Statements about the SCHWIND AMARIS Excimer Lasers

I have been using SCHWIND AMARIS for TransPRK treatment since 2010. Based on my experience, TransPRK is significantly superior in terms of clinical results and shows fewer complications compared to other laser-assisted vision correction methods. Better visual performance, predictability, safety and stability along with less pain, haze, aberration induction and other complications convinced me to consider TransPRK with the SCHWIND AMARIS platform as my treatment of choice for the majority of corneal laser ablation procedures. One of the outstanding characteristics of the SCHWIND AMARIS is its flexibility for modifications needed for each patient. This allows me to tailor an individualized treatment setting for each single eye (refined TransPRK) with satisfactory clinical results, giving me peace of mind.

The comprehensive analysis of our patients’ data confirms the high predictability. It demonstrates excellent results for using TransPRK in myopic, high myopic, hyperopic and astigmatic cases. Notable numbers of the patients achieve outstanding vision after the treatment. Questionnaire-based data, as well as objective contrast sensitivity assessments, indicate enhanced quality of patients' vison along with an improvement in quantitative indices. These results have been presented at various international ophthalmology conferences. As a leading TransPRK research group, we continuously gather, analyse and monitor clinical outcomes to provide new information and systematically upgrade our clinical knowledge.

I have used the PresbyMAX method since 2012 for correction of presbyopia and have performed to date approximately 250 LASIK treatments with PresbyMAX and the AMARIS. This technique has proven to be very successful. I started with the Symmetric treatment type. The near uncorrected visual accuity of patients was very good, but was unsatisfactory for distance (at least in the first months postoperative). Thereafter I used the µ-Monovision type – with better results, especially with distance vision. I achieved the best results, however, with PresbyMAX Hybrid. Already on the first day postoperative, most of the patients achieve a binocular, uncorrected far visual acuity of 20/20 and a near visual acuity of at least 20/30. The patients are the most satisfied this way. The preoperative patient selection is decisive for the success of a treatment. We now know exactly how to select good candidates for PresbyMAX treatment. I have also combined PresbyMAX with TransPRK, but the results here were not so convincing as with LASIK. I am totally convinced, however, with the results achieved with PresbyMAX. From my experience, PresbyMAX is superior to other methods because visual deficiencies, especially for the range up to +/- 5 diopters, can also be corrected precisely.

The SCHWIND AMARIS excimer laser technology takes you to the level of excellence that is necessary today for corneal refractive surgery. Its unparalleled performance for all refractive errors makes it an essential tool for my practise. Particularly remarkable is the treatment of high refractive errors, and here especially hyperopia, as well as the ability of the laser system to perform selective customised tabindex="-1">corneal wavefront guided ablations. I cannot think of anything better than AMARIS for my patients.

Technical advantages for the AMARIS including auto calibration, superior tracking, and rapid treatment are reflected in strong clinical results verified in multi-centre clinical trial data. In addition, there are two areas of particular strength for the AMARIS platform platform that I would highlight. Firstly, its transepithelial treatment modality (TransPRK) is very useful for therapeutic treatments - especially in keratoconus. Large area, minimum depth OWF guided ablation patterns created using a programming algorithm which is unique to the AMARIS have provided exciting early results in combined TransPRK and corneal collagen cross-linking for patients with stage II-III keratoconus and reduced spectacle corrected visual acuity. Secondly, the flexibility of programming on the AMARIS platform helps to ensure that the right treatment options are always available.  Most laser platforms focus on either manifest refraction based or wavefront guided treatment, AMARIS is equally strong for both - giving the surgeon a free choice in their preferred treatment approach. My personal preference is for wavefront guided treatment, but only in patients with a 6mm scan acquisition diameter and a consistent scan sequence. Where this is not achieved, I can be confident that the AMARIS has excellent compensation for induced aberrations in treatment based on the manifest refraction.

