Authors:
M. Dió Department of Imaging and Medical Instrumentation, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary

Search for other papers by M. Dió in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0003-4307-3114
,
Sz. Molnár Sasszem Klinika, Budapest, Hungary

Search for other papers by Sz. Molnár in
Current site
Google Scholar
PubMed
Close
,
Cs. Szekrényesi Department of Imaging and Medical Instrumentation, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary

Search for other papers by Cs. Szekrényesi in
Current site
Google Scholar
PubMed
Close
,
B. Halmai Sasszem Klinika, Budapest, Hungary

Search for other papers by B. Halmai in
Current site
Google Scholar
PubMed
Close
,
J. Takács Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary

Search for other papers by J. Takács in
Current site
Google Scholar
PubMed
Close
, and
Z.Z. Nagy Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary

Search for other papers by Z.Z. Nagy in
Current site
Google Scholar
PubMed
Close
Open access

Abstract

Purpose

The present study compares the efficacy of refractive surgery using third-generation and sixth-generation laser vision correction procedures in terms of postoperative visual acuity. The goal of the authors was to determine whether advances in laser technology had improved patients' uncorrected visual acuity, as measured at six-month follow-ups.

Materials/Methods

Results were reported from one of Europe's leading laser eye clinics, which has performed an outstandingly high number of treatments (over 100,000). The results of the clinic's first 10,000 treatments and most recent 10,000 treatments were evaluated.

Results

The analysis was performed by treated dioptric range and age group. The raw six-month visual acuity results show a statistically significant improvement over the last 10,000 interventions. The treatments resulted in significant improvements in all groups compared to the previous technology. With the new devices, visual acuity increased to above 1.0 in young myopes. The best results were seen in patients between 18 and 45 years of age, in the dioptric range between −1.0 D and −6.0 D.

Conclusions

It can be concluded that advances in technology improved refractive outcomes in all patient groups. This conclusion has excellent reliability and predictability due to the particularly high number of cases.

Abstract

Purpose

The present study compares the efficacy of refractive surgery using third-generation and sixth-generation laser vision correction procedures in terms of postoperative visual acuity. The goal of the authors was to determine whether advances in laser technology had improved patients' uncorrected visual acuity, as measured at six-month follow-ups.

Materials/Methods

Results were reported from one of Europe's leading laser eye clinics, which has performed an outstandingly high number of treatments (over 100,000). The results of the clinic's first 10,000 treatments and most recent 10,000 treatments were evaluated.

Results

The analysis was performed by treated dioptric range and age group. The raw six-month visual acuity results show a statistically significant improvement over the last 10,000 interventions. The treatments resulted in significant improvements in all groups compared to the previous technology. With the new devices, visual acuity increased to above 1.0 in young myopes. The best results were seen in patients between 18 and 45 years of age, in the dioptric range between −1.0 D and −6.0 D.

Conclusions

It can be concluded that advances in technology improved refractive outcomes in all patient groups. This conclusion has excellent reliability and predictability due to the particularly high number of cases.

Introduction

Refractive excimer laser surgery to improve visual acuity is a well-known and accepted procedure today. Continuous technological developments have been made over the last 30 years, with the appearance of new types of devices and new surgical techniques, together with parallel advances in diagnostic and surgical equipment. There are now six generations of excimer laser systems for corneal vaporisation and corneal reshaping [1].

Corneal refractive surgery began in 1987 in Europe and the United States in parallel. In Europe that year, radial keratotomy (RK) was performed by Theo Seiler using the first generation of excimer laser [2], while in the U.S., Marguerite McDonald performed a myopic surface ablation in a blind eye, which was later enucleated and pathologically assessed [3].

Radial keratotomy incisions made using an excimer laser produced similar refractive results to the original RK procedures carried out using a diamond knife. Surface ablation (photorefractive keratectomy, or PRK) showed higher predictability and safety compared to RK, thus for a long time PRK became the gold standard [4, 5]. Wound healing issues following the use of early laser technology necessitated the development of other methods, such as LASIK, Epi-LASIK, LASEK, and FemtoLASIK [6–8].

