Dr. Robert Maloney has had many years of clinical experience correcting the vision of thousands of patients using a variety of techniques, and has personally performed over 45,000 LASIK procedures.
1. Dr. Robert Maloney was voted one of America's Top Ten Vision Correction Specialists in a nationwide survey of eye surgeons.
2. Dr. Robert Maloney, Clinical Professor of Ophthalmology at UCLA and a member of the U.S. Department of Defenses Joint Civilian Orientation Conference, has operated on U.S. soldiers who have been deployed to the Gulf Region.
3. The Maloney Vision Institute has contributed more than 100 periodicals, abstracts and reports to professional journals and delivered more than 200 invited lectures on five continents.
4. Dr. Robert Maloney is a former Heed Foundation fellow, a Heed/Knapp fellow, and a John Harvard scholar. He received the Research to Prevent Blindness Career Development Award, and the Mericos Whittier Award for lifetime contributions to Ophthalmology.
5. Dr. Robert Maloney was associate editor for the Journal of Refractive Surgery from 1991-95
Dr. Robert Maloney : Refractive surgery, Therapeutic wavefront treatment used after LASIK
Corneal laser treatment can sometimes result in irregular astigmatism. This can be caused by a decentered ablation, irregularity in the laser energy applied on the cornea or irregular healing of the cornea postoperatively. This results in higher-order aberrations, which cannot be corrected by conventional spherical or astigmatic corrections. Wavefront-guided laser treatments are showing promise in treating such irregularities. We present a case in which therapeutic wavefrontguided LASIK was used to treat a reduction in best-corrected visual acuity caused by conventional laser treatment.
History
A 43-year-old man presented with a complaint of reduced quality of vision in his left eye after a LASIK procedure in 1999. His postoperative refraction in his right eye was –5.5 D, correcting the eye to 20/20, and the left eye was –5.75 D, correcting to 20/20. He had a LASIK procedure in both eyes with LASIK enhancement in the left eye. Preoperative examination Uncorrected visual acuity: Right eye: 20/20–2; left eye: 20/40 Manifest refraction: Left eye: 0.50 –0.25 3 070 BCVA: Left eye: 20/40 Corneal topography of the left eye (Figure 1) revealed a centered laser treatment without obvious topographic abnormalities. However, the waveprint map of the left eye (Figure 2) showed greater-thanaverage higher-order aberrations, with RMS value of 0.55. The normal value is usually less than 0.35. The patient was enrolled in our Food and Drug Administration trial of wavefront-guided treatment after previous laser surgery. The information from the waveprint map was transferred to the Visx Wavescan System for a custom therapeutic ablation.
Postoperative examination
Manifest refraction: Left eye: +1.00 –0.50 3 180 BCVA: Left eye: 20/25 Postoperatively, the patient’s complaint of glare at night was dramatically improved. The postoperative waveprint map showed a reduction in higher-order aberrations, with a RMS value of 0.45 Figure 1. This post-LASIK topography map of the left eye shows a central area of the myopic ablation without obvious topographic irregularity. Figure 2. The post-LASIK Wavescan map of the left eye reveals minimal residual refractive error (upper left map) but significant higher-order aberrations (lower left map). The RMS value of the higher-order aberration was 0.55. The visually significant aberration was mostly spherical aberration (lower right graph).
Discussion
Patients who suffer from induced irregular astigmatism, a reduction in BCVA or a loss of quality of vision from previous laser procedures can be helped by wavefront-guided re-treatments. Therapeutic wavefront treatment utilizes the Visx Wavescan System to map out the entire optical system of the eye and measure lowerorder aberrations (sphere and cylinder) and higher-order aberrations, such as spherical, aberration or coma. This information is programmed into the laser to reduce corneal aberrations, improving quality of vision.
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