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Advanced CustomVue
Technology
Truly Customized Laser Vision Correction




           Laser assisted in-situ keratomileusis (LASIK) can only be
           performed by a trained ophthalmologist and for specified
                 reduction or elimination of myopia, hyperopia, and
               astigmatism as indicated within the product labeling.
                           For safety information, please see inside.
Shaping the Future of
Laser Vision Correction
Advanced CustomVue Technology, the combination of the WaveScan WaveFront System and the
STAR S4 IR Excimer Laser, represents the only generation of laser vision correction that uses Fourier
wavefront analysis to measure unique vision imperfections in order to design a truly customized treatment.

The Broadest Range of Custom Wavefront-Guided Laser Vision Correction
The STAR S4 IR Excimer Laser System and the WaveScan WaveFront System
are approved by the U.S. FDA for:

       Treatment	               Refractive Error	          Approved Range

       CustomVue	       Myopia	            Up to -11.0 D MRSE with or without astigmatism up to -3.0 DC
       Wavefront-guided				
       LASIK	           Hyperopia	         Up to +3.0 D MRSE with or without astigmatism up to +2.0 DC
       					
       	                Mixed Astigmatism	 From 1.0 D to 5.0 DC, cylinder > sphere and of opposite sign	
       	

The STAR S4 IR Excimer Laser System is approved by the U.S. FDA for:

       Treatment	               Refractive Error	          Approved Range

       LASIK	 Myopia	            Up to -14.0 DS with or without astigmatism -0.5 to -5.0 DC
       					
       	      Hyperopia	         +0.5 to +5.0 DS with or without astigmatism up to +3 DC
       					
       	      Mixed Astigmatism	 Up to 6.0 DC, cylinder > sphere and of opposite sign	
       	
       PRK	   Myopia	            0 to -12.0 DS, with or without astigmatism -0.75 to -4.0 DC
       					
       	      Hyperopia	         +1.0 to +6.0 DS, with or without astigmatism +0.5 to +4.0 DC
       					
       PTK	   N/A	               Therapeutic/non-refractive treatments
       	      (Therapeutic)	     Contact AMO for more information

       Custom-CAP	              N/A	                       Topography-driven therapeutic treatments
       	                        (Therapeutic)	             Contact AMO for more information



Laser assisted in-situ keratomileusis (LASIK) can only be performed by a trained ophthalmologist and for specified reduction
or elimination of myopia, hyperopia, and astigmatism as indicated within the product labeling. Laser refractive surgery is
contraindicated for patients: a) with collagen vascular, autoimmune, or immunodeficiency diseases; b) who are pregnant
or nursing women; c) with signs of keratoconus or abnormal corneal topography; d) who are taking one or both of the
following medications: Isotretinoin (Accutane) and Amiodarone hydrochloride (Cordarone). Potential side effects to laser
refractive surgery may include glare, dry eye, as well as other visual anomalies. LASIK requires the use of a microkeratome
that cuts a flap on the surface of the cornea, potential side effects may include flap related complications. Patients are
requested to consult with their eye care professional and Patient Information Booklet regarding the potential risks and
benefits for laser refractive surgery, results may vary for each individual patient.

Restricted Device: U.S. Federal Law restricts this device to sale, distribution, and use by or on the order of a physician or
other licensed eye care practitioner. U.S. Federal Law restricts the use of this device to practitioners who have been trained
in its calibration and operation and who have experience in the surgical treatment and management of refractive errors.
STAR S4 IR Excimer Laser


                           WaveScan WaveFront System
Custom Wavefront-Guided Clinical Results
The Advanced CustomVue Procedure can provide a potentially superior vision correction alternative, because
it measures and treats individualized imperfections of each eye that are never treated with standard or optimized
treatments, or corrected with glasses or contacts.

Custom wavefront-guided clinical studies submitted to the FDA have shown:1



                                     Myopia — at Six Months Post-Op
                                                                                             u	
                                                                                               74%     of low to moderate
                                      Low to moderate myopes    High myopes
                              100%                                                                myopes achieved UCVA
                                                                      94
                                                                                                  20/16 or better (six
                              80%                                                  84             months post-op)
                              60%             74                                             u	   6
                                                                                                   5% of high myopes
                                                           65
                              40%
                                                                                                  achieved UCVA 20/16
                                                                                                  or better (six months
                              20%                                                                 post-op)
                               0%
                                                   20/16                   20/20



Hyperopia
u	   79% of eyes had either a decrease or change of less than or equal to 0.1 microns for
	    higher-order aberrations RMS (six months post-op)
u	   69% of study patients achieved UCVA 20/20 or better (six months post-op)

Mixed Astigmatism
u	
  100%     of eyes had either a decrease or change of less than or equal to 0.1 microns for higher-order aberrations
     RMS (three months post-op)
u	   60% of study patients achieved UCVA 20/20 or better (six months post-op)
Patient Satisfaction
u	   C
      linical study for all indications including mixed astigmatism shows higher post-op patient satisfaction with the
     Advanced CustomVue Procedure


                                              Pre-Op (N=332)                                    6 Months Post-Op (N=258)

                            Very Satisfied/                        Somewhat         Very Satisfied/                    Somewhat
           Myopia              Satisfied
                                                Not Sure        Dissatisfied/Very      Satisfied        Not Sure    Dissatisfied/Very
                                                                  Dissatisfied                                        Dissatisfied
           Sharpness
           and Clarity         87.9%             3.0%                9.0%              92.7%            2.3%               5.1%
           Overall Visual
           Comfort             78.9%             4.5%               16.6%              95.4%            2.3%               2.4%
           Consistency         84.3%             4.2%               11.4%              91.9%            5.0%               3.1%
           of Vision

           Night Vision        64.7%             9.9%               25.3%              84.9%            6.2%               9.0%
           Night Vision                                                                                                    7.8%
           with Glare          59.9%             11.1%              28.9%              81.0%            11.2%




                                         Glare and halos as seen at night

                                                               Simulated images




                                      No glare and halos as seen at night

                            The theoretical simulation shows the Advanced CustomVue treatment can
                            result in improved night driving due to reduced incidence of glare
The WaveScan WaveFront System —
The First Step Essential to Customized
Treatment Planning
An unmatched level of precision may be achieved by linking the advanced refractive information of the
WaveScan WaveFront System with the STAR S4 IR Excimer Laser, providing accurate alignment and centration
for every patient.

                                             Truly Customized
                                             The WaveScan WaveFront System is the industry standard
                                             for wavefront acquisition and diagnostic utility. It delivers the high
                                             level of measurement accuracy essential to optimizing outcomes.
                                             u	   Performing manifest refraction guided by data from the
                                             	    WaveScan WaveFront System saves a tremendous amount
                                             	    of time during the pre-operative evaluation2
                                             u	   The WaveScan System creates an accurate, objective
                                             	    measurement of the patient’s entire optical system, including
                                             	    both higher- and lower-order aberrations2
                                             u	   WaveScan measurements are 25 times more precise than
                                             	    standard measurements for glasses or contact lenses
                                             u	   The proprietary Fourier algorithm provides an innovative
                                             	    reconstruction method that overcomes the limitations of
                                             	    Zernike shapes, providing complete and precise corrective
                                             	    treatments
                                             u	   Maximized patient throughput is achieved with automatic
                                             	    acquisition modes and offline programming options


                                             Errors are not limited to spherical and astigmatic errors;
                                             they also include the eye’s higher-order aberrations as well
                                             as tilt. Therefore, a wavefront-guided treatment represents
                                             a higher level of customization than a wavefront-optimized
                                             LASIK treatment, which is based on the eye’s refraction,
                                             and K-readings. Such treatments are often called
                                             “Standard,” “Classic” or “Traditional” LASIK.3




  100% of approximately 240 data points
  (over a 7 mm pupil)
Unique Aberration Profiles for Customized Treatment
The use of WaveScan information makes every procedure truly personalized. Without this data and without a
custom wavefront-guided procedure, these patients would have received identical treatments — even though they
have dramatically different high-order aberrations.


OS: -2.36 DS: -0.49 DC x 176° @ 12.5 mm (6.00 Rx Calc)   OS: -2.35 DS: -0.32 DC x 91° @ 12.5 mm (6.00 Rx Calc)   OS: -2.39 DS: -0.44 DC x 1° @ 12.5 mm (6.00 Rx Calc)
           W.F. Diam: 6.25 mm Hi Order: 7.6%                       W.F. Diam: 6.00 mm Hi Order: 11.4%                      W.F. Diam: 7.00 mm Hi Order: 3.7%




             SE = -2.61 D                                             SE = -2.51 D                                            SE = -2.61 D




    Images courtesy of Marc Odrich, MD and Kenneth Greenberg, MD
STAR S4 IR Excimer Laser — Designed to Bring
    Customized Laser Vision Correction to Life
    Truly Customized
    The STAR S4 IR Excimer Laser sets the industry standard for outstanding treatment precision. Fast and powerful,
    it delivers precise levels of ablation accuracy essential to optimizing outcomes.

    Iris Registration Technology
    E
     xclusive Iris Registration technology captures and compensates for torsional angle and pupil centroid shift,
    providing greater alignment accuracy and allowing for instant re-registration in the event of intraoperative
    cyclotorsional movement.
    u	   Only Advanced CustomVue with Iris Registration correctly centers and aligns the treatment independent of
    	    pupil center migration
    u	   Iris Registration reduces the impact of cyclotorsional
    	    movement, provides more precise ablation placement
    	    and minimizes the chance of human error
    u	   Iris Registration provides greater alignment accuracy
    	    with sub-flap iris imaging, which enables the physician
    	    to instantly re-register in the event of intraoperative
    	    cyclotorsional movement




 Shift of pupil centroid between aberrometer and laser
	 0.0 mm	     0.1 mm	     0.2 mm	  0.3 mm	   0.4 mm	   0.5 mm	        0.6 mm	   0.7 mm	   0.8 mm	   0.9 mm	   1.0 mm

    Induced RMS error
	     0.0 μ	  0.09 μ	       0.19 μ	     0.30 μ	   0.40 μ	   0.51 μ	   0.61 μ	   0.72 μ	   0.83 μ	   0.94 μ	   1.04 μ	   Pre-Op




    Approximate impact of pupil centroid shift
Variable Spot Scanning (VSS) Technology
Ensures that the intricate shapes reconstructed by the Fourier wavefront algorithm are precisely ablated to optimize
treatment times using beam sizes ranging from 0.65 mm to 6.50 mm.

Variable Repetition Rate (VRR) Technology
Delivers proprietary algorithms that vary the laser’s pulse rate to conserve tissue and minimize thermal effects
on the cornea.



                                                                Small Spot Scanning Profile4                                                                                                                                                     Variable Spot Scanning Profile4

                                                                                                                           0         0                                                                                                                             0        0
                                                                     -0.5       -0.5                                                               0.5   0.5                                                                                                                                     6.5 mm mm
                                                                                                                                                                                                                                                                                                      6.5
                              -1                               -1                                                              0          0                            1   1                               -4                               -4     -2    -2             0        0   2   2   4   4
                                                                                                                                                                                                                                                                                                 6 mm 6 mm
                                                                                                                                                                                                                                                                                                 5.5 mm mm
                                                                                                                                                                                                                                                                                                      5.5
                                                                                                                                                                                                                                                                                                 5 mm 5 mm
  Ablation Depth in Microns

                                   Ablation Depth in Microns




                                                                                                                                                                               Ablation Depth in Microns

                                                                                                                                                                                                                Ablation Depth in Microns
                                                                                                                   -0.1            -0.1
                                                                                                                                                                                                                                                                                                 4.5 mm mm
                                                                                                                                                                                                                                                                                                      4.5
                                                                                                                                                                                                                                                               -0.1     -0.1
                                                                                                                                                                                                                                                                                                 4 mm 4 mm
                                                                                                                                                                                                                                                                                                 3.5 mm mm
                                                                                                                                                                                                                                                                                                      3.5
                                                                                                                   -0.2            -0.2                                                                                                                                                          3 mm 3 mm
                                                                                                                                                                                                                                                                                                 2.5 mm mm
                                                                                                                                                                                                                                                                                                      2.5
                                                                                                                                                                                                                                                                                                 2 mm 2 mm
                                                                                                                                                                                                                                                               -0.2     -0.2                     1.8 mm mm
                                                                                                                                                                                                                                                                                                      1.8
                                                                                                                   -0.3            -0.3                                                                                                                                                          1.6 mm mm
                                                                                                                                                                                                                                                                                                      1.6
                                                                                                                                                                                                                                                                                                 1.4 mm mm
                                                                                                                                                                                                                                                                                                      1.4
                                                                                                                                                                                                                                                                                                 1.2 mm mm
                                                                                                                                                                                                                                                                                                      1.2
                                                                                                                                                                                                                                                                                                 1 mm 1 mm
                                                                                                                   -0.4            -0.4                                                                                                                        -0 . 3   -0 . 3
                                                                      Distance from Pupil Center in mm mm
                                                                            Distance from Pupil Center in                                                                                                                                         Distance from Pupil Center in mm mm
                                                                                                                                                                                                                                                        Distance from Pupil Center in


                        The theoretical simulation shows Small Spot Scanning Gaussian beam profile with much higher peak energy, whereas Variable Spot
                        Scanning using an edge-smoothed top-hat beam profile shows less peak energy per pulse




                                                                                                                                                       VSS Simulation Results4

                                                                                                                           0.16
                                                                                                                                                 VSS
                                                                                                                                                 SSS
                                                                                              RMS (OPD) Error in Microns




                                                                                                                           0.12
                                                                            More Accurate




                                                                                                                           0.08



                                                                                                                           0.04



                                                                                                                               0
                                                                                                                                              Myopia           Hyperopia     Myopic                                                               Hyperopic           Mixed
                                                                                                                                                                           Astigmatism                                                           Astigmatism       Astigmatism




                                                                                            This theoretical simulation of VSS and VRR Technologies, when compared to the alternative
                                                                                            SSS ablation, shows improved precision and accuracy, or decreased fitting error, across the
                                                                                            above ablation profiles
“
“A wavefront-guided treatment using Advanced CustomVue Technology
results in superior clarity of vision, especially noticeable at night. A WaveScan
capture and Iris Registration are key components of custom treatments
because they provide the precise alignment necessary to measure and treat
all ocular aberrations.”
									
                                  “             – Captain [Ret.] Steven Schallhorn, MD
VISX Wavefront-guided LASIK for Correction of Myopic, Hyperopic, and Mixed Astigmatism (CustomVue LASIK Laser Treatment)

Statements regarding the potential benefits of wavefront-guided LASIK (CustomVue) are based upon the results of clinical trials. These results are indicative of not only the CustomVue Treatment but also the care of the clinical physicians, the control
of the surgical environment by those physicians, the clinical trials’ treatment parameters and the clinical trials’ patient inclusion and exclusion criteria. Although many clinical trial patients after the CustomVue Procedure saw 20/20 or better and/or had
or reported having better vision during the day and at night, compared to their vision with glasses or contact lenses before the procedure, individual results may vary. You can find information about the clinical trials below and in the Professional Use
Information Manuals for the VISX STAR S4 Excimer Laser System and WaveScan WaveFront System (CustomVue Treatments).