While the long-term refractive results appear to be similar regardless of the surgical method used, they may be more profoundly affected by the different generations of excimer lasers. The first generation of excimer lasers operated with large beam technology (Summit, VISX), leaving central island phenomena that caused under-correction and other visual complaints [9]. Scanning slit and flying spot technology, with the use of the third generation of excimer lasers, showed significantly higher predictability and safety in myopic and hyperopic eyes. Subsequent generations of excimer lasers still operate with flying spot beam delivery, which remains the optimal technology [10, 11]. Table 1 presents the different generations of excimer lasers [1].

Table 1.

The different generations of excimer lasers

Excimer laserFeatures
1st generationPre-clinical phase (Touton, VISX, Summit). This period was experimental from a technical and biological point of view, thus the technical level was rudimentary and unpredictable.
2nd generationBroad beam, fixed optical zone. A laser beam corresponding to the full treatment diameter was used, with internal masks or diaphragms corresponding to the dioptre treated. The removal of tissue vapours was not usually possible, thus so-called central islands formed due to absorption by the masking.
3rd generationScanning-slit technology, multi-zone treatments. This was an improved broad beam technique with a variable optical zone. A laterally moving laser beam with a slit cross-section scanned the area to be treated.
4th generationFlying spot lasers, built-in eye trackers, and hyperopia treatments. A beam with a cross-section of a few millimetres, typically with a Gaussian energy distribution, produced the desired refractive result in unit shots scattered in space and time. The dispersed ablation reduced the uniform temperature rise and the masking effect of the tissue vapour released at the moment of ablation.
5th generationWavefront-guided and optimised treatments. Aberrometry measurements are taken into account during treatment. Treatment is planned by computer, based on a preoperative aberrometry map of the eye.
6th generationHigh-repetition-rate laser and automatic eye-tracking system. The main objectives are to control as many environmental variables as possible; select optimal pupil size; improve ablation profiles; continuously monitor cyclotorsion and eye movements, with the corresponding correction of the laser beam; and continuously monitor corneal thickness during therapy in some systems.

Materials and methods

The laser outpatient clinic selected for the study has been performing corneal laser vision correction procedures continuously since 1998, always using the highest technical standards available. All treatments have taken place in the operating room at the Sasszem Klinika. In both the initial and recent periods, the surgeries were performed by five ophthalmologists, all of them trained to perform laser surgery. The specialists in both periods had equally high qualifications. The only differences between the treatments offered in the two periods lies in the type and level of sophistication of the diagnostic tools, the technical capabilities of the laser devices, and precise laser control during laser firing.

The total number of treatments performed at the clinic since 1998 exceeds 100,000. The first 10,000 treatments were carried out using third-generation scanning-slit technology (using an Aesculap-Meditec MEL 60 laser). Although these excimer laser devices had already achieved high predictability, the treatment was inconvenient, since a beam-shielding mask weighing 80–100 g had to be placed on the surface of the cornea, and the treatment took about 60 s for the correction of a refractive error of −4.0 dioptres, for example.

For the second group of 10,000 evaluated treatments, a sixth-generation high-repetition-rate flying spot laser with eye-tracking technology (SCHWIND AMARIS 500, SW Version: 6.1.2117.8001) was used. This is a non-contact procedure that takes about 18 s for −4.0 dioptre correction.

In the present study, the six-month follow-up results for the two different treatments were grouped for comparability by dioptric range:

  1. -Low myopia (low myop): between −1.0 D and −3.0 D
  2. -Medium myopia (medium myop): between −3.0 D and −6.0 D
  3. -High myopia (high myop): above −6.0 D
  4. -Low hyperopia (low hyperop): up to +3.0 D
  5. -High hyperopia (high hyperop): above +3.0 D.

The results of the six-monthly follow-ups are shown in Table 2. The six-monthly average visus, the number of eyes, and the standard deviation are given for each group. Further subdivision by age has also been applied, as this may also affect postoperative results.

