HOW TO IMPROVE YOUR REFRACTIVE OUTCOMES – PERFORMING AN OUTCOMES ANALYSIS v4.x
The information on this page is provided to assist you in the basics of operating the software. If you need additional support, please see the support page.
1. Establish one surgical protocol.
2. Follow the established protocol exactly for at least 50 procedures. Try to use the same length of time for each step of the procedure. Try not to vary the steps, such as how much you hydrate the cornea, how you treat the flap, which microkeratome you use, etc. Most importantly, use the Regression Analysis to improve the outcomes.
3. After you have at least two months of follow-up data for 50 eyes, analyze your results using the LASIK, PRK, and Phakic IOL DatabaseOutcomes Analysis Software program.
- Select your 50 eyes that were controlled for surgical variables (including surgeon, laser, and microkeratome). You may make the selection using the preformatted Myopia/Astigmatism Find (the first find in the Analyze records menu). Alternatively, you may use the Custom Find, which is the last menu on the Analyze records menu. Following the find, you will be given three choices: List View, Table, or Chart. If you select Table, you will see the data presented as the percentage of eyes within ± 0.5 D or 1 D of emmetropia, and the percentage and number of eyes with 20/20 or 20/40 uncorrected visual acuity.
- Next, go to the layout Records and Analyses and select the Chart Button. You will see several chart choices. The scatterplot permits you to easily visualize where your nomogram is creating under or over corrections. The scatterplot shows individual eyes within one diopter of emmetropia. Eyes significantly under corrected are below the lines and those overcorrected are above the lines.
- Next, click the REPORTS/ANALYSIS button. Clicking these buttons will show you the individual eye results for the key parameters that account for your results. Look at the overall averages for all 50 eyes. By using the these reports, you can decide which variables have an outcome that is or is not satisfactory.
- Click the many choices to the right of the OUTCOMES button under the REPORTS and ANALYSES layout. The report that appears summarizes all of the eyes as a group in terms of the percentage of eyes within 0.50 and 1.00 diopter, and the percentage of eyes with visual acuities of 20/20 or 20/40. Your enhancement rate for flap lifts and incisional procedures is also listed. Looking at these numbers, you can decide if you have an outcome that is or is not satisfactory.
- Click the ANALYZE DATA button on the HOME page or under the OPTIONS button. Then click the NOMOGRAM button. Select the surgical procedure, preoperative diagnosis, surgeon, laser used, time since operated, and microkeratome used. Click the PERFORM FIND button to generate a nomogram. The data displays the MEAN POSTOPERATIVE SPHERICAL EQUIVALENT for each ten (10) years of age for each diopter of preoperative myopia spherical equivalent.
- You have a layout of Surgical Planning., if you have a Summit, VISX, LADARVision, or Wavelight excimer laser, there are four existing regression analyses made from those lasers from the experience of one surgeon. You run those analyses to see what your planned data might generate.
- Use the Regression Analysis button for each case (eye). The program examines the most recent 50 eyes that have undergone a similar procedure and provides the user with the best sphere and cylinder entry to use to tighten the refractive outcomes based on DISTANCE procedures (monovision excluded). If you accept the recommendations, click the right arrow and the data will be transferred into the laser sphere and laser cylinder fields. Use these numbers in your laser’s computer to improve your outcomes.
Once you have your data, you can then decide what, if anything, you need to modify to improve your results. If you use the Regression Analysis, you need not do anything as the program will take into account the previous results.
If you do not use the Regression analysis continue…. Is your percentage of eyes with levels of visual acuity 20/25 or greater satisfactory? If not, you need to ask, is the reason that the acuity levels are unsatisfactory because of significant undercorrections? If the answer is yes, then you know that you will have to change your laser nomogram to input a greater spherical and/or cylindrical error to improve your results, depending on which of the above two factors accounts for your levels of uncorrected vision. You would perform a similar analysis if your errors are unsatisfactory outside of the range of plus or minus 0.50 or 1.00 diopter.
4. Look at other variables in your surgical procedure that account for the spread of your results. The spread of results is the main problem with outcomes analyses after LASIK. Your mean results may be satisfactory, but you may have a wide spread so that unsatisfactory results lie on both sides of the mean. Such spreadscannot be modified by changing the refractive input into the laser computer. On the contrary, look at other factors that influence the spread. Such factors may be the time delay from creating the flap to completing the laser ablation, the cap thickness, or the patient age. Use the Outcomes Analysis Software to isolate what may be accounting for the spread of your results.
5. Export your selected records into a spreadsheet. You may accomplish this by clicking on the OPTIONS menu, and then on the EXPORT TO EXCEL button. Click on the fields that you want to see exported, and the program will do it for you automatically. Once the data from the selected records are in the spreadsheet, you can manipulate it through a Microsoft Excel™ (or equivalent) spreadsheet. For example, you can stratify your results based on the thickness of your cap or patient age. Or you may chose to examine your data and create your own regression analysis.
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Outcomes Analysis Software, Inc.
2500 6th Avenue, Ste. 307 - San Diego, CA 92103 - US
Phone/Fax: 619-702-7963
Email: lasiksupport@aol.com
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