As with any surgical procedure, there are risks associated with the CustomVue Treatment. Before treating patients with the CustomVue Procedure, you should carefully review the Professional Use Information Manual, complete the Physician CustomVue
Certification Course, provide your patients with the Patient Information Booklet for CustomVue LASIK Laser Treatment, and discuss the risks associated with this procedure and questions about the procedure with your patients.

WAVEFRONT-GUIDED LASIK INDICATIONS AND INTENDED USES:
The VISX STAR S4 Excimer Laser System and WaveScan WaveFront System are approved to perform wavefront-guided laser assisted in-situ keratomileusis (LASIK) treatments for the reduction or elimination of low to moderate myopic astigmatism
up to -6.00 D MRSE, with cylinder between 0.00 and -3.00 D in patients 21 years of age or older; and in patients with documented evidence of a change in manifest refraction of no more than 0.50 D (in both cylinder and sphere components) for at least
one year prior to the date of pre-operative examination.

Wavefront-guided LASIK for correction of low to moderate myopic astigmatism is an elective procedure with the alternatives including but not limited to eyeglasses, contact lenses, photorefractive keratectomy (PRK), conventional LASIK, and other
refractive surgeries. Approval of the low to moderate myopic astigmatism application is based on a clinical trial of 351 eyes (189 primary and 162 secondary). Of all eyes treated, 318 were evaluated for effectiveness with 98.8% accountability at 3
months, 277 eyes with 96.9% accountability at 6 months, 102 eyes with 95.3% accountability at 9 months, and 86 eyes with 95.6% accountability at 12 months. The studies found that of the 277 eyes eligible for the uncorrected visual acuity (UCVA)
analysis of effectiveness at 6 months, 100% were corrected to 20/40 or better, and 95.8% were corrected to 20/20 or better in 71 spherical myopia eyes; and 99.5% were corrected to 20/40 or better, and 93.2% were corrected to 20/20 or better in 206
astigmatic myopia eyes. The study showed that at the 3 month stability time point: there was a loss of ≥2 lines of best corrected vision that can be obtained with spectacles in 1 of 239 astigmatic myopia eyes and there was no loss of ≥2 lines of best
corrected vision in 79 spherical myopia eyes; there was 1 of 239 astigmatic myopia eyes with best spectacle corrected visual acuity (BSCVA) worse than 20/25 and none in 79 spherical myopia eyes with BSCVA worse than 20/25. During the course of
study, no eye lost 2 lines of BSCVA and no eye had a BSCVA worse than 20/40.

The VISX STAR S4 IR Excimer Laser System with VSS Technology and WaveScan WaveFront System are approved to perform wavefront-guided laser assisted in-situ keratomileusis (LASIK) treatments for the reduction or elimination of high myopic
astigmatism from -6.00 D to -11.00 D MRSE, with cylinder between 0.00 and -3.00 D in patients 21 years of age or older; and in patients with documented evidence of a change in manifest refraction of no more than 1.00 D (in both cylinder and sphere
components) for at least one year prior to the date of pre-operative examination.

Wavefront-guided LASIK for correction of high myopic astigmatism is an elective procedure with the alternatives including but not limited to eyeglasses, contact lenses, photorefractive keratectomy (PRK), conventional LASIK, and other refractive
surgeries. Approval of the application is based on a clinical trial of 184 eyes. Of all eyes treated, 180 were evaluated for effectiveness with 97.8% accountability at 3 months, 178 eyes with 96.7% accountability at 6 months, 170 eyes with 96.5%
accountability at 9 months, and 107 eyes with 93.9% accountability at 12 months. The studies found that of the 178 eyes eligible for the uncorrected visual acuity (UCVA) analysis of effectiveness at 6 months, 98.3% were corrected to 20/40 or better,
97.2% were corrected to 20/32 or better, and 84.3% were corrected to 20/20 or better without spectacles or contact lenses. The study showed that of 83 spherical and 101 astigmatic eyes, no eyes lost 2 or more lines of best corrected vision that can
be obtained with spectacles (BSCVA) and none of the eyes had BSCVA worse than 20/40.

The VISX STAR S4 Excimer Laser System and WaveScan WaveFront System are approved to perform wavefront-guided laser assisted in-situ keratomileusis (LASIK) treatments for the reduction or elimination of hyperopic astigmatism up to 3.00 D
MRSE, with cylinder between 0.00 and 2.00 D in patients 21 years of age or older; and in patients with documented evidence of a change in manifest refraction of no more than 1.00 D (in both cylinder and sphere components) for at least one year prior
to the date of pre-operative examination.

Wavefront-guided LASIK for the correction of hyperopic astigmatism is an elective procedure with the alternatives including but not limited to eyeglasses, contact lenses, photorefractive keratectomy (PRK), conventional LASIK, and other refractive
surgeries. Approval of the hyperopic astigmatism application is based on a clinical trial of 144 eyes (74 primary and 70 secondary). Of all eyes treated, 134 were evaluated for effectiveness with 98.5% accountability at 3 months, 131 eyes with 97.0%
accountability at 6 months, 118 eyes with 90.8% accountability at 9 months, and 27 eyes with 87.1% accountability at 12 months. The studies found that of the 131 eyes eligible for the uncorrected visual acuity (UCVA) analysis of effectiveness at
6 months, 97.3% were corrected to 20/40 or better, and 66.2% were corrected to 20/20 or better in 74 spherical hyperopia eyes; and 93.0% were corrected to 20/40 or better, and 56.1% were corrected to 20/20 or better in 57 astigmatic hyperopia
eyes. The study showed that at the 6 month stability time point: there was no loss of ≥2 lines of best corrected vision that can be obtained with spectacles in either 63 astigmatic hyperopia eyes or 74 spherical hyperopia eyes; none of the 63 astigmatic
hyperopia eyes or 74 spherical hyperopia eyes had best spectacle corrected visual acuity (BSCVA) worse than 20/25. During the course of study, one of 63 eyes with astigmatic hyperopia lost 2 lines of BSCVA at 1 month, no eyes with spherical hyperopia
lost 2 lines of BSCVA, and no eye had a BSCVA worse than 20/40.

The VISX STAR S4 IR Excimer Laser System with VSS Technology and WaveScan WaveFront System are approved to perform wavefront-guided laser assisted in-situ keratomileusis (LASIK) treatments for the reduction or elimination of naturally
occurring mixed astigmatism when the magnitude of cylinder (from 1.0 to 5.0 D) is greater than the magnitude of sphere and the cylinder and sphere have opposite signs; in patients 21 years of age or older; and in patients with documented evidence
of a change in manifest refraction of no more than 0.50 D (in both cylinder and sphere components) for at least one year prior to the date of pre-operative examination.

Wavefront-guided LASIK for the correction of mixed astigmatism is an elective procedure with the alternatives including but not limited to eyeglasses, contact lenses, photorefractive keratectomy (PRK), conventional LASIK, and other refractive surgeries.
Approval of the mixed astigmatism application is based on a clinical trial of 86 eyes. Of all eyes treated, 86 were evaluated for effectiveness with 100.0% accountability at 3 months, 80 eyes with 95.2% accountability at 6 months, 69 eyes with 86.3%
accountability at 9 months, and 63 eyes with 94.0% accountability at 12 months. The studies found that of the 86 eyes eligible for the uncorrected visual acuity (UCVA) analysis of effectiveness at 3 months, 95.3% were corrected to 20/40 or better,
91.9% were corrected to 20/32 or better, and 61.6% were corrected to 20/20 or better without spectacles or contact lenses. The study showed that of 86 astigmatic eyes, one eye temporarily lost 2 lines of best corrected vision that can be obtained with
spectacles at 1 month and at 6 months and none of the eyes had best spectacle corrected visual acuity (BSCVA) worse than 20/40.

CONTRAINDICATIONS:
Wavefront-guided LASIK is contraindicated in patients with collagen vascular, autoimmune or immunodeficiency disease, signs of keratoconus or abnormal corneal topography, patients taking Isotretinoin (Accutane®) or Amiodarone hydrochloride
(Cordarone®) or are pregnant or nursing.