Table 2.

Results of the six-monthly follow-ups after refractive treatment

Results of the first 10,000 treatments (six-monthly follow-up raw visus results)Results of the last 10,000 treatments (six-monthly follow-up raw visus results)
AgeVisus groupEye, nPostop visusAgeVisus groupEye, nPostop visus
MeanSDMeanSD
18–40low myop2,5981.040.0318–40low myop3,4191.170.13
medium myop4,0921.010.03medium myop3,8861.150.15
high myop1,7240.820.07high myop1,4751.080.20
low hyperop620.800.04low hyperop140.990.18
high hyperop470.790.07high hyperopnanana
18–40 total8,5230.980.0518–40 total8,7941.150.15
41–65low myop1890.940.0441–65low myop2401.010.29
medium myop3510.880.04medium myop5230.970.31
high myop3420.630.08high myop1850.890.29
low hyperop3980.950.04low hyperop2140.950.32
high hyperop1970.790.05high hyperop440.840.26
41–65 total1,4770.840.0641–65 total1,2060.960.30
Sum total10,0000.960.05Sum total10,0001.130.19

Notes. na: not available.

In the present study, the results obtained with the third and sixth generation of excimer laser are compared.

Data analysis

No sampling was performed. The first 10,000 subjects from two time periods, 1998–2002 and 2017–2019, were included in the study. The comparison was based on the results of the six-monthly follow-up measurements, which were carried out using the same method in both cases.

To compare means, MedCalc Statistical Software version 22.0.16 was used (MedCalc Software bv, Ostend, Belgium; https://www.medcalc.org; 2020). Mean differences with 95% CI, standard error, t-value, and P-value were reported. Hedges's g was also calculated as an effect size measurement. The level of significance was set at α = 0.05.

Results

The results for the two periods are shown in Table 2. The follow-ups were performed by conventional visus testing.

To summarise, there was a statistically significant difference between the first (third-generation) and the last (sixth-generation) 10,000 treatments, regardless of age, t (19,998) = 86.528, P < 0.001, g = 1.22. The effect of the difference between the treatments was higher in the younger age group, t (17,315) = 99.413, P < 0.001, g = 1.51, compared to the 41–65 age group, t (2,681) = 15.010, P < 0.001, g = 0.44 (see Table 3).

Table 3.

Differences between the first and last 10,000 treatments

AgeVisus groupDifferenceSE95% CItPg
18–40A-Low myop0.130.000.125, 0.13549.969<0.0011.30
B-Medium myop0.140.000.135, 0.14558.485<0.0011.31
C-High myop0.260.010.25, 0.2750.485<0.0011.79
D-Low hyperop0.190.020.14, 0.247.669<0.0012.27
E-High hyperopna
18–40 Total0.170.000.167, 0.17399.413<0.0011.51
41–65A-Low myop0.070.020.03, 0.113.2930.0010.32
B-Medium myop0.090.020.06, 0.125.408<0.0010.37
C-High myop0.260.020.23, 0.2915.534<0.0011.41
D-Low hyperop0.000.02na0.0001.0000.00
E-High hyperop0.050.020.01, 0.092.5150.0120.43
41–65 Total0.120.010.10, 0.1415.010<0.0010.44
Total0.170.000.166, 0.17486.528<0.0011.22

Notes. SE: standard error; 95% CI: 95% confidence interval for the difference; t: t-value; P: P-value; g: Hedges's effect size measurement.

In the 18–40 age group, the effect of the difference between the treatments was highest in the high myopia and low hyperopia groups. In the 41–65 age group, there was no significant difference between the treatments in the low hyperopia group. Similarly to the younger group, the effect of the difference between the treatments was highest in the high myopia group (Fig. 1).

Fig. 1.
Fig. 1.

Differences, with 95% CI, between the first and last 10,000 treatments in patients aged 18–40 and 41–65 years (A-Low myop, B-Medium myop, C-High myop, D-Low hyperop, E-High hyperop)

Citation: Developments in Health Sciences 2024; 10.1556/2066.2024.00063

In recent years, hyperopia of around +3.0 D has not been treated with excimer laser. Instead, clear lens exchange is suggested to patients as a treatment modality [12].

