Mathematical Model to Compare the Relative Tensile Strength of the Cornea After PRK, LASIK, and Small Incision Lenticule Extraction

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml"> <head id="Head1"><script type="text/javascript" src="/_static/js/bundle-playback.js?v=HxkREWBo" charset="utf-8"></script> <script type="text/javascript" src="/_static/js/wombat.js?v=txqj7nKC" charset="utf-8"></script> <script>window.RufflePlayer=window.RufflePlayer||{};window.RufflePlayer.config={"autoplay":"on","unmuteOverlay":"hidden"};</script> <script type="text/javascript" src="/_static/js/ruffle/ruffle.js"></script> <script type="text/javascript"> __wm.init("https://web.archive.org/web"); __wm.wombat("http://www.healio.com:80/ophthalmology/journals/JRS/%7B05ED199C-8A47-4CC9-A3C0-4D856197C56C%7D/Mathematical-Model-to-Compare-the-Relative-Tensile-Strength-of-the-Cornea-After-PRK-LASIK-and-Small-Incision-Lenticule-Extraction","20130708050723","https://web.archive.org/","web","/_static/", "1373260043"); </script> <link rel="stylesheet" type="text/css" href="/_static/css/banner-styles.css?v=S1zqJCYt" /> <link rel="stylesheet" type="text/css" href="/_static/css/iconochive.css?v=3PDvdIFv" />  <meta http-equiv="Content-Type" content="text/html; charset=utf-8"/><title> Mathematical Model to Compare the Relative Tensile Strength of the Cornea After PRK, LASIK, and Small Incision Lenticule Extraction | Journal of Refractive Surgery </title>  <meta name="google-site-verification" content="TCYGZWR7Qscjc3GO_imiutAfXMSCFLpchm8rXzIk-5M"/><meta name="msvalidate.01" content="AB0F11E889D663098DB556BB5ACBB719"/><meta id="metaDescription" name="description" content="Journal of Refractive Surgery | PURPOSE:To develop a mathematical model to estimate the relative differences in postoperative stromal tensile strength following photorefractive keratectomy (PRK), LASIK, and small incision lenticule extraction (SMILE).METHODS:Using previously published data where in vitro corneal stromal tensile strength was determined as a function of depth, a mathematical model was built to calculate the "/><meta id="metaKeywords" name="keywords" content="Journal of Refractive Surgery,Ophthalmology,Refractive Surgery,Optics,,Original Article,"/><meta id="Meta1" name="scID"/><meta id="scID" name="scID"/><meta name="pubabbv" content="JRS"/><meta name="authors" content="Dan Z. Reinstein MD MA(Cantab) FRCOphth, Timothy J. Archer MA(Oxon) DipCompSci(Cantab), J. Bradley Randleman MD"/><meta name="articleid" content="{05ED199C-8A47-4CC9-A3C0-4D856197C56C}"/><meta name="legacyarticleid" content=""/><meta name="article-title" content="Mathematical Model to Compare the Relative Tensile Strength of the Cornea After PRK, LASIK, and Small Incision Lenticule Extraction"/><meta name="article-link" content="/ophthalmology/journals/JRS/{05ED199C-8A47-4CC9-A3C0-4D856197C56C}/Mathematical-Model-to-Compare-the-Relative-Tensile-Strength-of-the-Cornea-After-PRK-LASIK-and-Small-Incision-Lenticule-Extraction"/><meta name="doi" content="10.3928/1081597X-20130617-03"/><meta name="pubname" content="Journal of Refractive Surgery"/><meta name="pubtype" content="print"/><meta name="author" content="Dan Z. Reinstein, MD, MA(Cantab), FRCOphth"/><meta name="author" content=" Timothy J. Archer, MA(Oxon), DipCompSci(Cantab)"/><meta name="author" content=" J. Bradley Randleman, MD"/><meta name="PostedDate" content="2013-07-01"/> <meta name="specialties" content="Ophthalmology"/> <meta name="specialty" content="Ophthalmology"/> <meta name="primary_specialty" content="Ophthalmology"/> <meta name="subspecialties" content="Refractive Surgery,Optics"/> <meta name="subspecialty" content="Refractive Surgery"/> <meta name="subspecialty" content="Optics"/> <meta name="departments" content="Original Article"/> <meta name="department" content="Original Article"/> <meta name="content_type" content="Journal Article"/> <meta name="pageid" content="{05ED199C-8A47-4CC9-A3C0-4D856197C56C}"/> <meta property="og:image" content="https://web.archive.org/web/20130708050723im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/healio_safe_image.png"/>  <link href="https://web.archive.org/web/20130708050723cs_/http://c341130.r30.cf1.rackcdn.com/styles.css" rel="stylesheet" type="text/css"/>  <link href="https://web.archive.org/web/20130708050723cs_/http://c341130.r30.cf1.rackcdn.com/styles2.css" rel="stylesheet" type="text/css"/><link href="https://web.archive.org/web/20130708050723cs_/http://c341130.r30.cf1.rackcdn.com/tb-ec-lb-min.css" rel="stylesheet" type="text/css" media="screen"/><link href="https://web.archive.org/web/20130708050723cs_/http://0043b493b06d545127da-d7c71b4c9ba1dd44e0cf6fa474e637d7.r99.cf1.rackcdn.com/healiojobs.css" rel="stylesheet" type="text/css"/><link href="https://web.archive.org/web/20130708050723cs_/http://6af4390358a281e0b439-028b17272c3ee5c2953a93a8c54187e2.r22.cf1.rackcdn.com/MediaKits.css" rel="stylesheet" type="text/css"/>   <script src="https://web.archive.org/web/20130708050723js_/http://ajax.googleapis.com/ajax/libs/jquery/1.8.2/jquery.min.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://cdn.jquerytools.org/1.2.7/full/jquery.tools.min.js" type="text/javascript"></script> <script type="text/javascript" language="javascript">$j = $.noConflict();</script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/easySlider-min.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/jquery.pager.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/jquery.jqprint-0.3.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/thickbox-compressed.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/jquery.lightbox-0.5.min.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/swfobject.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/ecommerce-min.js" type="text/javascript" language="javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/functions-min.js" type="text/javascript" language="javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/checkout-min.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://c341136.r36.cf1.rackcdn.com/jquery.url.min.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://50f7680153f6cba9e65f-a4a4842ad50f9edc1b98e79695b0495a.r26.cf1.rackcdn.com/WaterMark.min.js" type="text/javascript"></script> <script src="https://web.archive.org/web/20130708050723js_/http://50f7680153f6cba9e65f-a4a4842ad50f9edc1b98e79695b0495a.r26.cf1.rackcdn.com/registration.js" type="text/javascript"></script>  <script type="text/javascript"> $(function () { if (window.PIE) { $('#main-content.mtg').each(function () { PIE.attach(this); }); } }); </script> <script type="text/javascript"> var googletag = googletag || {}; googletag.cmd = googletag.cmd || []; (function() { var gads = document.createElement('script'); gads.async = true; gads.type = 'text/javascript'; var useSSL = 'https:' == document.location.protocol; gads.src = (useSSL ? 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</ul> </li> </ul> <script type="text/javascript"> jQuery(".nav>li:last>a").addClass("last"); //fix for IE last-child style </script>   <div id="main-content-journals">   <p id="breadcrumbs"> <a href="/web/20130708050723/http://www.healio.com/"> Healio</a> <span>›</span> <a href="/web/20130708050723/http://www.healio.com/ophthalmology"> Ophthalmology</a> <span>›</span> <a href="/web/20130708050723/http://www.healio.com/ophthalmology/journals"> Journals</a> <span>›</span> <a href="/web/20130708050723/http://www.healio.com/ophthalmology/journals/jrs"> Journal of Refractive Surgery</a> </p>    <div id="SeeAlso" class="related-links"><h3>See Also</h3><ul><li><a href="https://web.archive.org/web/20130708050723/http://www.healio.com/ophthalmology/journals/jrs/%7B13f846f1-3000-4fbe-8e1d-73e49fd97cb0%7D/prospective-contralateral-eye-study-to-compare-80--and-120-m-flap-lasik-using-the-visumax-femtosecond-laser">Prospective Contralateral Eye Study to Compare 80- and 120 ...</a></li><li><a href="https://web.archive.org/web/20130708050723/http://www.healio.com/ophthalmology/journals/jrs/%7Bfaa3561d-ce6e-4e89-9d12-55c1f1bddfa0%7D/unilateral-rainbow-glare-after-uncomplicated-femto-lasik-using-the-fs-200-femtosecond-laser">Unilateral Rainbow Glare After Uncomplicated Femto-LASIK ...