WARNINGS:
Wavefront-guided LASIK is not recommended in patients who have diabetes, a history of Herpes simplex or Herpes zoster keratitis, significant dry eye that is unresponsive to treatment, or severe allergies. For the treatment of low to moderate myopic
astigmatism, lower uncorrected visual acuity may be anticipated in the treatment of higher degrees of myopia with and without astigmatism (≥5.0 D MRSE).

PRECAUTIONS:
The safety and effectiveness of wavefront-guided LASIK surgery has ONLY been established with an optical zone of 6 mm and an ablation zone of 8 mm for myopic astigmatism, and an optical zone of 6 mm and an ablation zone of 9 mm for hyperopic
and mixed astigmatism. Long-term risks of wavefront-guided LASIK beyond 12 months have not been studied. The safety and effectiveness of the STAR S4 IR Excimer Laser System have NOT been established for wavefront-guided treatment of low
to moderate myopic astigmatism in patients: whose WaveScan WaveFront diameter is less than 6 mm, for treatments greater than 6 diopters of MRSE or with greater than 3 diopters of astigmatism and for retreatment with CustomVue LASIK. The
safety and effectiveness of the STAR S4 IR Excimer Laser System have NOT been established for wavefront-guided treatment of high myopic astigmatism in patients: whose WaveScan WaveFront diameter is less than 5 mm, for treatments greater
than -11 diopters of MRSE or with greater than 3 diopters of astigmatism. The safety and effectiveness of the STAR S4 IR Excimer Laser System have NOT been established for wavefront-guided treatment of hyperopic astigmatism in patients: whose
WaveScan WaveFront diameter is less than 5 mm; for treatments greater than 3 diopters of MRSE or with greater than 2 diopters of astigmatism and for retreatment with CustomVue LASIK. The safety and effectiveness of the STAR S4 IR Excimer
Laser System have NOT been established for wavefront-guided treatment of mixed astigmatism in patients: whose WaveScan WaveFront diameter is less than 5 mm, for treatments greater than 5 diopters or less than 1 diopter of astigmatism and for
retreatment with CustomVue LASIK.

Although the WaveScan WaveFront System measures the refractive error and wavefront aberrations of the human eyes, including myopia, hyperopia, astigmatism, coma, spherical aberration, trefoil, and other higher-order aberrations through sixth
order, in the clinical studies for low to moderate myopic astigmatism, hyperopic astigmatism and mixed astigmatism, the average higher-order aberration did not decrease after CustomVue Treatment. In the clinical studies for high myopic astigmatism,
the average higher-order aberration increased after CustomVue Treatment.

It is possible, after wavefront-guided LASIK treatment, that patients will find it more difficult than usual to see in conditions such as very dim light, rain, snow, fog, or glare from bright lights at night. Visual performance possibly could be worsened by
large pupil sizes or decentered pupils. Pupil size should be evaluated under mesopic illumination conditions.

The use of Percentage Nomogram Adjustment should be based upon careful consideration of patient and surgeon information, in addition to environmental conditions surrounding the surgery. The simultaneous use of the Percentage Nomogram
Adjustment and the Physician Adjustment has not been studied in controlled investigations, and should not be attempted until the accuracy of the Nomogram setting has been verified for the same laser, treatment conditions and type of treatment.
Therefore, the combined simultaneous use of the Percentage Nomogram Adjustment and the Physician Adjustment is not recommended without careful analysis of post-operative refractive results.

ADVERSE EVENTS AND COMPLICATIONS:
The clinical trial for low to moderate myopic astigmatism showed that the following adverse events or complications occurred in at least 1% of the 351 eyes at any interval up to 6 months post-treatment: inflammation of the cornea under the flap (1.4%);
double or ghost images (1.4%); and scratch on the surface of the eye (1.4%). The following subjective symptoms frequency rated “often or always” were increased in the effectiveness cohort at 6 months post-treatment on 258 eyes compared with
pre-treatment on 332 eyes: dryness (9% vs. 6%); fluctuation of vision (3% vs. 2%); glare (4% vs. 2%) and halos (7% vs. 5%).

The clinical trial for high myopic astigmatism showed that the following adverse events or complications occurred in at least 1% of the 184 eyes at one or more post-operative examinations up to 6 months post-treatment: epithelium in the interface
(1.1%); peripheral corneal epithelial defect at 1 month or later (2.2%); corneal edema between 1 week and 1 month post-operatively (2.7%) and double vision (or “ghost images”) in the operative eye (6.0%). The following subjective symptoms were
reported as present “often or always” by a higher percentage of subjects 6 months after treatment than before treatment: dryness (10.8% vs. 9.3%); halos (21.6% vs. 15.4%); and ghosting or shadowing of images (2.8% vs. 1.1%).

The clinical trial for hyperopic astigmatism showed that the following adverse events or complications occurred in at least 1% of the 144 eyes at any interval up to 6 months post-treatment: cells growing under the flap (2.1%); feeling of something in
the eye (1.4%); double or ghost images (11.3%); and scratch on the surface of the eye (2.1%). The following subjective symptoms rated “often or always” were increased in the effectiveness cohort at 6 months post-treatment on 131 eyes compared
with pre-treatment on 136 eyes: dryness (17% vs. 6%); blurry vision (10% vs. 7%); fluctuation of vision (14% vs. 6%); halos (10% vs. 5%); double or ghost images (7% vs. 3%).

The clinical trial for mixed astigmatism showed that the following adverse events or complications occurred in at least 1% of the 86 eyes at one or more post-operative examinations up to 3 months post-treatment: miscreated flap (1.2%); cells growing
under the flap (4.7%); and double vision (or “ghost images”) in the operative eye (8.1%). The following subjective symptoms were reported as present “often or always” by a higher percentage of subjects 3 months after treatment than before treatment:
dryness (22% vs. 6%); halos (20% vs. 13%).
The iLASIK Solution
        Innovative Technologies Delivering Exceptional Results
        The iLASIK Solution, available exclusively from AMO, is the combination of IntraLase and Advanced
        CustomVue Technologies. This unique blend of technologies sets a new standard for laser vision correction.
        u	 Beyond 20/20.

        	 The iLASIK Technology Suite provides a truly customized treatment,
           helping you take more of your patients beyond 20/20 vision*
        u	 Good Enough for NASA and Your Patients.

        	 NASA astronauts and U.S. fighter pilots can have laser vision correction
           surgery today because of the exclusive, validated safety and precision
           performance of iLASIK Technologies
        u	    Leading Innovation.
        	     With over 20 years of innovation, more than 15 million procedures
        	     worldwide and the broadest range of FDA wavefront-guided LASIK
        	     approvals, iLASIK Technologies are the true industry leaders
        u	    Unsurpassed Service, Support and Value.
        	     Our award-winning† service and post-sales support enhance the
        	     value of your investment in the premium iLASIK Platform by
        	     maximizing reliability, quality and patient outcomes

        	     For more information and to contact an AMO representative,
        	     go to www.amo-ilasik.com or call 1-877-AMO-4LIFE.




Laser assisted in-situ keratomileusis (LASIK) can only be performed by a trained ophthalmologist and for specified reduction
or elimination of myopia, hyperopia, and astigmatism as indicated within the product labeling. Laser refractive surgery is
contraindicated for patients: a) with collagen vascular, autoimmune, or immunodeficiency diseases; b) who are pregnant
or nursing women; c) with signs of keratoconus or abnormal corneal topography; d) who are taking one or both of the
following medications: Isotretinoin (Accutane®) and Amiodarone hydrochloride (Cordarone®). Potential side effects to laser
refractive surgery may include glare, dry eye, as well as other visual anomalies. LASIK requires the use of a microkeratome
that cuts a flap on the surface of the cornea, potential side effects may include flap related complications. Patients are
requested to consult with their eye care professional and Patient Information Booklet regarding the potential risks and
benefits for laser refractive surgery, results may vary for each individual patient.

Restricted Device: U.S. Federal Law restricts this device to sale, distribution, and use by or on the order of a physician or
other licensed eye care practitioner. U.S. Federal Law restricts the use of this device to practitioners who have been trained
in its calibration and operation and who have experience in the surgical treatment and management of refractive errors.


*20/16 results delivered with excimer laser; clinical studies sent to the FDA via P930016 supplement 021.
†
  AMO won the 2010 Omega NorthFace ScoreBoardSM Award for delivering world-class customer service and consistently exceeding customer expectations.
This is the ninth straight year AMO has won the award.

References	
1.	 Data on file. AMO Development, LLC. CustomVue Procedure clinical trials submitted to the FDA; 2003, 2004, 2005  2007.
2.	 Greenberg K. WaveScan WaveFront system key to individualized LASIK treatment. Refractive Eyecare. April 2010.
3.	 Alcon’s Wavelight Allegretto Procedure Manual Addendum, August 2005.
4.	 Dai GM, Gross E, Liang J. System performance evaluation of refractive surgical lasers: a mathematical approach. Appl Opt. 2006;45(9):2124-2134.


©2010 Abbott Medical Optics Inc. Advanced CustomVue, CustomVue, iLASIK, IntraLase, STAR S4 IR, VISX, VRR, WaveScan and
WaveScan WaveFront are trademarks owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. Accutane is a registered
trademark of Hoffman-LaRoche Inc. Cordarone is a registered trademark of Sanofi-Synthelabo, Inc. 2009.07.30-IL1181 Rev. A

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ParkAvenueLasek.com - iAdvanced CustomVue Technology - Truly Customized Laser Vision Correction

  • 1. Advanced CustomVue Technology Truly Customized Laser Vision Correction Laser assisted in-situ keratomileusis (LASIK) can only be performed by a trained ophthalmologist and for specified reduction or elimination of myopia, hyperopia, and astigmatism as indicated within the product labeling. For safety information, please see inside.
  • 2. Shaping the Future of Laser Vision Correction Advanced CustomVue Technology, the combination of the WaveScan WaveFront System and the STAR S4 IR Excimer Laser, represents the only generation of laser vision correction that uses Fourier wavefront analysis to measure unique vision imperfections in order to design a truly customized treatment. The Broadest Range of Custom Wavefront-Guided Laser Vision Correction The STAR S4 IR Excimer Laser System and the WaveScan WaveFront System are approved by the U.S. FDA for: Treatment Refractive Error Approved Range CustomVue Myopia Up to -11.0 D MRSE with or without astigmatism up to -3.0 DC Wavefront-guided LASIK Hyperopia Up to +3.0 D MRSE with or without astigmatism up to +2.0 DC Mixed Astigmatism From 1.0 D to 5.0 DC, cylinder > sphere and of opposite sign The STAR S4 IR Excimer Laser System is approved by the U.S. FDA for: Treatment Refractive Error Approved Range LASIK Myopia Up to -14.0 DS with or without astigmatism -0.5 to -5.0 DC Hyperopia +0.5 to +5.0 DS with or without astigmatism up to +3 DC Mixed Astigmatism Up to 6.0 DC, cylinder > sphere and of opposite sign PRK Myopia 0 to -12.0 DS, with or without astigmatism -0.75 to -4.0 DC Hyperopia +1.0 to +6.0 DS, with or without astigmatism +0.5 to +4.0 DC PTK N/A Therapeutic/non-refractive treatments (Therapeutic) Contact AMO for more information Custom-CAP N/A Topography-driven therapeutic treatments (Therapeutic) Contact AMO for more information Laser assisted in-situ keratomileusis (LASIK) can only be performed by a trained ophthalmologist and for specified reduction or elimination of myopia, hyperopia, and astigmatism as indicated within the product labeling. Laser refractive surgery is contraindicated for patients: a) with collagen vascular, autoimmune, or immunodeficiency diseases; b) who are pregnant or nursing women; c) with signs of keratoconus or abnormal corneal topography; d) who are taking one or both of the following medications: Isotretinoin (Accutane) and Amiodarone hydrochloride (Cordarone). Potential side effects to laser refractive surgery may include glare, dry eye, as well as other visual anomalies. LASIK requires the use of a microkeratome that cuts a flap on the surface of the cornea, potential side effects may include flap related complications. Patients are requested to consult with their eye care professional and Patient Information Booklet regarding the potential risks and benefits for laser refractive surgery, results may vary for each individual patient. Restricted Device: U.S. Federal Law restricts this device to sale, distribution, and use by or on the order of a physician or other licensed eye care practitioner. U.S. Federal Law restricts the use of this device to practitioners who have been trained in its calibration and operation and who have experience in the surgical treatment and management of refractive errors.
  • 3. STAR S4 IR Excimer Laser WaveScan WaveFront System
  • 4. Custom Wavefront-Guided Clinical Results The Advanced CustomVue Procedure can provide a potentially superior vision correction alternative, because it measures and treats individualized imperfections of each eye that are never treated with standard or optimized treatments, or corrected with glasses or contacts. Custom wavefront-guided clinical studies submitted to the FDA have shown:1 Myopia — at Six Months Post-Op u 74% of low to moderate Low to moderate myopes High myopes 100% myopes achieved UCVA 94 20/16 or better (six 80% 84 months post-op) 60% 74 u 6 5% of high myopes 65 40% achieved UCVA 20/16 or better (six months 20% post-op) 0% 20/16 20/20 Hyperopia u 79% of eyes had either a decrease or change of less than or equal to 0.1 microns for higher-order aberrations RMS (six months post-op) u 69% of study patients achieved UCVA 20/20 or better (six months post-op) Mixed Astigmatism u 100% of eyes had either a decrease or change of less than or equal to 0.1 microns for higher-order aberrations RMS (three months post-op) u 60% of study patients achieved UCVA 20/20 or better (six months post-op)
  • 5. Patient Satisfaction u C linical study for all indications including mixed astigmatism shows higher post-op patient satisfaction with the Advanced CustomVue Procedure Pre-Op (N=332) 6 Months Post-Op (N=258) Very Satisfied/ Somewhat Very Satisfied/ Somewhat Myopia Satisfied Not Sure Dissatisfied/Very Satisfied Not Sure Dissatisfied/Very Dissatisfied Dissatisfied Sharpness and Clarity 87.9% 3.0% 9.0% 92.7% 2.3% 5.1% Overall Visual Comfort 78.9% 4.5% 16.6% 95.4% 2.3% 2.4% Consistency 84.3% 4.2% 11.4% 91.9% 5.0% 3.1% of Vision Night Vision 64.7% 9.9% 25.3% 84.9% 6.2% 9.0% Night Vision 7.8% with Glare 59.9% 11.1% 28.9% 81.0% 11.2% Glare and halos as seen at night Simulated images No glare and halos as seen at night The theoretical simulation shows the Advanced CustomVue treatment can result in improved night driving due to reduced incidence of glare
  • 6. The WaveScan WaveFront System — The First Step Essential to Customized Treatment Planning An unmatched level of precision may be achieved by linking the advanced refractive information of the WaveScan WaveFront System with the STAR S4 IR Excimer Laser, providing accurate alignment and centration for every patient. Truly Customized The WaveScan WaveFront System is the industry standard for wavefront acquisition and diagnostic utility. It delivers the high level of measurement accuracy essential to optimizing outcomes. u Performing manifest refraction guided by data from the WaveScan WaveFront System saves a tremendous amount of time during the pre-operative evaluation2 u The WaveScan System creates an accurate, objective measurement of the patient’s entire optical system, including both higher- and lower-order aberrations2 u WaveScan measurements are 25 times more precise than standard measurements for glasses or contact lenses u The proprietary Fourier algorithm provides an innovative reconstruction method that overcomes the limitations of Zernike shapes, providing complete and precise corrective treatments u Maximized patient throughput is achieved with automatic acquisition modes and offline programming options Errors are not limited to spherical and astigmatic errors; they also include the eye’s higher-order aberrations as well as tilt. Therefore, a wavefront-guided treatment represents a higher level of customization than a wavefront-optimized LASIK treatment, which is based on the eye’s refraction, and K-readings. Such treatments are often called “Standard,” “Classic” or “Traditional” LASIK.3 100% of approximately 240 data points (over a 7 mm pupil)
  • 7. Unique Aberration Profiles for Customized Treatment The use of WaveScan information makes every procedure truly personalized. Without this data and without a custom wavefront-guided procedure, these patients would have received identical treatments — even though they have dramatically different high-order aberrations. OS: -2.36 DS: -0.49 DC x 176° @ 12.5 mm (6.00 Rx Calc) OS: -2.35 DS: -0.32 DC x 91° @ 12.5 mm (6.00 Rx Calc) OS: -2.39 DS: -0.44 DC x 1° @ 12.5 mm (6.00 Rx Calc) W.F. Diam: 6.25 mm Hi Order: 7.6% W.F. Diam: 6.00 mm Hi Order: 11.4% W.F. Diam: 7.00 mm Hi Order: 3.7% SE = -2.61 D SE = -2.51 D SE = -2.61 D Images courtesy of Marc Odrich, MD and Kenneth Greenberg, MD
  • 8. STAR S4 IR Excimer Laser — Designed to Bring Customized Laser Vision Correction to Life Truly Customized The STAR S4 IR Excimer Laser sets the industry standard for outstanding treatment precision. Fast and powerful, it delivers precise levels of ablation accuracy essential to optimizing outcomes. Iris Registration Technology E xclusive Iris Registration technology captures and compensates for torsional angle and pupil centroid shift, providing greater alignment accuracy and allowing for instant re-registration in the event of intraoperative cyclotorsional movement. u Only Advanced CustomVue with Iris Registration correctly centers and aligns the treatment independent of pupil center migration u Iris Registration reduces the impact of cyclotorsional movement, provides more precise ablation placement and minimizes the chance of human error u Iris Registration provides greater alignment accuracy with sub-flap iris imaging, which enables the physician to instantly re-register in the event of intraoperative cyclotorsional movement Shift of pupil centroid between aberrometer and laser 0.0 mm 0.1 mm 0.2 mm 0.3 mm 0.4 mm 0.5 mm 0.6 mm 0.7 mm 0.8 mm 0.9 mm 1.0 mm Induced RMS error 0.0 μ 0.09 μ 0.19 μ 0.30 μ 0.40 μ 0.51 μ 0.61 μ 0.72 μ 0.83 μ 0.94 μ 1.04 μ Pre-Op Approximate impact of pupil centroid shift
  • 9. Variable Spot Scanning (VSS) Technology Ensures that the intricate shapes reconstructed by the Fourier wavefront algorithm are precisely ablated to optimize treatment times using beam sizes ranging from 0.65 mm to 6.50 mm. Variable Repetition Rate (VRR) Technology Delivers proprietary algorithms that vary the laser’s pulse rate to conserve tissue and minimize thermal effects on the cornea. Small Spot Scanning Profile4 Variable Spot Scanning Profile4 0 0 0 0 -0.5 -0.5 0.5 0.5 6.5 mm mm 6.5 -1 -1 0 0 1 1 -4 -4 -2 -2 0 0 2 2 4 4 6 mm 6 mm 5.5 mm mm 5.5 5 mm 5 mm Ablation Depth in Microns Ablation Depth in Microns Ablation Depth in Microns Ablation Depth in Microns -0.1 -0.1 4.5 mm mm 4.5 -0.1 -0.1 4 mm 4 mm 3.5 mm mm 3.5 -0.2 -0.2 3 mm 3 mm 2.5 mm mm 2.5 2 mm 2 mm -0.2 -0.2 1.8 mm mm 1.8 -0.3 -0.3 1.6 mm mm 1.6 1.4 mm mm 1.4 1.2 mm mm 1.2 1 mm 1 mm -0.4 -0.4 -0 . 3 -0 . 3 Distance from Pupil Center in mm mm Distance from Pupil Center in Distance from Pupil Center in mm mm Distance from Pupil Center in The theoretical simulation shows Small Spot Scanning Gaussian beam profile with much higher peak energy, whereas Variable Spot Scanning using an edge-smoothed top-hat beam profile shows less peak energy per pulse VSS Simulation Results4 0.16 VSS SSS RMS (OPD) Error in Microns 0.12 More Accurate 0.08 0.04 0 Myopia Hyperopia Myopic Hyperopic Mixed Astigmatism Astigmatism Astigmatism This theoretical simulation of VSS and VRR Technologies, when compared to the alternative SSS ablation, shows improved precision and accuracy, or decreased fitting error, across the above ablation profiles