Discussion

The real value of Table 2 is that the analysis of postoperative results is based on a huge amount of data. To our knowledge, no analysis of such a large amount of data has previously been published in the literature [13–19].

The tables contain a basic set of descriptive statistics for data evaluation. In the latter 10,000 cases, the standard deviation is larger. This is not a real problem, as the standard deviation means that visual acuity is around 1.0 for patients in the lower improvement range too, which is the average visual acuity of a healthy young adult. Based on the self-reported data, patients were satisfied with the results of their treatment.

With respect to patients between 41 and 65 years of age, in both the low myopia and medium myopia groups the difference was not statistically significant, while in the high myopia group the difference was statistically significant. In the low hyperopia group, the difference was not statistically significant, while in the high hyperopia group the difference was statistically significant.

Conclusions

With its extremely high number of cases of laser corneal refractive surgery, the clinic is able to provide a remarkable amount of data, making it possible to assess whether the technical devices used influence treatment results. The analysis of the two groups of 10,000 treatments shows that the reliable third-generation laser systems, operating at the earlier technical level, already delivered good results with high predictability. The results of the comparison demonstrate the increased effectiveness of the sixth-generation laser systems. Overall, among the more recent 10,000 cases, the average visus of treated patients increased from 0.96 to 1.13 in the low myopia group. The improvement was most pronounced among patients aged between 18 and 40, treated for refractive errors of between −1.0 D and −6.0 D. Overall, it can be concluded that the improvement in technology was justified, as it resulted in the improved effectiveness of laser refractive vision correction.

Authors' contribution

MD: study conception and design, SzM: data collection, CsSz: draft manuscript, BH: analysis, JT: interpretation of results, ZZN: study conception and revise manuscript. All authors approved the final manuscript.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and according to the requirements of all applicable local and international standards.

Conflicts of interest

The authors declare no conflict of interest. No financial support was received for this study.

ZZN and JT are members of the Editorial Board of the journal.

Acknowledgements

We would like to thank the management and staff of the Sasszem Klinika for providing us with extremely valuable treatment data.

References

  • 1.

    El Bahrawy M, Alió JL. Excimer laser 6(th) generation: state of the art and refractive surgical outcomes. Eye Vis (Lond) 2015;2:6. https://doi.org/10.1186/s40662-015-0015-5.

    • Search Google Scholar
    • Export Citation
  • 2.

    Seiler T, Kahle G, Kriegerowski M. Excimer laser (193 nm) myopic keratomileusis in sighted and blind human eyes. Refract Corneal Surg 1990;6:16573.

    • Search Google Scholar
    • Export Citation
  • 3.

    Andrade HA, McDonald MB, Liu JC, Abdelmegeed M, Varnell R, Sunderland G. Evaluation of an opacity lensometer for determining corneal clarity following excimer laser photoablation. Refract Corneal Surg 1990;6:34651.

    • Search Google Scholar
    • Export Citation
  • 4.

    Nagy ZZ, Füst A, Németh J, Szabó A, Süveges I. Az excimer lézeres fotorefraktív keratectomia tapasztalatai 2053 szem kezelése kapcsán [Results of photorefractive keratectomy after treatment of 2053 eyes]. Orv Hetil 1999;140:74754. [Article in Hungarian].

    • Search Google Scholar
    • Export Citation
  • 5.

    Nagy ZZ, Krueger RR, Süveges I. Photorefractive keratectomy for astigmatism with the Meditec MEL 60 laser. J Refract Surg 2001;17:44153. https://doi.org/10.3928/1081-597X-20010701-06.

    • Search Google Scholar
    • Export Citation
  • 6.

    Reinstein DZ, Archer TJ, Gobbe M. The history of LASIK. J Refract Surg 2012;28:2918. https://doi.org/10.3928/1081597X-20120229-01.

  • 7.

    Brar S, Rathod DP, Roopashree CR, Ganesh S. One-year visual and refractive outcomes following LASIK for myopia and myopic astigmatism with MEL 90 versus Schwind Amaris 750S excimer laser: a comparative study. J Ophthalmol 2021;2021:9929181. https://doi.org/10.1155/2021/9929181.

    • Search Google Scholar
    • Export Citation
  • 8.

    Li L, Zhang B, Liu S, Xiong L, Wang Z. Comparison of clinical outcomes of 2 platforms for topography-guided LASIK in primary eyes. J Cataract Refract Surg 2021;47:118390. https://doi.org/10.1097/j.jcrs.0000000000000592.

    • Search Google Scholar
    • Export Citation
  • 9.

    Pidro A, Biscevic A, Pjano MA, Mravicic I, Bejdic N, Bohac M. Excimer lasers in refractive surgery. Acta Inform Med 2019;27:27883. https://doi.org/10.5455/aim.2019.27.278-283.

    • Search Google Scholar
    • Export Citation
  • 10.

    Nagy ZZ, Palágyi-Deák I, Kelemen E, Kovács A. Wavefront-guided photorefractive keratectomy for myopia and myopic astigmatism. J Refract Surg 2002;18:S6159. https://doi.org/10.3928/1081-597X-20020901-23.

    • Search Google Scholar
    • Export Citation
  • 11.

    Nagy ZZ, Palágyi-Deak I, Kovács A, Kelemen E, Förster W. First results with wavefront-guided photorefractive keratectomy for hyperopia. J Refract Surg 2002;18:S6203. https://doi.org/10.3928/1081-597X-20020901-24.

    • Search Google Scholar
    • Export Citation
  • 12.

    Moshirfar M, Megerdichian A, West WB, et al. Comparison of visual outcome after hyperopic LASIK using a wavefront-optimized platform versus other excimer lasers in the past two decades. Ophthalmol Ther 2021;10:54763. https://doi.org/10.1007/s40123-021-00346-1.

    • Search Google Scholar
    • Export Citation
  • 13.

    Yildirim Y, Olcucu O, Alagoz N, Agca A, Karakucuk Y, Demirok A. Comparison of visual and refractive results after transepithelial and mechanical photorefractive keratectomy in myopia. Int Ophthalmol 2018;38:62733. https://doi.org/10.1007/s10792-017-0501-y.

    • Search Google Scholar
    • Export Citation
  • 14.

    Gadde AK, Srirampur A, Katta KR, Mansoori T, Armah SM. Comparison of single-step transepithelial photorefractive keratectomy and conventional photorefractive keratectomy in low to high myopic eyes. Indian J Ophthalmol 2020;68:75561. https://doi.org/10.4103/ijo.IJO_1126_19.

    • Search Google Scholar
    • Export Citation
  • 15.

    Branger GA, Le MT, Inauen LO, Reichmuth V, Kaufmann C, Baenninger P. Ten-year outcome of topography-guided transepithelial surface ablation for refractive myopia treatment. Klin Monbl Augenheilkd 2022;239:3825. https://doi.org/10.1055/a-1739-0212.

    • Search Google Scholar
    • Export Citation
  • 16.

    Ozdas D, Yesilirmak N, Sarac O, Cagil N. 36-Month outcomes of mechanical and transepithelial PTK epithelium removal techniques prior to accelerated CXL for progressive keratoconus. J Refract Surg 2022;38:191200. https://doi.org/10.3928/1081597X-20220114-03.

    • Search Google Scholar
    • Export Citation
  • 17.

    Hashemian MN, Faegh A, Latifi G, Abdi P. Clinical outcomes of transepithelial photorefractive keratectomy with epithelial ablation targeting actual epithelial thickness vs default laser platform values. J Cataract Refract Surg 2022;48:58490. https://doi.org/10.1097/j.jcrs.0000000000000803.

    • Search Google Scholar
    • Export Citation
  • 18.

    Yilmaz BS, Agca A, Taskapili M. Comparison of long-term visual and refractive results of transepithelial and mechanical photorefractive keratectomy. Beyoglu Eye J 2022;7:1215. https://doi.org/10.14744/bej.2022.06978.

    • Search Google Scholar
    • Export Citation
  • 19.

    Hashemi H, Alvani A, Aghamirsalim M, Miraftab M, Asgari S. Comparison of transepithelial and conventional photorefractive keratectomy in myopic and myopic astigmatism patients: a randomized contralateral trial. BMC Ophthalmol 2022;22:68. https://doi.org/10.1186/s12886-022-02293-2.

    • Search Google Scholar
    • Export Citation
  • 1.

    El Bahrawy M, Alió JL. Excimer laser 6(th) generation: state of the art and refractive surgical outcomes. Eye Vis (Lond) 2015;2:6. https://doi.org/10.1186/s40662-015-0015-5.

    • Search Google Scholar
    • Export Citation
  • 2.

    Seiler T, Kahle G, Kriegerowski M. Excimer laser (193 nm) myopic keratomileusis in sighted and blind human eyes. Refract Corneal Surg 1990;6:16573.

    • Search Google Scholar
    • Export Citation
  • 3.

    Andrade HA, McDonald MB, Liu JC, Abdelmegeed M, Varnell R, Sunderland G. Evaluation of an opacity lensometer for determining corneal clarity following excimer laser photoablation. Refract Corneal Surg 1990;6:34651.

    • Search Google Scholar
    • Export Citation
  • 4.

    Nagy ZZ, Füst A, Németh J, Szabó A, Süveges I. Az excimer lézeres fotorefraktív keratectomia tapasztalatai 2053 szem kezelése kapcsán [Results of photorefractive keratectomy after treatment of 2053 eyes]. Orv Hetil 1999;140:74754. [Article in Hungarian].

    • Search Google Scholar
    • Export Citation
  • 5.

    Nagy ZZ, Krueger RR, Süveges I. Photorefractive keratectomy for astigmatism with the Meditec MEL 60 laser. J Refract Surg 2001;17:44153. https://doi.org/10.3928/1081-597X-20010701-06.

    • Search Google Scholar
    • Export Citation
  • 6.

    Reinstein DZ, Archer TJ, Gobbe M. The history of LASIK. J Refract Surg 2012;28:2918. https://doi.org/10.3928/1081597X-20120229-01.

  • 7.

    Brar S, Rathod DP, Roopashree CR, Ganesh S. One-year visual and refractive outcomes following LASIK for myopia and myopic astigmatism with MEL 90 versus Schwind Amaris 750S excimer laser: a comparative study. J Ophthalmol 2021;2021:9929181. https://doi.org/10.1155/2021/9929181.

    • Search Google Scholar
    • Export Citation
  • 8.

    Li L, Zhang B, Liu S, Xiong L, Wang Z. Comparison of clinical outcomes of 2 platforms for topography-guided LASIK in primary eyes. J Cataract Refract Surg 2021;47:118390. https://doi.org/10.1097/j.jcrs.0000000000000592.

    • Search Google Scholar
    • Export Citation
  • 9.

    Pidro A, Biscevic A, Pjano MA, Mravicic I, Bejdic N, Bohac M. Excimer lasers in refractive surgery. Acta Inform Med 2019;27:27883. https://doi.org/10.5455/aim.2019.27.278-283.

    • Search Google Scholar
    • Export Citation
  • 10.

    Nagy ZZ, Palágyi-Deák I, Kelemen E, Kovács A. Wavefront-guided photorefractive keratectomy for myopia and myopic astigmatism. J Refract Surg 2002;18:S6159. https://doi.org/10.3928/1081-597X-20020901-23.

    • Search Google Scholar
    • Export Citation
  • 11.

    Nagy ZZ, Palágyi-Deak I, Kovács A, Kelemen E, Förster W. First results with wavefront-guided photorefractive keratectomy for hyperopia. J Refract Surg 2002;18:S6203. https://doi.org/10.3928/1081-597X-20020901-24.