SmartSurfACE
The AMARIS platform abilities have established this system at the forefront for therapeutic corneal laser treatments. The latest advance has been the introduction of a new spot overlap algorithm (SmartPulse) giving a smoother surface with faster healing capabilities. Patients and surgeons like SmartSurfACE – the most comfortable no touch ablation technique - because it is quick and easy to do. In routine refractive correction, SmartSurfACE technology challenges the dominance of interfacial modalities such as LASIK and SMILE.

I have used SCHWIND technologies for more than twelve years, starting in 2002 with the SCHWIND ESIRIS and continued with the sophisticated SCHWIND AMARIS technology. Since 2013, we have assessed the efficacy, predictability and safety of LASIK for the correction of low to moderate myopia and astigmatism using the AMARIS 1050RS, the new flagship of the SCHWIND excimer laser portfolio.The clinical outcomes with AMARIS 1050RS were excellent and convincing from the beginning. The safe, highly precise and exactly predictable results are substantiated by a LASIK study based on 114 eyes with a manifest refraction spherical equivalent (MRSE) from -0.75 to -7.88 D (mean, -3.13 ±1.47 D) and up to 3.50 D of astigmatism (mean, 0.84 ±0.80 D). At 3 months postoperative, the average MRSE was -0.12 ±0.18 D. Almost all eyes were within ±0.50 D of intended correction and had astigmatism of 0.50 D or less. UCVA was 20/20 or better in 96 % of eyes. Moreover, the outcomes confirmed the advantages of the Aberration-Free concept: no significant high-order aberrations were induced during treatment.

I chose SCHWIND AMARIS technology because I strived for the highest quality available in the market. AMARIS offers an extremely wide range of applications in refractive and therapeutic corneal surgery. For example, by treating exactly what we have measured on corneal topography, the combination of tabindex="-1">corneal wavefront-guided treatment pattern and TransPRK ablation profile on the Schwind Amaris laser platform has helped to dramatically improve many patients with extreme corneal irregularities like post corneal transplantation, decentered ablations, and mild to moderate keratoconic corneas in combination with collagen cross-linking.

SmartSurfACE
SmartSurfACE is a no touch, all-laser procedure that has helped my patients feel better during and see appreciably better in the first few weeks after, compared with conventional aspheric PRK. My patients have been able to resume office work and enjoy performing their daily activities much earlier with SmartSurfACE and with only a few days delay compared to LASIK. It has also been a true savior when LASIK fails, consistently providing the great and fast results the patients were expecting to get.

My principal criteria for selecting a laser system are software, hardware, and maintenance. No system is free of failures, but with the SCHWIND AMARIS integral maintenance is performed promptly and in a preventive approach. The SCHWIND AMARIS is very reliable in the refractive results that you expect to obtain. We observed some undercorrections in the astigmatism, and we are now increasing the astigmatism plan by 10% of the defect, in cases with more than 3.00 D of astigmatism. The speed limits the requirements for the patient's fixation and decreases exposure time. It has the dual fluence approach that has made a great contribution in improving performance levels by increasing ablation speed.

It also allows for the possibility of including the excimer laser as an instrument to perform anterior segment procedures like lamellar grafts. The software gives the surgeon the possibility to face the patient with a very good armamentarium by using three different profiles: aberration-free, corneal wavefront and ocular wavefront, providing all of them consistent results and reliable outcomes.

Over the past 18 years I have performed more than 10,000 procedures using SCHWIND excimer lasers. I began using PresbyMAX for presbyopia correction in 2010 and have treated successfully more than 1,500 eyes, representing about 40 % of the treatments I perform with the excimer laser. By adding PresbyMAX to the list of laser treatments I offer, I have been able to significantly increase the number of annual procedures I perform. In the majority of cases, this treatment achieves encouragingly satisfactory results. The innovative PresbyMAX Hybrid version has become my most favoured treatment option.

PresbyMAX is a promising technique for presbyopia correction. In our clinical study, the flexibility of this treatment and the accuracy of the AMARIS' ablations have led to consistent results. In our experience, we have achieved an 86 % success rate. Moreover, only 1 % of our patients required a PresbyMAX reversal procedure. We feel that this is a great back-up solution to remove corneal multifocality. In the rare case that retreatment or reversal is required, the patient can achieve successful treatment with satisfactory outcome.

