Surgical Planning with a New Laser

by Guy M. Kezirian, MD, MBA, FACS

June 2014


I am often asked:  Why can’t DataLink just give me a recommendation for higher treatments for my first cases with my new laser?


My answer: It could, but the recommendation won’t be valid.


As more surgeons upgrade to the latest technology such as the Alcon WaveLight. EX 500 laser, they are re-discovering that it is necessary to restart the nomogram development process. This means starting with treatments that tend to perform predictably from laser to laser, i.e., between +3 and -7 D spheroequivalent with 3 D or less astigmatism.


This range is selected based on the comparison of nomogram differences between many lasers over many years, and it hasn’t changed despite all the improvements in technology. Within this range, nomogram differences exists but are manageable, using our average library nomograms as a starting point. Beyond that range nomograms vary widely and all bets are off.

Some surgeons seem unaware of the fact that it is not possible for anyone to provide a valid surgical plan for treatments outside this range without prior data. It is not possible for you, for me, or for any other software or paper nomogram. This is not a reason to abandon validated nomograms, but rather a reason to start out slowly with a new laser and enter postop data as soon as possible.


If you must treat beyond the +3 to -7 range before SurgiVision® DataLink has received postop data then I recommend you just guess. Seriously. Your guess is as good as mine. You’ve seen your initial patients immediately after surgery (e.g., one day postops). We don’t, since SurgiVision® DataLink doesn’t consider data until 21 days after surgery. As such, you have more information than I do. In fact, your guess in early cases is better than mine.


As you know, as soon as you enter postop data on even as few as 10 eyes, SurgiVision® DataLink will give you a valid nomogram and perform surgical planning outside the +3 to -7 range. This is faster than any other source can do so, and it is only possible because of all the data we have in the database, contributed by you.


At present, the SurgiVision® DataLink database already has thousands of eyes with the EX 500! We have nomograms to cover different optical zones, hyperopia, myopia and mixed astigmatism.


Well done.


The key to building a successful refractive surgery practice is to have prior and existing patients refer their family and friends. This only happens when your patients are delighted with their results, and patients that require enhancements are seldom delighted. Start out with “slam dunk” cases when you switch to a new laser so you can be confident of your results. Develop your nomogram as quickly as possible by entering your postop data into SurgiVision® DataLink Alcon Edition as soon as possible. Expand beyond the starting range of +3 to -7 only after you have entered postop data.


This is the safest approach to starting with a new laser, and to building a reputation as the “surgeon who gets is right the first time.”