    • Search Google Scholar
    • Export Citation
  • 12.

    Moshirfar M, Megerdichian A, West WB, et al. Comparison of visual outcome after hyperopic LASIK using a wavefront-optimized platform versus other excimer lasers in the past two decades. Ophthalmol Ther 2021;10:54763. https://doi.org/10.1007/s40123-021-00346-1.

    • Search Google Scholar
    • Export Citation
  • 13.

    Yildirim Y, Olcucu O, Alagoz N, Agca A, Karakucuk Y, Demirok A. Comparison of visual and refractive results after transepithelial and mechanical photorefractive keratectomy in myopia. Int Ophthalmol 2018;38:62733. https://doi.org/10.1007/s10792-017-0501-y.

    • Search Google Scholar
    • Export Citation
  • 14.

    Gadde AK, Srirampur A, Katta KR, Mansoori T, Armah SM. Comparison of single-step transepithelial photorefractive keratectomy and conventional photorefractive keratectomy in low to high myopic eyes. Indian J Ophthalmol 2020;68:75561. https://doi.org/10.4103/ijo.IJO_1126_19.

    • Search Google Scholar
    • Export Citation
  • 15.

    Branger GA, Le MT, Inauen LO, Reichmuth V, Kaufmann C, Baenninger P. Ten-year outcome of topography-guided transepithelial surface ablation for refractive myopia treatment. Klin Monbl Augenheilkd 2022;239:3825. https://doi.org/10.1055/a-1739-0212.

    • Search Google Scholar
    • Export Citation
  • 16.

    Ozdas D, Yesilirmak N, Sarac O, Cagil N. 36-Month outcomes of mechanical and transepithelial PTK epithelium removal techniques prior to accelerated CXL for progressive keratoconus. J Refract Surg 2022;38:191200. https://doi.org/10.3928/1081597X-20220114-03.

    • Search Google Scholar
    • Export Citation
  • 17.

    Hashemian MN, Faegh A, Latifi G, Abdi P. Clinical outcomes of transepithelial photorefractive keratectomy with epithelial ablation targeting actual epithelial thickness vs default laser platform values. J Cataract Refract Surg 2022;48:58490. https://doi.org/10.1097/j.jcrs.0000000000000803.

    • Search Google Scholar
    • Export Citation
  • 18.

    Yilmaz BS, Agca A, Taskapili M. Comparison of long-term visual and refractive results of transepithelial and mechanical photorefractive keratectomy. Beyoglu Eye J 2022;7:1215. https://doi.org/10.14744/bej.2022.06978.

    • Search Google Scholar
    • Export Citation
  • 19.

    Hashemi H, Alvani A, Aghamirsalim M, Miraftab M, Asgari S. Comparison of transepithelial and conventional photorefractive keratectomy in myopic and myopic astigmatism patients: a randomized contralateral trial. BMC Ophthalmol 2022;22:68. https://doi.org/10.1186/s12886-022-02293-2.

    • Search Google Scholar
    • Export Citation
  • Collapse
  • Expand
The author instructions are available in PDF.
Please, download the file from HERE.

 

The Author Declaration Form is available in PDF.
Please, download the file from HERE.

 

Senior Editors

Editor-in-Chief: Zoltán Zsolt NAGY
Vice Editors-in-Chief: Gabriella Bednárikné DÖRNYEI, Ákos KOLLER
Managing Editor: Johanna TAKÁCS

