Nomograms can help to improve patient outcomes

Lasers are designed to treat people based on averages in a population. However, an individual or a class of individuals may respond slightly differently to the laser pattern that has been designed by the manufacturer.

Manufacturers adjust the laser patterns over time based on outcomes, and surgeons need to adjust their treatments over time based on outcomes. Certain factors, such as surgeon technique and environment, can make a particular surgeon's results different from the manufacturer's results. So, it is valuable to track your patients' outcomes over time.

Developing a nomogram

Then, they can track postoperative outcomes at different time points-1 week, 1 month, 3 months, and 6 months postoperatively. By collecting all of these data and by analyzing them in a multivariate way, surgeons can determine appropriate adjustments for future patients who have similar measurements or characteristics. The data can be analyzed by hand using a spreadsheet or a database or by using commercially available software.

Interestingly, making certain basic adjustments can hone your results. The most important factor to adjust for is preoperative measurement. This is the factor that correlates most with postoperative results, and it can be adjusted for using linear regression.

Surgeons can also adjust for age and gender. Simply adjusting for preoperative measurements, age, and gender can make a significant impact on postoperative results. This customizes treatment for each individual based on the statistical data that surgeons have collected from previous patients.

Success with CustomCornea

Tracking these data is especially important for surgeons who use the LADARVision CustomCornea (Alcon Laboratories) procedure. The pattern that CustomCornea puts on the eye is individualized and customized, whereas conventional treatment is not. For example, if one patient has –4 D of myopia, his or her custom treatment is going to be very different from another patient with –4 D of myopia. So, you must be aware of the variability of factors that might affect each specific treatment.

It requires meticulous work, and treating cases with CustomCornea is more difficult than with conventional treatment. However, using CustomCornea is well worth it because patients end up with better, tighter results. This is because the system takes so many different factors into account. It makes a very sophisticated personalized measurement.

If a surgeon is having difficulty with CustomCornea, he or she needs to be more vigilant about patient selection. The following protocol is useful for surgeons who are new to custom treatments and for those who are struggling with consistent results: