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Slide 2 Freedom to See Freedom to Be Freedom to Do Anything You Want Slide 3 VISX Star S4 Excimer Laser System Features Bausch & Lomb Orbscan Lasik Procedure Procedure Risks and Benefits Surgeon Experience Questions VISX Star S4 Excimer Laser System Features Bausch & Lomb Orbscan Lasik Procedure Procedure Risks and Benefits Surgeon Experience Questions Discussion Topics Slide 4 VISX Leadership 1983 Stephen Trokel, MD invents laser vision correction 1987 VISX system used to treat 1st human eye 1995 VISX Star TM launched 1998 VISX Star S2 TM launched 1999 VISX CAP TM Method launched & Millionth VISX procedure performed in the United States 2001 VISX WaveScan TM WaveFront System VISX STAR S3 TM 1983 Stephen Trokel, MD invents laser vision correction 1987 VISX system used to treat 1st human eye 1995 VISX Star TM launched 1998 VISX Star S2 TM launched 1999 VISX CAP TM Method launched & Millionth VISX procedure performed in the United States 2001 VISX WaveScan TM WaveFront System VISX STAR S3 TM Slide 5 VISX New Technology Variable Sized Beams (VSS) STAR S4 ActiveTrak System Larger ablation zones Variable Sized Beams (VSS) STAR S4 ActiveTrak System Larger ablation zones Slide 6 Variable Sized Beams (VSS) Variable offset scanning beam sizes and shapes Active 3D eye tracker Tracks entire natural pupil No dilation required Tracks eye in X,Y, and Z planes No pre-imaging required Larger Ablation Zones Reduced Incidence of night vision problems Variable Sized Beams (VSS) Variable offset scanning beam sizes and shapes Active 3D eye tracker Tracks entire natural pupil No dilation required Tracks eye in X,Y, and Z planes No pre-imaging required Larger Ablation Zones Reduced Incidence of night vision problems VISX STAR S4 ActiveTrak TM key features Slide 7 Beam diameter increases as treatment progresses Variable Sized Beams Myopic treatments use variable size beam Treatment starts at 0.65 mm Treatment finishes at up to 6.5 mm Myopic treatments use variable size beam Treatment starts at 0.65 mm Treatment finishes at up to 6.5 mm Slide 8 Variable shaped beam myopic astigmatism Exclusive elliptical treatment combines sphere and cylinder shapes Variable shaped beam myopic astigmatism Exclusive elliptical treatment combines sphere and cylinder shapes Elliptical shape corrects both myopia and astigmatism Variable Sized Beams Slide 9 Beam scans in periphery to steepen central cornea Variable Sized Beams Offset beam with scanning capabilities Hyperopic treatments use offset scanning Offset rectangular beam scans across the cornea Offset beam with scanning capabilities Hyperopic treatments use offset scanning Offset rectangular beam scans across the cornea Slide 10 Variable Sized Beams More treatment options than any other laser Variable beam size Beam changes shape and size to address all refractive errors Scanning capabilities SmartBeam scans across the cornea with hyperopia and larger ablation zones Personalized treatments Capable of performing individualized treatments More treatment options than any other laser Variable beam size Beam changes shape and size to address all refractive errors Scanning capabilities SmartBeam scans across the cornea with hyperopia and larger ablation zones Personalized treatments Capable of performing individualized treatments Slide 11 VISX STAR S4 ActiveTrak Eye Tracker features and benefits Active eye tracker Moves beam to compensate for all eye movements 3D infrared eye tracker Dual side-mounted infrared cameras monitor x, y, and z No dilation required Patient comfort and convenience Maintains LASIK wow factor Active eye tracker Moves beam to compensate for all eye movements 3D infrared eye tracker Dual side-mounted infrared cameras monitor x, y, and z No dilation required Patient comfort and convenience Maintains LASIK wow factor Slide 12 VISX STAR S4 ActiveTrak Eye Tracker features and benefits Flexible, responsive eye tracking Assures eye remains in optimal 3D window No pre-imaging required Direct measurement of pupil position Fast patient throughput Doctor controls eye tracker function Doctor engages tracker, controlling centration and alignment Flexible, responsive eye tracking Assures eye remains in optimal 3D window No pre-imaging required Direct measurement of pupil position Fast patient throughput Doctor controls eye tracker function Doctor engages tracker, controlling centration and alignment Slide 13 VISX STAR S4 ActiveTrak Eye Tracker Dual side-mounted, infrared cameras monitor x, y, and z movements Oblique IR lighting does not interfere with procedure Dual side-mounted, infrared cameras monitor x, y, and z movements Oblique IR lighting does not interfere with procedure Slide 14 VISX STAR S4 ActiveTrak Eye Tracker Tracker is engaged by physician Laser, reticle, and pupil indicator are active and aligned Tracker is engaged by physician Laser, reticle, and pupil indicator are active and aligned Slide 