Editorial Board

  • Zoltán BALOGH (Department of Nursing, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Klára GADÓ (Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • István VINGENDER (Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Attila DOROS (Department of Imaging and Medical Instrumentation, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Judit Helga FEITH (Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Mónika HORVÁTH (Department of Physiotherapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Illés KOVÁCS (Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Ildikó NAGYNÉ BAJI (Department of Applied Psychology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Tamás PÁNDICS (Department for Epidemiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • József RÁCZ (Department of Addictology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Lajos A. RÉTHY (Department of Family Care Methodology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • János RIGÓ (Department of Clinical Studies in Obstetrics and Gynaecology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Andrea SZÉKELY (Department of Oxyology and Emergency Care, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Márta VERESNÉ BÁLINT (Department of Dietetics and Nutritional Sicences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Gyula DOMJÁN (Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Péter KRAJCSI (Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • György LÉVAY (Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Csaba NYAKAS (Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Vera POLGÁR (Department of Morphology and Physiology, InFaculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • László SZABÓ (Department of Family Care Methodology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Katalin TÁTRAI-NÉMETH (Department of Dietetics and Nutrition Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Katalin KOVÁCS ZÖLDI (Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Gizella ÁNCSÁN (Library, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • András FALUS (Department of Genetics, Cell- and Immunbiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary)
  • Zoltán UNGVÁRI (Department of Public Health, Faculty of medicine, Semmelweis University, Budapest, Hungary)
  • Romána ZELKÓ (Faculty of Pharmacy, Semmelweis University, Budapest, Hungary)
  • Mária BARNAI (Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary)
  • László Péter KANIZSAI (Department of Emergency Medicine, Medical School, University of Pécs, Pécs, Hungary)
  • Bettina FŰZNÉ PIKÓ (Department of Behavioral Sciences, Faculty of Medicine, University of Szeged, Szeged, Hungary)
  • Imre SEMSEI (Faculty of Health, University of Debrecen, Debrecen, Hungary)
  • Teija-Kaisa AHOLAAKKO (Laurea Universities of Applied Sciences, Vantaa, Finland)
  • Ornella CORAZZA (University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom)
  • Oliver FINDL (Department of Ophthalmology, Hanusch Hospital, Vienna, Austria)
  • Tamás HACKI (University Hospital Regensburg, Phoniatrics and Pediatric Audiology, Regensburg, Germany)
  • Xu JIANGUANG (Shanghai University of Traditional Chinese Medicine, Shanghai, China)
  • Paul GM LUITEN (Department of Molecular Neurobiology, University of Groningen, Groningen, Netherlands)
  • Marie O'TOOLE (Rutgers School of Nursing, Camden, United States)
  • Evridiki PAPASTAVROU (School of Health Sciences, Cyprus University of Technology, Lemesos, Cyprus)
  • Pedro PARREIRA (The Nursing School of Coimbra, Coimbra, Portugal)
  • Jennifer LEWIS SMITH (Collage of Health and Social Care, University of Derby, Cohehre President, United Kingdom)
  • Yao SUYUAN (Heilongjiang University of Traditional Chinese Medicine, Heilongjiang, China)
  • Valérie TÓTHOVÁ (Faculty of Health and Social Sciences, University of South Bohemia, České Budějovice, Czech Republic)
  • Tibor VALYI-NAGY (Department of Pathology, University of Illonois of Chicago, Chicago, IL, United States)
  • Chen ZHEN (Central European TCM Association, European Chamber of Commerce for Traditional Chinese Medicine)
  • Katalin LENTI FÖLDVÁRI-NAGY LÁSZLÓNÉ (Department of Morphology and Physiology, Semmelweis University, Budapest, Hungary)
  • László FÖLDVÁRI-NAGY (Department of Morphology and Physiology, Semmelweis University, Budapest, Hungary)

Developments in Health Sciences
Publication Model Online only Gold Open Access
Submission Fee none
Article Processing Charge none
Subscription Information Gold Open Access

Developments in Health Sciences
Language English
Size A4
Year of
Foundation
2018
Volumes
per Year
1
Issues
per Year
2
Founder Semmelweis Egyetem
Founder's
Address
H-1085 Budapest, Hungary Üllői út 26.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 2630-9378 (Print)
ISSN 2630-936X (Online)

Monthly Content Usage

Abstract Views Full Text Views PDF Downloads
Feb 2024 0 0 0
Mar 2024 0 0 0
Apr 2024 0 0 0
May 2024 0 0 0
Jun 2024 0 473 30
Jul 2024 0 70 12
Aug 2024 0 0 0