I always perform surface ablation, Lasek and Epi-Lasek, and it is well known that surface ablation needs a smooth surface. The dual fluence and the intelligent thermal effect control of the SCHWIND AMARIS lead to heating control and a more even surface. These points determine fast visual recovery and stability for reducing every apoptosis phenomenons. The ergonomics of the instrument can be appreciated just from the first operation; microscope, working distance and eye tracker are the most impressive improvements detected. When the footswitch lets the laser start, the speed is achieved and also long treatments are performed within only few seconds. This aspect is not only comfortable for the surgeon and the patient, but reduces the risk of changes in stromal hydration and is another fact in improving precision.

I am used to performing topo-aberrometrical links following transplants, radial keratotomies, corneal scars and other irregular corneas. The eye tracker permits a perfect alignment between topography and eye, matching the two images. Thus, high order aberrations can be really reduced, almost disappearing.

With SCHWIND, I especially value their willingness to continuously produce clinically relevant innovations. This includes the company’s close cooperation with us surgeons during the development process. With the latest member of the SCHWIND AMARIS family, the AMARIS 1050RS, I achieve even more precision, thanks to the 7D eyetracking. I treat twice as fast with the 1050RS compared to many other laser systems. A TransPRK on a patient with -3 D and an optical zone of 7 mm takes only 23 seconds. The TransPRK is an efficient, safe method and requires less expenditure of time than with LASIK or LASEK. Eyes with higher aberrations also profit, because we treat exactly what our diagnostic systems „see“. Also particularly noteworthy are the good results of hyperopia treatment with the AMARIS technology, which allows exact centering and precise tracking of each and every eye movement during the laser ablation. Tissue-savings are possible with the unique asymmetrical centration strategy: The treatment zone remains concentric to the pupil centre; the sphero-cylindrical ablation itself is centered on the corneal vertex.

SmartSurfACE
Meanwhile 90 % of laser eye treatments are performed in our clinic with SmartSurfACE. The biggest advantage is the smoother surface after the laser treatment and the quick visual recovery. In 80 % of cases patients see 20/25 or better binocularly on day 4 after removal of the contact lens. Predictability and efficacy is extraordinary so that less than 1 % of eyes need a second treatment. Furthermore, our workflow has been optimised using SmartSurfACE. The whole procedure takes about 7 minutes for both eyes.

I have used SCHWIND laser technologies and software in refractive surgery since 2006. The “Sphere” laser surgery clinic is the first in Russia to start with the touchless method of vision correction - TransPRK, and presbyopia correction - PresbyMax, with the fastest eye tracker, SmartPulse technology and intraoperative pachymetry. All these solutions are absolutely safe and lead to lifelong happiness with perfect vision of my patients. We are able to treat high degrees of myopia (up to -11 D), astigmatism (up to 6 D) and hyperopia (up to 6 D), providing to our patients the fastest vision recovery, safety and excellent predictability of results. A scientific collaboration was provided to us at the “Sphere” clinic and, as a consequence, we received the honour of becoming a SCHWIND reference centre in Russia. A permanent follow-up of surgical outcomes, organized by "Sphere" Clinic in Moscow, has never disappointed us with results we got. Personal contacts and respect from Mr. Schwind, constant participation in SCHWIND research projects, regular feedback and 24 H support from the company - all together - give me the confidence in growth of already unbeatable quality and technologies.

I saw patients with pain and discomfort after the PRK procedure, so I changed to LASIK surgery. I had to do with many complications like incomplete flaps, button holes or dislocated flaps. With the combination of TransPRK and SmartPulse, I can offer my patients a real no-touch procedure with much less pain especially using Mytomicin C, a very smooth corneal surface and a fast recovery, especially of visual acuity. SmartSurfACE, at least in my practice, can compete with LASIK. We are very happy with it.

