation.

  16. Inability to follow the procedures of the study in the opinion of the investigator, e.g. due to language problems, psychological disorders, dementia, etc.

  17. Participation in another interventional study within the 30 days preceding and during the present study

  18. Patients with uncontrolled diabetes

  19. Patients who are taking one or both of the following medications:

      • Isotretinoin (e.g. Accutane®)
      • Amiodarone hydrochloride (e.g. Cordarone®)