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Alpins method

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The Alpins Method, developed by Australian ophthalmologist Noel Alpins, is a system to plan and analyze the results of refractive surgical procedures, such as laser in-situ keratomileus (LASIK).[1][2][3] The Alpins Method is also used to plan cataract/toric intraocular lens (IOL) surgical procedures.[4]

Introduced in 1993,[5] the Alpins Method has been used in some research studies of LASIK.[1][2][3][6] In 2006 the American National Standards Institute (ANSI) published guidelines based on the Alpins Method, designed to help manufacturers demonstrate the efficacy of refractive surgical lasers.[3][7][8]

The Alpins Method uses vector mathematics to determine a goal for astigmatism correction and analyze factors involved if treatment fails to reach that goal. The method can also be used to refine surgical techniques or correct laser settings in future procedures.[9] The Alpins Method is one of the “more sophisticated” approaches in analyzing surgical results.[1]

Background

In the early 1990s, Alpins began to examine astigmatism analysis and treatment as they applied to laser modalities. It became apparent to him that the approach to astigmatism at that time was inconsistent and confusing. He noted that many approaches simply compared pre- and postoperative astigmatism magnitude values with no consideration of the axis of astigmatism or the amount of attempted change. Other approaches calculated a mean of the axes. None of the methods assessed the success of the results or the extent to which surgical goals had been achieved. [10] The advent of excimer laser technology (e.g., laser-assisted in situ keratomileusis, or LASIK) also introduced a conundrum between incisional and ablation techniques; specifically, should treatment be planned according to refractive cylinder values as introduced with laser refractive surgery, or corneal astigmatism parameters as had been customary with incisional surgery.[11][12][13]

The Alpins Method has become the standard for reporting astigmatism results in the major ophthalmology journals. [14][15][16] It is accepted worldwide for studies that include refraction and corneal astigmatism measurements.[5][2][7][17] The Alpins Method provides a consistent, logical approach to quantifying and comparing the success of various refractive surgical procedures, and refining/planning surgery to achieve even better results, both in individuals and groups of individuals receiving refractive surgery.

Basics of the Alpins Method

The Alpins Method determines a treatment path and defined astigmatic target that in many instances is not zero, although prior to the Alpins Method zero had been a nearly unanimous, but inachievable, preference.[10]

The golf analogy

File:GolfPutt.jpg
’’’Vector mapping’’’ of a golf putt depicts the basics of the Alpins Method : the target induced astigmatism vector (TIA), which is the astigmatic change the surgeon intends to induce; the surgical induced astigmatism vector (SIA), which is the astigmatic change the surgeon actually induces; and the difference vector (DV), which is an astigmatic change, by magnitude and axis, that would allow the surgeon to reach target on a second attempt.

The Alpins Method of astigmatism analysis has many parallels to the game of golf[9] (schematic). A golf putt is a vector, possessing magnitude (length) and axis (direction). The intended putt (the path from the ball to the hole) corresponds to Alpins' target induced astigmatism vector (TIA), which is the astigmatic change (by magnitude and axis) the surgeon intends to induce in order to correct the patient's preexisting astigmatism to the derived or calculated target. The actual putt (the path the ball follows when hit) corresponds to Alpins' surgical induced astigmatism vector (SIA), which is the amount and axis of astigmatic change the surgeon actually induces. If the golfer misses the cup, the difference vector (DV) corresponds to the second putt—that is, a putt (by magnitude and axis) that would allow the golfer to hit the cup (the surgeon to completely correct) on a second attempt.[5][10]

References

  1. ^ a b c Koch, DD (1997). "Excimer laser technology: new options coming to fruition". Journal of Cataract and Refractive Surgery. 23 (10): 1429–30. doi:10.1016/s0886-3350(97)80001-6. PMID 9480341.
  2. ^ a b c Koch, DD (1998). "Reporting astigmatism data". Journal of Cataract and Refractive Surgery. 24 (12): 1545. doi:10.1016/s0886-3350(98)80335-0. PMID 9850884.
  3. ^ a b c Koch, DD (2006). "Astigmatism analysis: the spectrum of approaches". Journal of Cataract and Refractive Surgery. 32 (12): 1977–8. doi:10.1016/j.jcrs.2006.10.001. PMID 17137948.
  4. ^ Borasio, E; Mehta, JS; Maurino, V (2006). "Torque and flattening effects of clear corneal temporal and on-axis incisions for phacoemulsification". Journal of Cataract and Refractive Surgery. 32 (12): 2030–8. doi:10.1016/j.jcrs.2006.09.010. PMID 17137979.
  5. ^ a b c Alpins, NA (1993). "A new method of analyzing vectors for changes in astigmatism". Journal of cataract and refractive surgery. 19 (4): 524–33. doi:10.1016/s0886-3350(13)80617-7. PMID 8355160.
  6. ^ Goggin, M; Pesudovs, K (1998). "Assessment of surgically induced astigmatism: toward an international standard". Journal of Cataract and Refractive Surgery. 24 (12): 1548–50. doi:10.1016/S0886-3350(98)80337-4. PMID 9850888.
  7. ^ a b Eydelman, MB; Drum, B; Holladay, J; Hilmantel, G; Kezirian, G; Durrie, D; Stulting, RD; Sanders, D; Wong, B (2006). "Standardized analyses of correction of astigmatism by laser systems that reshape the cornea". Journal of Refractive Surgery. 22 (1): 81–95. PMID 16447941.
  8. ^ Dupps Jr, WJ (2008). "Impact of citation practices: Beyond journal impact factors". Journal of Cataract and Refractive Surgery. 34 (9): 1419–21. doi:10.1016/j.jcrs.2008.07.001. PMID 18721687.
  9. ^ a b Alpins, NA; Goggin, M (2004). "Practical astigmatism analysis for refractive outcomes in cataract and refractive surgery". Survey of Ophthalmology. 49 (1): 109–22. doi:10.1016/j.survophthal.2003.10.010. PMID 14711444.
  10. ^ a b c Alpins N, Stamatelatos G. "Chapter 24: The Cornea – Part X: Treatment and analysis of astigmatism during the laser era". In: Boyd BF, ed. Modern Ophthalmology: The Highlights. Clayton, Panama: Jaypee-Highlights Medical Publishers, Inc; 2010.[non-primary source needed]
  11. ^ Thornton, SP; Sanders, DR (1987). "Graded nonintersecting transverse incisions for correction of idiopathic astigmatism". Journal of cataract and refractive surgery. 13 (1): 27–31. doi:10.1016/s0886-3350(87)80005-6. PMID 3559948.
  12. ^ Nordan, LT (1986). "Quantifiable astigmatism correction: Concepts and suggestions, 1986". Journal of cataract and refractive surgery. 12 (5): 507–18. doi:10.1016/s0886-3350(86)80125-0. PMID 3772786.
  13. ^ Lindstrom, RL (1990). "The surgical correction of astigmatism: A clinician's perspective". Refractive & corneal surgery. 6 (6): 441–54. PMID 2076422.
  14. ^ American Academy of Ophthalmology website. Author information pack. 17 January 2016. Accessed 20 December 2016.
  15. ^ American Society of Cataract and Refractive Surgery website. Information for Authors. 2016. Accessed 20 December 2016.
  16. ^ Reinstein, DZ; Archer, TJ; Randleman, JB (2014). "JRS standard for reporting astigmatism outcomes of refractive surgery". Journal of Refractive Surgery. 30 (10): 654–659. doi:10.3928/1081597X-20140903-01. PMID 21913632.
  17. ^ Sakimoto, T; Rosenblatt, MI; Azar, DT (2006). "Laser eye surgery for refractive errors". Lancet. 367 (9520): 1432–47. doi:10.1016/S0140-6736(06)68275-5. PMID 16650653.
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