  • 10. “ “A wavefront-guided treatment using Advanced CustomVue Technology results in superior clarity of vision, especially noticeable at night. A WaveScan capture and Iris Registration are key components of custom treatments because they provide the precise alignment necessary to measure and treat all ocular aberrations.” “ – Captain [Ret.] Steven Schallhorn, MD
  • 11. VISX Wavefront-guided LASIK for Correction of Myopic, Hyperopic, and Mixed Astigmatism (CustomVue LASIK Laser Treatment) Statements regarding the potential benefits of wavefront-guided LASIK (CustomVue) are based upon the results of clinical trials. These results are indicative of not only the CustomVue Treatment but also the care of the clinical physicians, the control of the surgical environment by those physicians, the clinical trials’ treatment parameters and the clinical trials’ patient inclusion and exclusion criteria. Although many clinical trial patients after the CustomVue Procedure saw 20/20 or better and/or had or reported having better vision during the day and at night, compared to their vision with glasses or contact lenses before the procedure, individual results may vary. You can find information about the clinical trials below and in the Professional Use Information Manuals for the VISX STAR S4 Excimer Laser System and WaveScan WaveFront System (CustomVue Treatments). As with any surgical procedure, there are risks associated with the CustomVue Treatment. Before treating patients with the CustomVue Procedure, you should carefully review the Professional Use Information Manual, complete the Physician CustomVue Certification Course, provide your patients with the Patient Information Booklet for CustomVue LASIK Laser Treatment, and discuss the risks associated with this procedure and questions about the procedure with your patients. WAVEFRONT-GUIDED LASIK INDICATIONS AND INTENDED USES: The VISX STAR S4 Excimer Laser System and WaveScan WaveFront System are approved to perform wavefront-guided laser assisted in-situ keratomileusis (LASIK) treatments for the reduction or elimination of low to moderate myopic astigmatism up to -6.00 D MRSE, with cylinder between 0.00 and -3.00 D in patients 21 years of age or older; and in patients with documented evidence of a change in manifest refraction of no more than 0.50 D (in both cylinder and sphere components) for at least one year prior to the date of pre-operative examination. Wavefront-guided LASIK for correction of low to moderate myopic astigmatism is an elective procedure with the alternatives including but not limited to eyeglasses, contact lenses, photorefractive keratectomy (PRK), conventional LASIK, and other refractive surgeries. Approval of the low to moderate myopic astigmatism application is based on a clinical trial of 351 eyes (189 primary and 162 secondary). Of all eyes treated, 318 were evaluated for effectiveness with 98.8% accountability at 3 months, 277 eyes with 96.9% accountability at 6 months, 102 eyes with 95.3% accountability at 9 months, and 86 eyes with 95.6% accountability at 12 months. The studies found that of the 277 eyes eligible for the uncorrected visual acuity (UCVA) analysis of effectiveness at 6 months, 100% were corrected to 20/40 or better, and 95.8% were corrected to 20/20 or better in 71 spherical myopia eyes; and 99.5% were corrected to 20/40 or better, and 93.2% were corrected to 20/20 or better in 206 astigmatic myopia eyes. The study showed that at the 3 month stability time point: there was a loss of ≥2 lines of best corrected vision that can be obtained with spectacles in 1 of 239 astigmatic myopia eyes and there was no loss of ≥2 lines of best corrected vision in 79 spherical myopia eyes; there was 1 of 239 astigmatic myopia eyes with best spectacle corrected visual acuity (BSCVA) worse than 20/25 and none in 79 spherical myopia eyes with BSCVA worse than 20/25. During the course of study, no eye lost 2 lines of BSCVA and no eye had a BSCVA worse than 20/40. The VISX STAR S4 IR Excimer Laser System with VSS Technology and WaveScan WaveFront System are approved to perform wavefront-guided laser assisted in-situ keratomileusis (LASIK) treatments for the reduction or elimination of high myopic astigmatism from -6.00 D to -11.00 D MRSE, with cylinder between 0.00 and -3.00 D in patients 21 years of age or older; and in patients with documented evidence of a change in manifest refraction of no more than 1.00 D (in both cylinder and sphere components) for at least one year prior to the date of pre-operative examination. Wavefront-guided LASIK for correction of high myopic astigmatism is an elective procedure with the alternatives including but not limited to eyeglasses, contact lenses, photorefractive keratectomy (PRK), conventional LASIK, and other refractive surgeries. Approval of the application is based on a clinical trial of 184 eyes. Of all eyes treated, 180 were evaluated for effectiveness with 97.8% accountability at 3 months, 178 eyes with 96.7% accountability at 6 months, 170 eyes with 96.5% accountability at 9 months, and 107 eyes with 93.9% accountability at 12 months. The studies found that of the 178 eyes eligible for the uncorrected visual acuity (UCVA) analysis of effectiveness at 6 months, 98.3% were corrected to 20/40 or better, 97.2% were corrected to 20/32 or better, and 84.3% were corrected to 20/20 or better without spectacles or contact lenses. The study showed that of 83 spherical and 101 astigmatic eyes, no eyes lost 2 or more lines of best corrected vision that can be obtained with spectacles (BSCVA) and none of the eyes had BSCVA worse than 20/40. The VISX STAR S4 Excimer Laser System and WaveScan WaveFront System are approved to perform wavefront-guided laser assisted in-situ keratomileusis (LASIK) treatments for the reduction or elimination of hyperopic astigmatism up to 3.00 D MRSE, with cylinder between 0.00 and 2.00 D in patients 21 years of age or older; and in patients with documented evidence of a change in manifest refraction of no more than 1.00 D (in both cylinder and sphere components) for at least one year prior to the date of pre-operative examination. Wavefront-guided LASIK for the correction of hyperopic astigmatism is an elective procedure with the alternatives including but not limited to eyeglasses, contact lenses, photorefractive keratectomy (PRK), conventional LASIK, and other refractive surgeries. Approval of the hyperopic astigmatism application is based on a clinical trial of 144 eyes (74 primary and 70 secondary). Of all eyes treated, 134 were evaluated for effectiveness with 98.5% accountability at 3 months, 131 eyes with 97.0% accountability at 6 months, 118 eyes with 90.8% accountability at 9 months, and 27 eyes with 87.1% accountability at 12 months. The studies found that of the 131 eyes eligible for the uncorrected visual acuity (UCVA) analysis of effectiveness at 6 months, 97.3% were corrected to 20/40 or better, and 66.2% were corrected to 20/20 or better in 74 spherical hyperopia eyes; and 93.0% were corrected to 20/40 or better, and 56.1% were corrected to 20/20 or better in 57 astigmatic hyperopia eyes. The study showed that at the 6 month stability time point: there was no loss of ≥2 lines of best corrected vision that can be obtained with spectacles in either 63 astigmatic hyperopia eyes or 74 spherical hyperopia eyes; none of the 63 astigmatic hyperopia eyes or 74 spherical hyperopia eyes had best spectacle corrected visual acuity (BSCVA) worse than 20/25. During the course of study, one of 63 eyes with astigmatic hyperopia lost 2 lines of BSCVA at 1 month, no eyes with spherical hyperopia lost 2 lines of BSCVA, and no eye had a BSCVA worse than 20/40. The VISX STAR S4 IR Excimer Laser System with VSS Technology and WaveScan WaveFront System are approved to perform wavefront-guided laser assisted in-situ keratomileusis (LASIK) treatments for the reduction or elimination of naturally occurring mixed astigmatism when the magnitude of cylinder (from 1.0 to 5.0 D) is greater than the magnitude of sphere and the cylinder and sphere have opposite signs; in patients 21 years of age or older; and in patients with documented evidence of a change in manifest refraction of no more than 0.50 D (in both cylinder and sphere components) for at least one year prior to the date of pre-operative examination. Wavefront-guided LASIK for the correction of mixed astigmatism is an elective procedure with the alternatives including but not limited to eyeglasses, contact lenses, photorefractive keratectomy (PRK), conventional LASIK, and other refractive surgeries. Approval of the mixed astigmatism application is based on a clinical trial of 86 eyes. Of all eyes treated, 86 were evaluated for effectiveness with 100.0% accountability at 3 months, 80 eyes with 95.2% accountability at 6 months, 69 eyes with 86.3% accountability at 9 months, and 63 eyes with 94.0% accountability at 12 months. The studies found that of the 86 eyes eligible for the uncorrected visual acuity (UCVA) analysis of effectiveness at 3 months, 95.3% were corrected to 20/40 or better, 91.9% were corrected to 20/32 or better, and 61.6% were corrected to 20/20 or better without spectacles or contact lenses. The study showed that of 86 astigmatic eyes, one eye temporarily lost 2 lines of best corrected vision that can be obtained with spectacles at 1 month and at 6 months and none of the eyes had best spectacle corrected visual acuity (BSCVA) worse than 20/40. CONTRAINDICATIONS: Wavefront-guided LASIK is contraindicated in patients with collagen vascular, autoimmune or immunodeficiency disease, signs of keratoconus or abnormal corneal topography, patients taking