When choosing a new excimer laser, software, hardware and maintenance are of equal importance. In our high volume clinic with currently five running excimer lasers, more than 4,000 corneal refractive procedures per year and 18 years of experience, SCHWIND AMARIS with its state of the art technology in terms of eye tracking, speed and software options beats all its predecessors and contemporaries from different companies. With high quality software and hardware it meets all surgeon demands, and because of the reliable and repeatable clinical outcomes it fulfils the expectations of almost all patients. With the user-friendly planning software it eases the process of thinking for both experienced and novel surgeons leading to an optimised workflow. Whether you choose Aberration Free, TransPRK or more complex corneal wavefront guided treatments, results are predictable, reliable and repeatable. Excellent clinical outcomes are obtained for all levels and types of refractive errors. We would like to emphasize the outstanding results in treatment of high astigmatism with a low under-correction rate, performed with static and dynamic cyclotorsion control. A smooth surface and well defined diameter of both epithelium and stromal excimer laser ablation together with intelligent thermal effect control make TransPRK procedures almost free of pain with rapid corneal healing and visual recovery.

The AMARIS is a remarkable, very high-resolution and very user-friendly laser. It is equipped with software that considers all individual needs in an optimal manner. Therewith the very broad spectrum of requirements of a refractive surgeon is perfectly served. As we refractive surgeons strive for highest perfection, a small adaptation of the nomogram can be helpful.
Furthermore, the laser distinguishes itself through high stability, performance strength and reliability. Technical service and customer support through the SCHWIND distributor Rocol function exceptionally well. I am more than satisfied with the AMARIS excimer laser. My professionalism and prestige have grown with it as the treatment results are 150 percent convincing.

Using SCHWIND AMARIS lasers was love at the first touch. The technology provides highly predictability and does not deliver surprises for us, but our patients are often positively surprised by the excellent treatment results. I personally value in particular the human touch of the SCHWIND family company. I always can rely on professional assistance. The people who back me are not just service engineers, but you feel continuously the spirit and support of the whole SCHWIND family. It is a very relieving feeling which makes it possible to focus my full attention on serving my valuable patients. In other words, it is not just the advanced technology in the operating room, it is rather the whole relationship leading to the overall conclusion that I’m very happy with SCHWIND.
Every day we hear that actually there are no quality differences between lasers and clinics. But in general, you do not realize any difference until, for example, you have eaten in the best possible restaurant or driven a model of the new BMW 6 Series. This also applies to the AMARIS 750S and 1050RS laser systems. After the SCHWIND engineers completed the final fine-tuning, we were stunned by the performance quality of the laser. And after all these years using AMARIS, I am still amazed about the continuous high precision this technology delivers day after day.

After using a different excimer laser platform for eight years, in 2012 I made the conscious decision to switch to the Schwind AMARIS.The effectiveness of a modern excimer laser system is similar between platforms when patients with routine refractive errors are treated. However, differences emerge when I am faced with unusual and irregular optics.

My specialty is the correction of irregular astigmatism, especially in keratoconus. With these patients, I must carefully balance the regularization of the corneal surface with tissue sparing. The AMARIS offers a high degree of customisation in wavefront-guided treatments; specifically, I am able to switch on or off the correction of single Zernike polynomials. Besides, I appreciate the attention to detail to the technical aspects and the responsiveness of the entire team including the service technicians, application engineers and entire R&D department.
Finally, as a researcher with a background in cell biology, I appreciate the intense exchange with the R&D team. They “listen” to their end user and are always willing to improve at any cost or effort.

I have worked together with SCHWIND eye-tech-solutions now for over 15 years. In this time, my expectations in the cooperation were never disappointed. The innovative technology and the extremely professional and ever-accessible support from this long established company have convinced me and the nordBLICK Bellevue Eye Clinic over and over again. Trust counts in all areas of medicine – the personal contact with the different departments, and also with Mr. Schwind, which has more and more deepened over the years, is marked by precisely this trust and long-standing stability. Special applications such as TransPRK or PresbyMAX have become, in addition to standard procedures such as LASIK, an important component of our clinical daily routine. We currently work with the flagship of the AMARIS excimer laser family, the AMARIS 1050RS. For us, there is only one conclusion to add: Innovation, precision, continuity and reliability mark the cooperation with SETS.