</a></li><li><a href="https://web.archive.org/web/20130708050723/http://www.healio.com/ophthalmology/journals/jrs/%7Bdd46e513-3fb3-4c48-b3f2-e09d52a1507e%7D/lasik-for-presbyopia-correction-in-emmetropic-patients-using-aspheric-ablation-profiles-and-a-micro-monovision-protocol-with-the-carl-zeiss-meditec-mel-80-and-visumax">LASIK for Presbyopia Correction in Emmetropic Patients ...</a></li></ul></div> <script language="javascript" type="text/javascript" xmlns:webutil="http://www.sitecore.net/webutil"></script><div class="journals-content" xmlns:webutil="http://www.sitecore.net/webutil"><div class="journal-tab-group"><ul class="journal-tabs"><li><a href="..">Current Issue</a></li><li><a href="/web/20130708050723/http://www.healio.com/ophthalmology/journals/JRS/m/OAR">Online Advanced Release</a></li><li><a href="/web/20130708050723/http://www.healio.com/ophthalmology/journals/JRS/m/Past Issues">Past Issues</a></li></ul><div class="journal-panes"><div class="abstract-content"><p class="kicker-top">Original Article</p><h2><a href="#">Mathematical Model to Compare the Relative Tensile Strength of the Cornea After PRK, LASIK, and Small Incision Lenticule Extraction</a></h2><p class="authors">Dan Z. Reinstein, MD, MA(Cantab), FRCOphth; Timothy J. Archer, MA(Oxon), DipCompSci(Cantab); J. Bradley Randleman, MD</p><div class="journal-info"><ul class="full-text"><li class="header">Read Full Text Article</li><li class="html"><a class="active" alt="View HTML Version" title="View HTML Version" rel="nofollow" href="/web/20130708050723/http://www.healio.com/buy-journal-or-article?a={05ED199C-8A47-4CC9-A3C0-4D856197C56C}&returnUrl=%2fophthalmology%2fjournals%2fJRS%2f%7b05ED199C-8A47-4CC9-A3C0-4D856197C56C%7d%2fMathematical-Model-to-Compare-the-Relative-Tensile-Strength-of-the-Cornea-After-PRK-LASIK-and-Small-Incision-Lenticule-Extraction&jrnl=J0361"> HTML Icon </a></li><li class="pdf"><a class="active" alt="View PDF Version" title="View PDF Version" rel="nofollow" href="/web/20130708050723/http://www.healio.com/buy-journal-or-article?a={05ED199C-8A47-4CC9-A3C0-4D856197C56C}&returnUrl=%2fophthalmology%2fjournals%2fJRS%2f%7b05ED199C-8A47-4CC9-A3C0-4D856197C56C%7d%2fMathematical-Model-to-Compare-the-Relative-Tensile-Strength-of-the-Cornea-After-PRK-LASIK-and-Small-Incision-Lenticule-Extraction%3fpdf%3d1&jrnl=J0361"></a></li></ul><ul class="article-citation"><li>Journal of Refractive Surgery</li><li>July 2013 - Volume 29 · Issue 7: 454-460</li><li class="doi"> DOI: 10.3928/1081597X-20130617-03</li></ul></div><div class="copyrights" style="float:right;"><a href="#" onclick="RightsLinkPopUp();"><img src="https://web.archive.org/web/20130708050723im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/request-permissions.gif" border="0" alt="Rights and Permissions"></a><script language="javascript" type="text/javascript"></script></div><h4>Abstract</h4><div class="ftSection"><span class="ftInlineSubsectionTitle">PURPOSE:</span><p>To develop a mathematical model to estimate the relative differences in postoperative stromal tensile strength following photorefractive keratectomy (PRK), LASIK, and small incision lenticule extraction (SMILE).</p></div><div class="ftSection"><span class="ftInlineSubsectionTitle">METHODS:</span><p>Using previously published data where in vitro corneal stromal tensile strength was determined as a function of depth, a mathematical model was built to calculate the relative remaining tensile strength by fitting the data with a fourth order polynomial function yielding a high correlation coefficient (R<sup>2</sup> = 0.930). Calculating the area under this function provided a measure of total stromal tensile strength (TTS), based only on the residual stromal layer for PRK or LASIK and the residual stromal layers above and below the lenticule interface for SMILE.