Isotretinoin (Accutane®) or Amiodarone hydrochloride (Cordarone®) or are pregnant or nursing. WARNINGS: Wavefront-guided LASIK is not recommended in patients who have diabetes, a history of Herpes simplex or Herpes zoster keratitis, significant dry eye that is unresponsive to treatment, or severe allergies. For the treatment of low to moderate myopic astigmatism, lower uncorrected visual acuity may be anticipated in the treatment of higher degrees of myopia with and without astigmatism (≥5.0 D MRSE). PRECAUTIONS: The safety and effectiveness of wavefront-guided LASIK surgery has ONLY been established with an optical zone of 6 mm and an ablation zone of 8 mm for myopic astigmatism, and an optical zone of 6 mm and an ablation zone of 9 mm for hyperopic and mixed astigmatism. Long-term risks of wavefront-guided LASIK beyond 12 months have not been studied. The safety and effectiveness of the STAR S4 IR Excimer Laser System have NOT been established for wavefront-guided treatment of low to moderate myopic astigmatism in patients: whose WaveScan WaveFront diameter is less than 6 mm, for treatments greater than 6 diopters of MRSE or with greater than 3 diopters of astigmatism and for retreatment with CustomVue LASIK. The safety and effectiveness of the STAR S4 IR Excimer Laser System have NOT been established for wavefront-guided treatment of high myopic astigmatism in patients: whose WaveScan WaveFront diameter is less than 5 mm, for treatments greater than -11 diopters of MRSE or with greater than 3 diopters of astigmatism. The safety and effectiveness of the STAR S4 IR Excimer Laser System have NOT been established for wavefront-guided treatment of hyperopic astigmatism in patients: whose WaveScan WaveFront diameter is less than 5 mm; for treatments greater than 3 diopters of MRSE or with greater than 2 diopters of astigmatism and for retreatment with CustomVue LASIK. The safety and effectiveness of the STAR S4 IR Excimer Laser System have NOT been established for wavefront-guided treatment of mixed astigmatism in patients: whose WaveScan WaveFront diameter is less than 5 mm, for treatments greater than 5 diopters or less than 1 diopter of astigmatism and for retreatment with CustomVue LASIK. Although the WaveScan WaveFront System measures the refractive error and wavefront aberrations of the human eyes, including myopia, hyperopia, astigmatism, coma, spherical aberration, trefoil, and other higher-order aberrations through sixth order, in the clinical studies for low to moderate myopic astigmatism, hyperopic astigmatism and mixed astigmatism, the average higher-order aberration did not decrease after CustomVue Treatment. In the clinical studies for high myopic astigmatism, the average higher-order aberration increased after CustomVue Treatment. It is possible, after wavefront-guided LASIK treatment, that patients will find it more difficult than usual to see in conditions such as very dim light, rain, snow, fog, or glare from bright lights at night. Visual performance possibly could be worsened by large pupil sizes or decentered pupils. Pupil size should be evaluated under mesopic illumination conditions. The use of Percentage Nomogram Adjustment should be based upon careful consideration of patient and surgeon information, in addition to environmental conditions surrounding the surgery. The simultaneous use of the Percentage Nomogram Adjustment and the Physician Adjustment has not been studied in controlled investigations, and should not be attempted until the accuracy of the Nomogram setting has been verified for the same laser, treatment conditions and type of treatment. Therefore, the combined simultaneous use of the Percentage Nomogram Adjustment and the Physician Adjustment is not recommended without careful analysis of post-operative refractive results. ADVERSE EVENTS AND COMPLICATIONS: The clinical trial for low to moderate myopic astigmatism showed that the following adverse events or complications occurred in at least 1% of the 351 eyes at any interval up to 6 months post-treatment: inflammation of the cornea under the flap (1.4%); double or ghost images (1.4%); and scratch on the surface of the eye (1.4%). The following subjective symptoms frequency rated “often or always” were increased in the effectiveness cohort at 6 months post-treatment on 258 eyes compared with pre-treatment on 332 eyes: dryness (9% vs. 6%); fluctuation of vision (3% vs. 2%); glare (4% vs. 2%) and halos (7% vs. 5%). The clinical trial for high myopic astigmatism showed that the following adverse events or complications occurred in at least 1% of the 184 eyes at one or more post-operative examinations up to 6 months post-treatment: epithelium in the interface (1.1%); peripheral corneal epithelial defect at 1 month or later (2.2%); corneal edema between 1 week and 1 month post-operatively (2.7%) and double vision (or “ghost images”) in the operative eye (6.0%). The following subjective symptoms were reported as present “often or always” by a higher percentage of subjects 6 months after treatment than before treatment: dryness (10.8% vs. 9.3%); halos (21.6% vs. 15.4%); and ghosting or shadowing of images (2.8% vs. 1.1%). The clinical trial for hyperopic astigmatism showed that the following adverse events or complications occurred in at least 1% of the 144 eyes at any interval up to 6 months post-treatment: cells growing under the flap (2.1%); feeling of something in the eye (1.4%); double or ghost images (11.3%); and scratch on the surface of the eye (2.1%). The following subjective symptoms rated “often or always” were increased in the effectiveness cohort at 6 months post-treatment on 131 eyes compared with pre-treatment on 136 eyes: dryness (17% vs. 6%); blurry vision (10% vs. 7%); fluctuation of vision (14% vs. 6%); halos (10% vs. 5%); double or ghost images (7% vs. 3%). The clinical trial for mixed astigmatism showed that the following adverse events or complications occurred in at least 1% of the 86 eyes at one or more post-operative examinations up to 3 months post-treatment: miscreated flap (1.2%); cells growing under the flap (4.7%); and double vision (or “ghost images”) in the operative eye (8.1%). The following subjective symptoms were reported as present “often or always” by a higher percentage of subjects 3 months after treatment than before treatment: dryness (22% vs. 6%); halos (20% vs. 13%).
  • 12. The iLASIK Solution Innovative Technologies Delivering Exceptional Results The iLASIK Solution, available exclusively from AMO, is the combination of IntraLase and Advanced CustomVue Technologies. This unique blend of technologies sets a new standard for laser vision correction. u Beyond 20/20. The iLASIK Technology Suite provides a truly customized treatment, helping you take more of your patients beyond 20/20 vision* u Good Enough for NASA and Your Patients. NASA astronauts and U.S. fighter pilots can have laser vision correction surgery today because of the exclusive, validated safety and precision performance of iLASIK Technologies u Leading Innovation. With over 20 years of innovation, more than 15 million procedures worldwide and the broadest range of FDA wavefront-guided LASIK approvals, iLASIK Technologies are the true industry leaders u Unsurpassed Service, Support and Value. Our award-winning† service and post-sales support enhance the value of your investment in the premium iLASIK Platform by maximizing reliability, quality and patient outcomes For more information and to contact an AMO representative, go to www.amo-ilasik.com or call 1-877-AMO-4LIFE. Laser assisted in-situ keratomileusis (LASIK) can only be performed by a trained ophthalmologist and for specified reduction or elimination of myopia, hyperopia, and astigmatism as indicated within the product labeling. Laser refractive surgery is contraindicated for patients: a) with collagen vascular, autoimmune, or immunodeficiency diseases; b) who are pregnant or nursing women; c) with signs of keratoconus or abnormal corneal topography; d) who are taking one or both of the following medications: Isotretinoin (Accutane®) and Amiodarone hydrochloride (Cordarone®). Potential side effects to laser refractive surgery may include glare, dry eye, as well as other visual anomalies. LASIK requires the use of a microkeratome that cuts a flap on the surface of the cornea, potential side effects may include flap related complications. Patients are requested to consult with their eye care professional and Patient Information Booklet regarding the potential risks and benefits for laser refractive surgery, results may vary for each individual patient. Restricted Device: U.S. Federal Law restricts this device to sale, distribution, and use by or on the order of a physician or other licensed eye care practitioner. U.S. Federal Law restricts the use of this device to practitioners who have been trained in its calibration and operation and who have experience in the surgical treatment and management of refractive errors. *20/16 results delivered with excimer laser; clinical studies sent to the FDA via P930016 supplement 021. † AMO won the 2010 Omega NorthFace ScoreBoardSM Award for delivering world-class customer service and consistently exceeding customer expectations. This is the ninth straight year AMO has won the award. References 1. Data on file. AMO Development, LLC. CustomVue Procedure clinical trials submitted to the FDA; 2003, 2004, 2005 2007. 2. Greenberg K. WaveScan WaveFront system key to individualized LASIK treatment. Refractive Eyecare. April 2010. 3. Alcon’s Wavelight Allegretto Procedure Manual Addendum, August 2005. 4. Dai GM, Gross E, Liang J. System performance evaluation of refractive surgical lasers: a mathematical approach. Appl Opt. 2006;45(9):2124-2134. ©2010 Abbott Medical Optics Inc. Advanced CustomVue, CustomVue, iLASIK, IntraLase, STAR S4 IR, VISX, VRR, WaveScan and WaveScan WaveFront are trademarks owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. Accutane is a registered trademark of Hoffman-LaRoche Inc. Cordarone is a registered trademark of Sanofi-Synthelabo, Inc. 2009.07.30-IL1181 Rev. A