Athenaeum Refractive Center is the laser clinic with the most refractive procedures in Greece. Around 3000 laser operations a year are performed, approximately half of which are surface treatments (PRK/LASEK). Here the SCHWIND AMARIS laser ablation with two energy levels has proven to be an especially gentle treatment method. According to general comments from our PRK/LASEK patients, there is virtually no post-operative pain. In addition, the SCHWIND AMARIS is equipped with static and dynamic cyclotorsion control, which is not offered by any other competitor to the full extent. This is especially important in the correction of astigmatism, from which approximately 70% percent of our patients suffer. Already with a cylinder value of more than 1 D, the cyclotorsion control has significant influence on the results. Overall, the SCHWIND AMARIS as a laser system convinces through the sum of its properties. This is evidenced by the quality of the results – also with the consequence that we don’t require the use of nomograms. A further aspect is that the after sales services by Customer Support and Technical Service perfectly function.

With SmartSurfACE we have an excellent technique to treat hyperopia using surface ablation, particularly for optical zone sizes larger than 6.7mm (up to 7.5mm) and total ablation zones of up to 9.2 mm. The biggest advantage is the surface quality after the laser treatment (three times smoother than after conventional PRK) and the quick visual recovery even in hyperopic eyes. At the contact lens removal eyes are seeing in average 20/32 or better.

In a majority of cases the advanced surface laser treatment TransPRK is currently my preferred treatment option using the sophisticated SCHWIND AMARIS 750S excimer laser. In my clinic, it shows very good and similar treatment results for the conventional alcohol-assisted PRK and the TransPRK method. Both methods are predictable, effective and safe for the treatment of myopia and compound myopic astigmatism. But TransPRK is significantly more comfortable for surgeon and patient. At the moment I am very excited about using TransPRK in combination with Corneal Wavefront for difficult cases such as scarred corneal tissue or retreatment after radial keratotomy or corneal transplantation. This versatile approach is useful in all cases where a difficult epithelial flap is expected or when the epithelium covers corneal irregularities of the stromal tissue. First of all, the epithelium acts as a smoothing agent for the residual stromal bed, secondly all the preoperative data are taken with the epithelium on, including those being used for Corneal Wavefront ablation profile calculation. In general, I am very satisfied with the AMARIS 750S and I am not going to look for another one for a number of years.

I have been using the AMARIS platform since its first debut - the AMARIS 500, 750S and now the 1050RS. When you think it cannot get any better, Schwind surprises you once again. I have performed over 20,000 procedures with the AMARIS platform and have never wished to change the laser. Aberration free treatments in Femto LASIK and LASEK modes are wonderful but Trans PRK is genius, integrating a complete no touch technique that can be applied not only in virgin corneas but even in highly aberrated eyes such as post-PKP. From low to high dioptre ablations, Trans PRK is a versatile treatment method that gives the surgeon complete control and confidence. Asymmetric ablation patterns to eyes with high offsets result in minimizing nocturnal glare and maximising visual quality. I have applied the Amaris 1050RS to treat high dioptre cases with congenital nystagmus resulting in perfectly centered postoperative topographies. Static cyclotorsion control (SCC) together with dynamic cyclotorsion control maximises safety and efficacy. Once SCC is established and the tracker is on, the surgeon does not need to worry about tracker stability. Corneal Wavefront is a technology where Schwind is truly outstanding. Decentrations, high amounts of coma and even ectasia can be treated in combination with corneal crosslinking. Those patients with highly aberrated eyes are no longer a fear but a welcome challenge for me.