15 Laser Beam actively follows eye movements Actual eye movements VISX STAR S4 ActiveTrak Eye Tracker ACTIVE 3-D eye tracking video (Click on image to start the video) Slide 16 Data on file, VISX, Inc. VISX STAR S4 ActiveTrak Eye Tracker Eye movements during LASIK ActiveTrak tracks at 60 Hz 99.4% of all eye movements can be captured with a 20 Hz tracker Eye position is verified and safety checked before every laser pulse Continues to monitor between pulses Checks eye position 6 times for every pulse delivered to the cornea Eye movements during LASIK ActiveTrak tracks at 60 Hz 99.4% of all eye movements can be captured with a 20 Hz tracker Eye position is verified and safety checked before every laser pulse Continues to monitor between pulses Checks eye position 6 times for every pulse delivered to the cornea Slide 17 VISX STAR S4 ActiveTrak Technical Comparison VISX ActiveTrak 3D eye tracker Developed for laser vision correction No dilation Tracks X, Y, and Z axis movements LadarVision Developed for non-ophthalmic applications Requires dilation to minimum 7mm Limited range of motion (no z-axis) VISX ActiveTrak 3D eye tracker Developed for laser vision correction No dilation Tracks X, Y, and Z axis movements LadarVision Developed for non-ophthalmic applications Requires dilation to minimum 7mm Limited range of motion (no z-axis) Slide 18 VISX STAR S4 ActiveTrak Technical Comparison VISX ActiveTrak: DIRECT measurement of eye position in real time Tracks pupil in its natural position Direct measurement increases system accuracy LadarVision tracker: Requires pre-imaging for indirect measurement of eye position Pre-imaging is a source of error Extrapolates eye position from only 4 points, based on where the pupil center WAS when pre-imaging, not where it is during the actual surgery VISX ActiveTrak: DIRECT measurement of eye position in real time Tracks pupil in its natural position Direct measurement increases system accuracy LadarVision tracker: Requires pre-imaging for indirect measurement of eye position Pre-imaging is a source of error Extrapolates eye position from only 4 points, based on where the pupil center WAS when pre-imaging, not where it is during the actual surgery Slide 19 Radar Tracker-only 4 data points used 3-D Infrared Video Tracker- thousands of data points used Eye Tracker Centration Technical Comparison Slide 20 Beam sizes are varied from 1mm to 6mm in diameter Larger Ablation Zones with VSS Enlarged ablations using blend zones Uses scanning beams of varying sizes Allows 2.2 mm blend zone for total treatment of 8 mm Treatment times are reduced, Removes less tissue than fixed spot systems Enlarged ablations using blend zones Uses scanning beams of varying sizes Allows 2.2 mm blend zone for total treatment of 8 mm Treatment times are reduced, Removes less tissue than fixed spot systems Slide 21 Larger Ablation Zones With VSS Enlarged ablation zone benefits Increases treatment area to 8 mm Minimal added depth Minimal increase in treatment time Accurate Smooth Safe Enlarged ablation zone benefits Increases treatment area to 8 mm Minimal added depth Minimal increase in treatment time Accurate Smooth Safe Slide 22 Larger Ablation Zones With VSS Advantages of Blend Zone Decreases the angle of ablation edge May reduce incidence of night vision problems May help LASIK flap to lay smoother and fit better in the bed Advantages of Blend Zone Decreases the angle of ablation edge May reduce incidence of night vision problems May help LASIK flap to lay smoother and fit better in the bed Slide 23 Larger Ablation Zones With VSS VISX 8 mm ablation zone - actual treatment video Click on image to start video VISX 8 mm ablation zone - actual treatment video Click on image to start video Slide 24 Larger Ablation Zones With VSS Conclusion Larger ablation zones using VSS offers a new and unique approach to laser vision correction Advantages of quicker procedure times and less tissue removal Ability to extend ablation zone to 8 mm Is an accurate and safe treatment Conclusion Larger ablation zones using VSS offers a new and unique approach to laser vision correction Advantages of quicker procedure times and less tissue removal Ability to extend ablation zone to 8 mm Is an accurate and safe treatment Slide 25 Bausch & Lomb OrbScan System OrbScan TM Patients AcuityMap, a unique fingerprint of the eye Anterior Float map (left) Posterior Float map (right) OrbScan TM Patients AcuityMap, a unique fingerprint of the eye Anterior Float map (left) Posterior Float map (right) Slide 26 OrbScan System OrbScan TM interface: OrbScan TM maps show: Front and Rear Corneal Surfaces Keratometry Pachymetry (thickness) OrbScan TM interface: OrbScan TM maps show: Front and Rear Corneal Surfaces Keratometry Pachymetry (thickness) Slide 27 LASIK for Myopia Slide 28 Slide 29 Slide 30 Slide 31 Slide 32 Slide 33 Slide 34 Slide 35 Slide 36 Slide 37 Slide 38 Slide 39 Slide 40 Slide 41 Slide 42 Excimer: Ablatio