Along with panelists, moderators, and 4 other presenters, Dr. George Waring IV, MD, opened Refractive Surgery Subspecialty Day at AAO 2025 with a discussion on lasers that have been newly approved in the United States. The last FDA approval of an excimer laser was in 2011 with the Alcon EX500, he said, though additional indications have occurred since. He noted that the B+L Teneo, Zeiss MEL 90, and the Alcon EX500—3 of the 4 lasers that are currently in use in the United States—are considered to have high-speed repetition rates at 500 Hz. The treatment range among all the current lasers is also broad and includes myopia, hyperopia, and mixed astigmatism.
Dr. Waring noted that the Teneo has a small footprint and high repetition rate, and also includes Z tracking, which lets surgeons know when to recalibrate Z treatment. Mostly notably, he added, nomogram is not required, which for surgeons who are accustomed to this requires an adjustment period. Data he detailed from the FDA trial showed postoperative uncorrected improvement in nighttime driving, as well as starburst glare and halos.
“More than one-third of eyes gained 1 or more line of corrected distance visual acuity, and the [mean refractive spherical equivalent] for all eyes over 300 eyes at 9 months was -0.4 ... with no nomogram adjustment,” he said.
The MEL 90 is unique in its offerings and approach to the US martketplace, he said, in that it combined its indication launch. The scatter plots of predictability in the FDA study were tight across myopia, hyperopia, and mixed astigmatism, which is “not easy to achieve,” he noted.
Next, he discussed ray tracing-guided LASIK on the EX500 platform with WaveLight Plus and the InnovEyes diagnostic approach. He described the process: “[it] takes tomography, the wavefront, the axial scan, and creates a 3-dimensional model that allows you to actually perform these treatments in advance, and then apply these ray-traced guided treatments.” Data from 3 months, he said, showed predictability and effectiveness. Specifically, all eyes at both 1 month and 3 months were 20/20 or better, and the proportion of eyes in the supervision range were extraordinarily high.
Finally, he noted the recent introduction of the Zeiss VisuMax 800, which cuts a full lenticule in less than 10 seconds—2 million pulses per second or a 2 mHz treatment—and has broad indications and features, including allowing for cyclotorsion and centration compensation.
During questions after the presentation, Dr. Waring suggested that when considering a new laser, surgeons take into account which indications they need to treat, as well as clinic space and flow.