I have chosen the AMARIS 750S excimer laser for a number of reasons, including the responsiveness of the company to feedback and the outstanding performance features offered by this refractive platform. Main advantages of the laser include the 1,050-Hz eye tracker. The system tracks lateral eye-movements (X and Y ), movements along the optical axis (Z) as well as static and dynamic cyclotorsions and rolling movements. The AMARIS 750S eye tracker follows and actively compensates all these movements. This is important because the eyes move involuntarily up to 90 micrometres per millisecond in every direction, even during fixation. Consequently, precise centring and constant positioning of the eye is vitally important if high precision is to be achieved with eye laser surgery. Also remarkable is the short reaction time of the AMARIS 750S to avoid pulse positioning errors. The camera observes the position of the eye with a reaction time of just 1.6 milliseconds, while the total reaction time of the laser system as a whole is only around three milliseconds. We are using the AMARIS in combination with femtosecond laser flaps. The opaque interface bubble layer causes no problem for the eye tracker. Recognition is possible in almost 100 % of cases. Our clinical experience has shown that eye laser treatment using the AMARIS 750S with its active eye tracking is safe, predictable and yields very good patient outcomes.

The recovery is even faster than LASIK on the first day. After two days, patients can read phones, check computer monitors and do many other things. After 4-5 days, when the contact lenses come out, the patients can drive again their car without glasses and they easily achieve 20/40 or better. So the wow effect has come back to refractive surgery. The patients are happy, the surgeons are happy because there are no complications from LASIK or flaps or lenticule. It’s truly stressless surgery – a paradigm shift in refractive surgery. SmartSurf is the way to go.

We have been performing PresbyMAX at Bergman Clinics for the past 5 years, beginning with the basic approach, PresbyMAX Symmetric, and evolving to the latest approach, PresbyMAX Hybrid. Even though we took a yearlong break to explore the use of IOLs and corneal inlays for presbyopia correction, we eventually decided to return to performing presbyopia treatments with the latest excimer laser technology, which we believe is PresbyMAX Hybrid in combination with the AMARIS 750S. This treatment combines different multifocalities in both eyes with µ-monovision. It provides better distance visual acuity compared with PresbyMAX Symmetric but still achieves all of its known advantages. PresbyMAX Hybrid is a promising approach to maximize functional vision at all distances, especially distance vision. I use this technique regularly onpatients who are suitable for LASIK and require presbyopia correction.
Not only have our results been excellent, but SCHWIND PresbyMAX is the only excimer laser-based technique to provide a full and easy reversibility option if necessary. Additionally, we have achieved higher rates of patient satisfaction - even in demanding patients- with PresbyMAX Hybrid than with other PresbyMAX approaches.

I am the first surgeon to use AMARIS in China. Before AMARIS came to China, we used many lasers such as ZEISS and Wavelight. Since 2007, I have been paying close attention to the SCHWIND company and was looking forward to trying out the novel features offered exclusively by AMARIS. I believe AMARIS represents the future trends and the latest developments in refractive surgery technology, among which laser refractive surgery is gaining more and more favour. AMARIS TransPRK is an advanced one-step surface ablation that produces predictable results consistently. It is very useful not only in virgin eyes but also in enhancement and therapeutic cases.

The six-dimension eye tracking is another reason why we chose the AMARIS 750S. Before its arrival, most excimer lasers were only able to tack the eye in X and Y dimensions. The automatic tracking of AMARIS frees surgeons from the concerns of erroneous ablation and demonstrates clear information throughout the process. Furthermore, ablation center adjustment based on corneal vertex and asymmetric centration is very helpful in patients with a large angle Kappa. Our surgeons are happy to report fewer and fewer complaints from patients and very few cases requiring enhancement.

Using lasers of the SCHWIND AMARIS family, the AMARIS 500, 750S and 1050RS, I have always experienced very satisfactory results. More than 16,000 refractive surgery cases that I personally performed, delivered highly precise outcomes. Currently I work with the AMARIS 1050RS and it performs even better. With the link to SCHWIND SIRIUS tomography, highly precise customisation of each patient and eye is possible. With the variety of AMARIS modules, I can choose the most suitable surgery for my patients without any difficulties. TransPRK in combination with wavefront customisation showed very promising results, even in low myopic patients. With PresbyMAX Hybrid, we provide a very efficient treatment for presbyopic patients. In our clinic, not only first treatments are performed. We also treat complicated cases referred by physicians who have employed other laser platforms. Using AMARIS and SIRIUS, I am able to successfully treat patients who had suffered from visual discomfort before. The continuous efforts by SCHWIND enhance the quality of life for my patients and that they also meet my high demands for quality.

