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Corneal coupling of astigmatism applied to incisional and ablative surgery

Noel Alpins, FRANZCO, FRCOphth, FACS, James K.Y.Ong, BOptom Dr.rer.nat., George Stamatelatos, BScOptom

PURPOSE: To redefine measures of corneal coupling for use with incisional and ablation procedures for astigmatism.
SETTING: Private clinics, Melbourne, Victoria, Australia.
DESIGN: Retrospective nonrandomized study.
METHODS: The measures known as the coupling ratio (CR) and coupling constant (CC) were redefined to ensure validity in most cases of incisional procedures and laser vision correction procedures. In addition, a new measuredthe coupling adjustment (CAdj)dwas developed to quantify the amount of spherical adjustment that must be applied to compensate for coupling that occurs as a result of astigmatism treatment. These quantitative measures of coupling were applied to retrospective data to show their applicability.
RESULTS: Pure myopic, compound myopic, and compound hyperopic astigmatism excimer laser treatments showed a CR close to zero, a CC close to 0.5, and a CAdj close to zero. Incision LRIs showed a CR close to 1.0 and a CC close to zero. In all cases, the coupling measures were consistent for treatments with a larger astigmatic component (>1.0 diopter) but variable when the astigmatic component of the treatment was smaller.
CONCLUSIONS: The revised definitions of CR and CC can be used with incisional and ablative surgery. Incorporating the CAdj into the planning of spherocylindrical treatments allows one to factor in the effect of the astigmatic treatment on the spherical component and thus to more accurately target the desired spherical equivalent.
Financial Disclosure: Dr. Alpins and Mr. Stamatelatos have a financial interest in the Assort software program. Dr. Ong is an employee of Assort.
J Cataract Refract Surg 2014; 40:1813–1827 Q 2014 ASCRS and ESCRS