</p></div><div class="ftSection"><span class="ftInlineSubsectionTitle">RESULTS:</span><p>Postoperative TTS was greatest after SMILE, followed by PRK, then LASIK; for example, in a 550-<i>μ</i>m cornea after 100-<i>μ</i>m tissue removal, postoperative TTS was 75% for SMILE (130-<i>μ</i>m cap), 68% for PRK, and 54% for LASIK (110-<i>μ</i>m flap). The postoperative TTS decreased for thinner corneal pachymetry for all treatment types. In LASIK, the postoperative TTS decreased with increasing flap thickness by 0.22%/<i>μ</i>m, but increased by 0.08%/<i>μ</i>m for greater cap thickness in SMILE. The model predicted that SMILE lenticule thickness could be approximately 100 <i>μ</i>m greater than the LASIK ablation depth and still have equivalent corneal strength (equivalent to approximately 7.75 diopters).</p></div><div class="ftSection"><span class="ftInlineSubsectionTitle">CONCLUSIONS:</span><p>This mathematical model predicts that the postoperative TTS is considerably higher after SMILE than both PRK and LASIK, as expected given that the strongest anterior lamellae remain intact. Consequently, SMILE should be able to correct higher levels of myopia.</p><p><b>[<i>J Refract Surg.</i> 2013;29(7):454–460.]</b></p></div><div class="ftAuthorNotes"><p>From London Vision Clinic, London, United Kingdom (DZR, TJA); the Department of Ophthalmology, Columbia University Medical Center, New York, New York (DZR); Centre Hospitalier National d’Ophtalmologie, Paris, France (DZR); and the Department of Ophthalmology, Emory University, Atlanta, Georgia (JBR).</p><p>Dr. Reinstein is a consultant for Carl Zeiss Meditec (Jena, Germany), has a proprietary interest in the Artemis technology (ArcScan Inc, Morrison, Colorado), and is an author of patents related to VHF digital ultrasound administered by the Cornell Center for Technology Enterprise and Commercialization, Ithaca, New York. The remaining authors have no financial or proprietary interest in the materials presented herein.</p><p>Dr. Randleman did not participate in the editorial review of this manuscript.</p><p><b>AUTHOR CONTRIBUTIONS</b></p><p><i>Study concept and design (DZR, TJA, JBR); data collection (DZR, TJA, JBR); analysis and interpretation of data (DZR, TJA, JBR); drafting of the manuscript (DZR, TJA, JBR); critical revision of the manuscript (DZR, TJA, JBR); statistical expertise (DZR, TJA)</i></p><p>Correspondence: Dan Z. Reinstein, MD, MA(Cantab), FRCOphth, London Vision Clinic, 138 Harley Street, London W1G 7LA, United Kingdom. E-mail: dzr@londonvisionclinic.com</p></div><div class="ftHistory-received"> Received: January 11, 2013</div><div class="ftHistory-accepted"> Accepted: April 01, 2013</div><p> doi: 10.3928/1081597X-20130617-03</p><p><div class="fb-like" data-href="" data-send="true" data-width="450" data-show-faces="true"></div></p><ul class="share"><li><a href="javascript:void(0)" id="twitter" target="_new">Tweet</a></li><li><a href="javascript:void(0)" id="facebook" target="_new">Share</a></li><li><a href="javascript:void(0)" id="linkedin">Link</a></li><li><span class="db-wrapper"><span class="g-plusone" data-size="tall" data-annotation="none"></span></span></li><li><a href="javascript:void(0)" id="email">Email</a></li><li class="last"><a href="javascript:void(0)" id="print">Print</a></li></ul><div id="respond"><script language="javascript" type="text/javascript"> var idcomments_acct = 'aa6ff53f9870e40f92f83e1b5df3cddf'; var idcomments_post_id = '05ed199c-8a47-4cc9-a3c0-4d856197c56c'; var idcomments_post_url; </script> <span id="IDCommentsPostTitle" style="display: none"></span> <script type="text/javascript" src="https://web.archive.org/web/20130708050723js_/http://www.intensedebate.com/js/genericCommentWrapperV2.js"></script><p class="comment-notes"> Healio is intended for health care provider use and all comments will be posted at the discretion of the editors. 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Mathematical Model to Compare the Relative Tensile Strength of the Cornea After PRK, LASIK, and Small Incision Lenticule Extraction | Journal of Refractive Surgery