Why did we choose Schwind laser technology? Simply because I evaluate AMARIS as the currently most advanced laser technology on the market. We employ five Schwind Amaris lasers at our Gemini Eye Clinics in the Czech Republic. Integration with diagnostic devices via online data transfer, versatility of the software, online pachymetry and last but not least the high speed and precision of Amaris 1050RS are the key advantages. The laser runs very reliable at our high volume refractive practice. Not only standard cases are performed with precise outcomes and with no need for nomogram adjustment but also high astigmatism and high hyperopia can be corrected reliably. Topography guided procedures reducing higher order aberrations can be performed with a great degree of success. I admire the company’s passion for innovation. AMARIS was the best choice for us.

After having used the 750S for so many years, I now have the 1050RS and it is even better. The seven-dimensional tracking is a real boon and even at the higher speed of 1050Hz, the centration of the ablation is perfect (as seen on the post-operative topographies). Because of the 7th dimension, patients who are nervous can now be reassured that their movements will not affect the centration of the laser ablation. The higher speed also helps to shorten treatment times especially in cases of TransPRK, over and above the already short times that PRK, LASEK and LASIK patients have. With the increase of speed from 750Hz to 1050Hz, the laser has even a more pleasant pitch which is higher and softer and appears to be beneficial to nervous patients who are sensitive to loud noises. The shorter treatment times have not led to any change in my nomogram and in fact, my patients have better vision one day post-operation than before with most of them being 20/20 or better on the first day after surgery. I believe that the shortened treatment times especially in high myopes will reduce the effects of corneal dehydration with the flap open and make the results even more accurate than before. The 1050RS is the very best laser on the market!

SmartSurfACE
The AMARIS laser includes SmartPulse technology, what basically means, that it is smooth over the corneal surface. This is especially important, when you are doing treatments with what is called transepithelial PRK. TransPRK originally is done in a two-step procedure by other lasers. SmartSurfACE (TransPRK and SmartPulse Technology) removes the epithelium and treats the corneal shape all in one step. This makes it very simple. There is no hyperopic shift, there is no inconsistency in the myopic correction. SmartSurf is also very, very good for treatment of difficult cases. Cases with scars, cases with irregular corneas, and SmartSurfACE guided by corneal wavefront treatment is the best for treating difficult cases.

CustomEyes
CustomEyes involves mapping 150,000 points on the cornea. This high-resolution data is used for customized treatments – what SCHWIND calls CustomEyes. Not only are your lower order aberrations like shortsightedness and astigmatism corrected but, the higher order aberrations like spherical aberration and coma are also corrected in a personalized fashion using the SCHWIND ORK-CAM treatment software. The SCHWIND AMARIS ablates the minimum amount of corneal tissue, maintaining a high level of corneal stability for the maximum amount of visual improvement. The total corneal wavefront technology with CustomEyes is derived from more than 20 years of experience in wavefront-guided customization. These types of treatment are renowned for their accuracy, quality of vision and stability over time. In my opinion, CustomEyes is the best tool for the correction of lower order and higher order aberrations.

I have used SCHWIND AMARIS technologies since 2009. During my time as Medical Director at Shinagawa LASIK Center, the clinic had the highest volume of refractive surgeries in the world, with more than 1.1 million procedures completed by the end of 2013. Shinagawa had also performed the highest volume of AMARIS treatments in the world, completing about 400,000 procedures by the end of 2013 with the AMARIS 500, AMARIS 500E, AMARIS 750S, and AMARIS 1050RS models. Consequently, I gained a lot of experience with the whole product family and their different performance features. From my point of view, this technology provides best patient results at a reasonable price. A recently published large study shows the effectiveness of LASIK using the AMARIS 500*. The study comprised 10,235 eyes of 5,191 patients between 18 and 56 years of age and showed highly predictable and precise outcomes. The mean preoperative manifest refraction spherical equivalent (MRSE) was -5.02 ±2.17 D (ranging from -2.75 to -11.50 D). Three months postoperatively, 96.9% of eyes achieved an uncorrected distance visual acuity of 0.00 logMAR or better, and 82% achieved -0.18 logMAR or better. Even though the study included a broad range of myopia and patient age, the scattering of the results was very small.

*Tomita M, Waring IV GO, Magnago T, Watabe M. Clinical results of using a high-repetition-rate excimer laser with an optimized ablation profile for myopic correction in 10235 eyes. JCRS 39(10):1543-1549.

SCHWIND AMARIS uniquely offers the possibility of performing tabindex="-1">corneal wavefront guided treatment with a transepithelial PRK approach. I believe this novel method of refractive surgery is the first to achieve precise correspondence between preoperative examination and intraoperative ablation. The TransPRK mode also eliminates the need to prepare a flap or re-lift the flap, minimising induced aberrations. For some complicated enhancement cases, I have opted for TransPRK and achieved pretty good results. Recently, I found this can also be carried out using a two-step approach more predictably in patients with poor BSCVA and whose manifest refraction is difficult to measure accurately: reducing corneal irregularities/aberrations first and then correcting the low-order aberrations.

Today, SmartSurfACE (TransPRK and SmartPulse) constitutes about 35% of our refractive practice compared to years ago when less than 1% of cases where treated - thanks to the new ablation pattern called SmartPulse providing a very big improvement in the smoothness of the corneal surface. We achieved optimal optical outcomes and we were also able to add several new patient target groups to our practice: those with thinner corneas, those without keratoconus but with unusual topographies, patients scared of the microkeratome.

After more than 25 years’ experience with excimer laser cornea-based refractive surgery, my current laser system is the AMARIS 750S. I have found that Schwind is a responsive, flexible company that consistently aims to improve this device’s hardware and software. A variety of features distinguish the AMARIS 750S from other refractive laser platforms on the market. The laser’s tracking system and centration can track eye movements in six dimensions. The system determines the visual axis, tracks it, and automatically centers the ablation of LOAs on this axis. By contrast, HOA ablation is centered on the pupil center, from which it has been calculated. This makes a difference in outcomes; postoperative maps show better centration of the refractive ablation, and results are no longer sensitive to the angle kappa. Perhaps most impressive is the prolate shape of corneas after treatment with this system. Even after a myopic ablation, postoperative corneal maps show a prolate cornea. It can be difficult to determine whether these eyes have been treated or not. Other advantages of the laser include its large optical zone size and its speed. Most cases performed with the AMARIS 750S are completed within 60 seconds from the start of ablation. This platform also enables the surgeon to treat highly irregular corneas with little difficulty. But most important is the capability to treat difficult cases such as retreatment, dystrophies or scars with the custom ablation program and the integrated OCT keeping the surgeon informed on corneal pachymetry better than anything else.

I’m a committed SCHWIND AMARIS 750S user since 2011 and performed more than 1,000 topography guided treatments with this advanced laser system so far. Especially in patients, who undergone radial keratotomy or excimer laser surgery before, I made excellent experience using AMARIS 750S. In earlier years I built up a considerable experience in re-treating difficult cases.

In these highly aberrated eyes, we aim not only to correct a residual refractive error but to smoothen the corneal surface, enlarge an optical zone and possibly recenter a previous treatment by using tabindex="-1">Corneal Wavefront. In some cases this needs to be done as a two-step-treatment: a residual refractive result is then corrected in a second stage either with the Aberration-Free or with the Corneal Wavefront treatment. Compared to other laser systems I used before, SCHWIND technology offers numerous advantages: It simplifies the pre-treatment diagnostics, improves the predictability of the results, and lowers the retreatment rate. Furthermore, no nomogram changes are needed in customised treatments. Moreover, based on my confidence in AMARIS 750S technology, I even started - in these difficult cases - to treat both eyes at the same time.